Osteoporosis and Bone Health: Treating 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: If a patient presents with a painful vertebral compression fracture, what are the options to treat that patient?
Dr. Faye Hant: Certainly, one of the big things is pain control. That needs to be evaluated. A lot of times, patients have these fractures and their underlying bone health is not assessed, so, again, a thorough work-up for osteoporosis should be undertaken. There are other options, such a physical therapy. Bracing of the back is sometimes utilized. There are procedures that can be done with the help of interventional radiologists, and other surgeons, to try to improve the acute pain of a fracture.
Dr. Marcy Bolster: Are there medications that are needed to treat the patient who has had a vertebral compression fracture?
Dr. Faye Hant: Yes. There are several agents available to treat osteoporosis. Bisphosphonates are a class of medicines which are felt to be the best in terms of treating someone’s low bone mineral density, but there are other options as well.
Dr. Marcy Bolster: What are some of the bisphosphonates by name?
Dr. Faye Hant: So, you might hear things like Fosamax, Actonel, Boniva, those are the big ones. Reclast, as well, which is a newer once-yearly IV formulation.
Dr. Marcy Bolster: Are there any other treatments that a patient might be given to treat the osteoporosis that caused the compression fracture?
Dr. Faye Hant: Yes. There are other agents. There’s synthetic parathyroid hormone, something called Forteo, which can be used in high-risk patients, as well as patients who may have failed bisphosphonate therapy. There are certain indications for that. Not used alone, but often as an adjunct to vertebral compression fracture pain, patients may receive something called Calcitonin, which is an intranasal medication, or given via injection. And then for people who are completely intolerant, or unable to take any of these medicines, there is Evista.
Dr. Marcy Bolster: It seems that vertebral compression fractures are a very common problem. How does this relate to our knowledge of osteoporosis and our ability to diagnose and treat it?
Dr. Faye Hant: Well, the vertebral compression fracture is the most common osteoporotic fracture. And, when you think of osteoporosis as a whole, it’s a silent condition. So, until you fracture your hip, or your back, you may not know you have it. And so, I think, as a total approach, because it is so devastating when people do fracture, and because it does increase your mortality once you’ve fractured, it is a great opportunity to be proactive and practice preventative medicine in these populations.
Dr. Marcy Bolster: What do you mean by practice preventive medicine?
Dr. Faye Hant: Meaning, we want to diagnose patients with osteoporosis early, so that they can get on therapies and don’t go on to fracture. Now, that being said, there are people who are treated for osteoporosis who do fracture. However, I think it’s a missed opportunity to not try to find those patients and treat them appropriately.
Dr. Marcy Bolster: Are the treatments that we have effective for treating osteoporosis? Specifically, do our treatments prevent fracture?
Dr. Faye Hant: They do. And there’s about a 50 percent reduction in fracture while taking the available medicines that we have. That being said, a lot of research is going on now looking at other mechanisms, and other drugs, to treat patients, so we’re very excited about what the future holds in treating this disease.
Dr. Marcy Bolster: Dr. Hant, I know that you’re involved in the Vertebral Fracture Clinic, which is one component of the Center for Osteoporosis and Bone Health at MUSC. Can you describe the Vertebral Fracture Clinic?
Dr. Faye Hant: Sure. It was created as multidisciplinary approach to patients for their vertebral compression fracture and, thus, their overall bone health. The way it works is, ideally, the patient is seen by a physical medicine and rehabilitation doctor who evaluates the actual compression fracture for the acuity of the fracture, meaning how new or old it is. Imaging is done, depending on what needs to be done. There are also spinal surgeons and interventional radiologists present who review the images and evaluate the patient to determine whether or not they would benefit from a procedure for their compression fracture. After this, the patients are seen in our rheumatology clinic where they’re treated and evaluated further for their bone health, in terms of their osteoporosis.
Dr. Marcy Bolster: So, the patient would come to the clinic and see the physiatrist, or physical medicine and rehabilitation doctor? And you mentioned that the patient could then have further imaging if needed, what type of imaging would the patient expect, what type of x-rays?
Dr. Faye Hant: Usually, they have plain x-rays. But, in addition to that, we do have the availability of same-day MRI and/or CAT scans, should that be necessary. Also, a large benefit of this is that patients are seen within the same day. All of this is coordinated so that they’re seen by the physiatrist, the interventional doctor, as well as the rheumatologist within a single day. I think that the multidisciplinary approach, to comprehensively look the patient, is a big plus.
Dr. Marcy Bolster: It is. It’s very valuable. So, if the patient is seen by a spine surgeon, does that mean that they might have spine surgery? What type of procedure are you indicating that the patient might consider?
Dr. Faye Hant: Sure. One of the big things with vertebral compression fractures is assessing whether there’s any sort of neurologic issue, because nerves, and the spinal cord, could be involved. In terms of needing a procedure, what I refer to, mainly, is something called kyphoplasty, and vertebroplasty. Vertebroplasty is a procedure where the doctor places a needle into the bone in the back and injects cement to try to stabilize the fracture, or the break that’s in that bone. Similarly, although a little different, kyphoplasty utilizes a small balloon where the doctor goes in, inflates a balloon within the bone, removes that balloon, and then injects cement into that cavity that’s created by that balloon.
Various studies have shown that patients do get pain relief after these procedures, and that, depending on the patient, the type of fracture they have, and how new or old their fracture is, they may benefit from the procedure. But not everyone gets this procedure.
Dr. Marcy Bolster: And is that procedure done the same day as the clinic visit, or is the patient scheduled to come back for the procedure? And, is the procedure done in the hospital, or as an outpatient?
Dr. Faye Hant: Usually, the procedure is an outpatient procedure. Often, the patient would need to be scheduled to come back pending preoperative work-up, and that sort of thing, although it is an outpatient procedure.
Dr. Marcy Bolster: Is there a nurse who is central to the Vertebral Fracture Clinic?
Dr. Faye Hant: Yes. We’re very lucky to have Sheryl Naugle , our nursing coordinator for the Vertebral Fracture Clinic. We also have a very catchy phone number for her: 876-BONE. She is great at coordinating, getting patients seen, and we really aim to see patients very quickly.
Dr. Marcy Bolster: I think that’s important. So, if a patient has a painful vertebral compression fracture, is it easy for that patient to get into clinic within the next few days to be seen?
Dr. Faye Hant: Definitely. That’s one of the aims of the clinic. We don’t want to miss an opportunity where we can really make a difference for these patients. We actually have specific slots within our schedules aimed, specifically, for seeing these types of patients.
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.