Vertebral crush fracture osteoporosis

In the United States osteoporosis afflicts 267o of the Caucasian female population, and they have vertebral crush fractures by age... 

Type 1 osteoporosis, also known as postmenopausal osteoporosis, involves loss of trabecular bone in the vertebrae, leading to crush fracture with minimal trauma. It is essentially a condition affecting postmenopausal women, with a femaleimale ratio of 10 1. Type 11 osteoporosis (senile osteoporosis) is osteoporotic hip fracture. It shows only a 2 1 excess of females over males and a geometric increase in incidence with increasing age. The two types of osteoporosis are not exclusive, and type 1 patients are more susceptible to hip fracture, whereas many hip fracture patients have asymptomatic vertebral crush fractures. 

Osteoporosis is the most prevalent metabolic bone disease in the United States and results in 1.5 million fractures each year. Osteoporosis is associated with an increased risk for vertebral, hip, and distal forearm fractures. At age 50, women have a lifetime fracture risk (any of the above three sites) of about 40%. Men have a lifetime fracture risk of approximately one third that of women. Since trabecular bone turns over at five to seven times the rate of cortical bone, fractures of bones that are predominantly trabecular (vertebra and distal forearm) occur earlier in life. One third of women older than 65 years suffer vertebral crush fractures. Vertebral crush fractures can occur acutely and result in disabling pain and discomfort. Long-term complications include immobility and loss of height. Secondary problems include protuberant abdomen, chronic constipation, and loss of self-esteem. Fractures of bone with more cortical bone (proximal femur or hip) occur later in life. For women, the lifetime risk of hip fracture is 15%. The mortality rate accompanying hip fracture may be as high as 20%. Twenty-five percent of the survivors are confined to long-term care... 

Osteoporosis is a skeletal disease that is characterized by loss of bone mass as well as microarchitectural deterioration of the bone tissue. This disease is associated with increased bone fragility and susceptibility to fracture. It is a condition that is characterized not by inadequate bone formation but, rather, by a deficiency in the production of well-mineralized bone mass. Whereas no medical cause typically is evident in primary osteoporosis (3), secondary osteoporosis classically stems from medical illness or medication use. There are two types of primary adult osteoporosis, type I, or postmenopausal, and type II, or senile (Table 35.1). In type I osteoporosis, there is an accelerated rate of bone loss via enhanced resorption at the onset of menopause. In this form of the disease, the loss of trabecular bone is threefold greater than the loss of cortical bone. This disproportionate loss of bone mass is the primary cause of the vertebral crush fractures and the wrist and ankle fractures experienced by postmenopausal women. In type II osteoporosis, which is associated with aging, the degree of bone loss is similar in both trabecular and cortical bone (5) and is caused by decreased bone formation by the osteoblasts. 

Fig. 2 Crush fractures of vertebral bodies from patient with osteoporosis. Reproduced by kind permission of Dr W. Kuinlhomthip.

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