Osteoporosis and Bone Health: Vertebral Compression Fractures
Guest: Dr. Faye Hant – Rheumatology & Immunology
Host: Dr. Marcy Bolster – Rheumatology & Immunology
Welcome to an MUSC Podcast
Dr. Marcy Bolster: I’m Dr. Marcy Bolster. I’m a professor of Medicine in the Division of Rheumatology at the Medical University of South Carolina. I’m also the medical director for the MUSC Center for Osteoporosis and Bone Health. I’ll be speaking, today, with Dr. Faye Hant about vertebral compression fractures. Dr. Faye Hant is an assistant professor of Medicine in the Division Rheumatology at MUSC. She also sees patients in the Vertebral Fracture Clinic as a rheumatologist who manages their bone health and osteoporosis. Dr. Hant, welcome. I’m glad to have you here today to talk to us about vertebral compression fractures.
Dr. Faye Hant: Thank you, Dr. Bolster.
Dr. Marcy Bolster: Dr. Hant, let’s start with the definition of a vertebral compression fracture. What does this mean?
Dr. Faye Hant: It basically represents a fracture within the bones of your back. Often, these are asymptomatic, meaning people might not even know that they have them.
Dr. Marcy Bolster: How common are vertebral compression fractures?
Dr. Faye Hant: There’s estimated to be about 700,000 vertebral fractures in the United States annually. It’s fairly common. And I think that, overall, it may be missed, especially in an asymptomatic patient.
Dr. Marcy Bolster: If somebody has a vertebral compression fracture, does it mean that they’re more likely to have another vertebral compression fracture?
Dr. Faye Hant: Yes. Actually, I believe, if you have a vertebral compression fracture, you have a 20 percent increased risk of having another one within that year. If someone has already fractured, they’re at increased risk for fracturing again, and we want to see patients before that happens.
Dr. Marcy Bolster: What can be done to help a patient so that they don’t suffer from a vertebral compression fracture?
Dr. Faye Hant: Well, having seen first-hand how devastating it can be for patients, I think it’s very important that patients that have risk factors for osteoporosis be proactively, and preventatively, assessed. Someone who smokes, is of low body weight, has low calcium and vitamin D intake, who may have a family history, or a previous history of fracture really should undergo bone densities testing. That may help find the underlying disorder and, thus, it may be treated before they develop a fracture.
Dr. Marcy Bolster: Do both men and women get vertebral compression fractures?
Dr. Faye Hant: Yes. There’s no gender predominance. Both men and women are equally subject to possibly getting vertebral compression fractures.
Dr. Marcy Bolster: Are they usually painful?
Dr. Faye Hant: Not necessarily. Up to two thirds of patients, actually, can have asymptomatic fractures, meaning they don’t know anything, or they don’t feel any pain. About a third of patients will have pain.
Dr. Marcy Bolster: So, if a patient has a spine fracture, a vertebral compression fracture, and it’s asymptomatic, how does the patient find out that they have this?
Dr. Faye Hant: Sure. Often, it’s just incidentally found. For instance, if someone is getting a chest x-ray, or another x-ray, or imaging of their chest or another part of their body for another purpose, it may be incidentally found.
Dr. Marcy Bolster: Are there any things that happen to a patient in terms of postural changes if they have one or more of these insufficiency fractures.
Dr. Faye Hant: Sure. You know, sometimes folks will notice that they’ve lost height. Sometimes they can develop the so-called dowager’s hump, or a leaning forward type posture. Sometimes people will feel a sense of fullness in their abdomen, for instance, if they have multiple fractures that are pushing down.
Dr. Marcy Bolster: Because their spine is causing them to lean forward?
Dr. Faye Hant: Exactly.
Dr. Marcy Bolster: So, in a patient that has a painful compression fracture, what might cause that to happen?
Dr. Faye Hant: Sometimes it’s even something such as a cough. Depending on their overall bone health, something as minimal as just coughing, lifting a vase or something off the floor, sometimes it could be just bending down while gardening. It really can be minimal activity, such as a sneeze or a cough, all the way to somebody who bends and suddenly feels their back catching.
Dr. Marcy Bolster: What would alert a patient that this may be, actually, a vertebral compression fracture?
Dr. Faye Hant: Often, the pain tends to be localized around the back. It doesn’t often radiate, unless there’s spinal cord involvement. Especially in an elderly patient, the sudden onset of back pain, and certainly somebody who is not used to having back pain that has new back pain would certainly be an alert.
Dr. Marcy Bolster: So, if a patient is told that they have a spine compression fracture from a routine x-ray, what does that mean to the patient?
Dr. Faye Hant: It means that they need to have a work-up done to tell why they had that fracture. If it’s an incidental finding, meaning the patient was
completely asymptomatic and had no idea, that patient may very well have osteoporosis, as long as it wasn’t traumatic, and they should undergo further testing for osteoporosis.
Dr. Marcy Bolster: Does the presence of a vertebral compression fracture in a patient who does not have a history of trauma mean the patient has osteoporosis?
Dr. Faye Hant: Yes, it does.
Dr. Marcy Bolster: So, by definition, that patient has osteoporosis? What do they do at that point?
Dr. Faye Hant: At that point, the patient’s overall bone health needs to be assessed. So, certainly, they’ll need to undergo laboratory testing to ensure that there’s no obvious abnormality in their labs that could show there may be a secondary cause as to why they have osteoporosis. As long as their kidney function is fine and there are no contraindications to medicines, they would probably be put on a medication. In addition to that, they should have a gold standard test, called a bone density test, which would not only assess their bone mineral density in their back, but their hip, and if necessary, in their arm.
Another name for a bone density study is a DEXA scan, which is a painless 15-minute study where we can assess one or both hips, preferably both, the lumbar spine, and if necessary, the forearm to look at the bone mineral density, comparing folks to young, healthy patients as well as patients in their own age group.
Dr. Marcy Bolster: Dr. Hant, thank you very much for being here today. This has been very informative and helpful.
Dr. Faye Hant: Thank you, Dr. Bolster.
Thank you for listening to the information about the Center for Osteoporosis and Bone Health at the Medical University of South Carolina. In order to get an appointment, patients may self-refer or they may be referred by their physician. The scheduling number is (843) 876-2663 (876-BONE.) I hope this information is helpful to you.