Management of Vertebral Body Fractures

Epidemiology and incidence

In the United States about 20 million people above the age of 45 are affected by osteoporosis and associated fractures and 200 million women worldwide suffer from osteoporosis and its complications.1, 2 In the year 2000 there were 3.79 male idiopathic osteoporosis (MIO) fractures per year in the European Union whereby—worldwide—vertebral fractures are the most frequent fracture type among osteoporotic fractures.3, 4 In addition there is a clear association of advancing age with an increased vertebral fracture incidence.5, 6 The continually increasing risk of clinically relevant vertebral fractures is equivalent to the risk for cardiovascular disease with a higher disease burden in terms of disability and excess mortality than common cancers.7–10 The incidence of vertebral body fractures in industrial countries is estimated at 64/100000 people, 4/100000 of whom have a form of neurological impairment.11

Abstract

Vertebral compression fractures (VCFs) are the most frequent osteoporotic fracture type throughout the Western societies with millions of affected women and men. These fractures severely impair the quality of life and are associated with an increased mortality, thus stating a major health and socioeconomic burden on the societies.

Vertebral compression fractures may be due to trauma, primary osteoporosis, or secondary osteoporosis as a consequence of metabolic-, endocrine-, malassimilation-, medication-, or malignancy-associated disorders of bone metabolism. Therefore an interdisciplinary approach for the proper treatment of the underlying cause and of the mechanical consequences of VCF is required. Many VCFs cause immediate or chronic pain and immobility that also needs the interdisciplinary evaluation whether conservative management, osteoplastic procedures, or major spine surgical approaches are required to improve the patient's situation. Osteoplastic procedures provide an alternative approach between conservative VCF management and reconstructive spine surgery offering the advantages of a minimally invasive procedure with a rapid pain relief, an immediate stabilization of the VCF, and a possible reheightening of an acutely compressed vertebral body. Therefore if technically feasible, osteoplastic procedures in patients with painful VCF are an option to rapidly improve quality of life and simultaneously decrease mortality—which are the ultimate goals of all medical treatment and interventions.

Keywords

vertebral fracture, management, osteoporosis, kyphoplasty, back pain