Compression Fracture

Osteoporosis is a loss of bone density occurring when the loss of bone substance exceeds the rate of bone formation. Bones become porous, brittle, and fragile. Compression fractures of the vertebrae are common. This disorder occurs most often in postmenopausal women, but can occur in men as well. 

Table 11.28 gives the yield stress (E) under compression, fracture strength fracture... 

The spinal cord emerges from the brain stem at the base of the skull and terminates at the second lumbar vertebra. The thoracic spine is most vulnerable to cord compression because of natural kyphosis and because the width of the thoracic spinal canal is the smallest among the vertebrae. Most spinal cord compression is due to adjacent vertebral metastases that compress the spinal cord or from pathologic compression fracture of the vertebra. This results in significant edema and inflammation in the affected area. 

Daniell, H., Osteoporosis and the slender smoker vertebral compression fractures and loss of metacarpal cortex in relation to postmenopausal cigarette smoking and lack of obesity, Archives of Internal Medicine, 136, 298, 1976. 

Approximately 50% to 60% of patients develop Cushing-induced osteoporosis about 40% present with back pain and 20% will progress to compression fractures of the spine. 

In fatal cases, the pathologic findings are entirely nonspecific. They usually consist of petechial hemorrhages and congestion of the organs, indicating combined action of severe convulsions and anoxia. Compression fractures and related injury may be found in cases with violent tetany. ... 

One in four postmenopausal women have osteoporosis. Osteoporosis, a decrease in bone mass, constitutes the most serious effect of menopause. It has been estimated that following cessation of ovarian function, the loss of bone mass proceeds at a rate of 2 to 5% per year. As a result of osteoporosis, as many as 50% of women develop spinal compression fractures by age 75, and 20% will have hip fractures by age 90. 

Once bone loss is sufficient to result in a compression fracture, pharmacological therapy is much less effective. However, even after fractures have occurred, the use of the bisphosphonates and rPTH has been shown to increase bone densities and reduce the rate of subsequent fractures. Nasal calcitonin (200 units daily) is effective in promoting fracture healing and also exhibits an analgesic effect by reducing pain in persons with acute lumbar compression fractures. Whatever compound is used for prophylaxis or treatment of osteoporosis, calcium and Ds supplementation are required for maximum benefit. 

Fluoride is well established as effective for the prophylaxis of dental caries and has been under investigation for the treatment of osteoporosis. Both therapeutic applications originated from epidemiologic observations that subjects living in areas with naturally fluoridated water (1-2 ppm) had less dental caries and fewer vertebral compression fractures than subjects living in nonfluoridated water areas. Fluoride is accumulated by bones and teeth, where it may stabilize the... 

Muscle weakness, steroid myopathy, loss of muscle mass, severe arthralgia, vertebral compression fractures, aseptic necrosis of humeral and femoral heads, pathologic fracture of long bones, osteoporosis... 

Of the effects of glucocorticoids on the skeleton, osteoporosis is the most important clinically manifestations can include vertebral compression fractures, scoliosis resulting in respiratory embarrassment, and fractures of the long bones. The risk of vertebral fractures is not different in patients taking or not taking glucocorticoids in whom bone mineral density is similar (197). 

Her x-ray series revealed generalized under-mineralization throughout the bony structures. Her ribs were thin, and the spine showed the presence of multiple compression fractures at the thoracolumbar level. There was marked bowing of all extremities with evidence of old fractures in femurs, humerus, and left ulna. A bone mineral density study of the lumbar vertebral bodies (L1-L4) performed at 5 years of age revealed a value of 6.57 standard deviations below the mean for children of the same age. 

J. Lankford, Dynamic Compressive Fracture in Fiber-Reinforced Ceramic Matrix Composites, Material Science and Engineering, A107, 261-268 (1989). 

Haldeman S, Rubinstein SM. Compression fractures iu patients undergoing spinal manipulative therapy. J Manipulative Physiol Ther 1992 15(7) 450-4. 

Chang, Y.P, Cheah, P.B., and Seow, C.C. Variations in flexural and compressive fracture behavior of a brittle cellular food (bread) in response to moisture sorption, /. Texture Stud., 31, 525, 2000. 

Eck JC, Hodges SD, Humphreys SC. Vertebroplasty A new treatment strategy for osteoporotic compression fractures. Am J Orthop 2002 31 123-127, discussion 128. 

For many patients the first indication of the disease is when they suffer a vertebral compression fracture, a fracture of the distal radius or a fractured neck of femur. Crush fractures of vertebrae may occur slowly and relatively painlessly over a period of lime (Figs. 2 and. 3). 

Selective Estrogen Receptor Modulators Raloxifene (EVISTa) acts as an estrogen agonist on bone and liver, is inactive on the uterus, and acts as an estrogen antagonist on the breast. In postmenopausal women, raloxifene modestly increases bone mineral density and has been shown to reduce the risk of vertebral compression fractures in this setting, it is approved for both the prevention and treatment of osteoporosis. The major adverse effect is worsened vasomotor symptoms the drug also increases the incidence of deep venous thrombosis. 

The treatment for osteoporotic compression fracture of the vertebrae has been investigated on human cadaver vertebrae with calcium phosphate cement (Ikeuchi et al. 

Paget s disease (Table 35.6) is characterized by excessive bone resorption, followed by replacement of the normally mineralized bone with soft, poorly mineralized tissue (20). It has been determined that the osteoclasts have an abnormal structure, are hyperactive, and are present at elevated levels (20). Patients afflicted with this painful condition often suffer from multiple compression fractures. Administration of calcitonin and oral calcium and phosphate supplements had been the treatment of choice until the bisphosphonate risedronate was approved by the U.S. Food and Drug Administration (FDA). Daily administration of risedronate results in a decreased rate of bone turnover and a decrease in the levels of serum alkaline phosphatase and urinary hydroxyproline, two biochemical markers of bone turnover (4,20). A significant advantage to treatment with the bisphosphonates is long-term suppression of the disease (20). Calcium supplementation, which often is necessary in these patients, must be dosed separately from risedronate, because calcium- and aluminum- or... 

The elderly female client has been diagnosed with compression fractures of the vertebrae and has been taking large doses of ibuprofen for pain. Which nursing intervention should the nurse implement ... 

S.M. Kurtz, M.L. Villarraga, K. Zhao, A.A. Edidin, Static and fatigue mechanical behavior of bone cement with elevated barium sulfate content for treatment of vertebral compression fractures, Biomateri-afr26(2005) 3699-3712. 

---