1. Osteoporotic Fracture- presentation Sudden onset pain in thoracic or lumbar spine Minor trauma Sometimes there is no trauma A T10 fracture can cause pain in the lower lumbar spine- so palpate the whole spine A wedge fracture on xray may be tumour or an osteoporotic fracture- so an MRI scan is essential

2. Management Blood tests: ESR, CRP, Bone Chemistry, Serum Electrophoresis, Renal and Thyroid function, Vitamin D levels. Rule out secondary causes and tumours MRI scan and Xray Consider a Bone Density Scan Advise rest and pain killers If pain not settling in 6 weeks refer to spinal unit COMMON SECONDARY CAUSES OF OSTEOPOROSIS Renal problems Diabetes Thyroid dysfunction Early menopause Steroid usage Drugs for Epilepsy Parathyroid dysfunction

3. Epidemiology 300,000 hip fractures/yr USA. 700,000 spinal fractures/yr. 1/3 new, 2/3 old. 14 bed days/fracture. 20% collapse can progress to 70% collapse. Sex: 75% women. At 80 same incidence as men.

4. Problems after Vertebral fractures Transient Ileus Urinary retention Pain Problems with immobilization Kyphosis Muscle deconditioning Insomnia Depression Protuberant abdomen Decreased pulmonary function Increased mortality 0.5% risk of paraplegia

5. 23% increased mortality in women > 65years with Vertebral Compression Fractures compared with age matched controls. KADO et al. Arch Intern med. 1999 9% reduction in Forced vital capacity per thoracic compression fracture

6. Vertebroplasty- Bone Cement injection into vertebral body Originated in France – 1986 70-90% pain relief 1-6% risk of complications

7. How does Vertebroplasty work? Reduced micro-motion and restoration of load transmission

8. NEEDLES PLACED IN VERTEBRAL BODY UNDER XRAY CONTROL

9. NEEDLES PLACED IN THE VERTERAL BODY UNDER XRAY CONTROL

10. BONE CEMENT BEING INJECTED INTO VERTEBRAL BODY

11. XRAY MONITORING OF CEMENT PLACEMENT THROUGHOUT

12. AP XRAY OF CEMENT IN THE VERTEBRAL BODY

13. F= 67. 6 year H/o back pain- 90% better after the procedure

14. Results Significant pain relief is seen in 75-90% of osteoporotic fractures And in 59-86% of malignant fractures. Increased mobility Reduced analgesic requirement Results are sustained over time Complication rates are low and include cement leakage