CC May 2016 Vertebral Compression Fractures (#2)

echoecho's version from 2016-07-24 14:51


Question Answer
With an aging population in the US, the is an increased incidence of what?Osteoporosis and osteoporosis-related complications including osteoporotic fractures
What is the most common osteoporotic fracture ?Vertebral compression fractures
Vertebral fractures account for about 1/2 of the _______million osteoporotic fractures seen every year?1.5
What is the lifetime risk of vertebral compression fracture in women? In men? 18% ; 11%
Some osteoporotic compression fractures occur over time and may be _______?Asymptomatic
Describe how an acute vertebral compression rapture can present as?Sudden, severe back pain in the thoracic or lumbar regions that may occur associated with activities as benign as coughing or brnding
It is difficult to distinguish a compression fracture form what other common causes of back pain in older adults?1) degenerative disc disease. 2) malignancy
Describe the physical exam of a suspected compression fracture?1) direct palpating of the spine which may elicit tenderness. 2) a neurological exam of the lower extremities
What type of testing is recommended if a vertebral compression fracture is suspected?Imaging
*** What imaging is recommended by the American College of Radiology?1) DEXA with VFA (vertebral fracture assessment)
*** What is the benefit of DEXA with VFA compared to traditional radiographs of the spine (appropriateness rating 9/9)?DXA with VFA has a lower cost and lower radiation exposure than traditional radiographs
What is the advantage of having VFA with the DEXA?1) the VFA can be done at the same time as the DEXA (because VFA utilizes data from the DEXA to assess for prevalent (fx that exists at a discrete point in time) and incident fractures (fracture that occurs between 2 points in time) 3) enhances fracture identification
What is the radiographic findings of compression fracture?A 20-25% in height or a 4 mm absolute reduction in height when compared to previous radiographs
When would an MRI be done?1) if radiographs are equivocal OR 2) to distinguish new from old compression fractures
Why are CT not recommended? It involves high radiation exposure
What type of patients can be managed conservatively?1) stable fractures. 2)ability to perform activities of daily living. 3) controllable pain
Patient should be encouraged to remain as active as possible, true or false?true
Prolonged bed rest is associated with what?1) skin breakdown 2) venous thromboembolic disease 3) loss of function
What medication has been shown toreduce the pain from vertebral compression fractures after 1 week of use?intranasal calcitonin-salmon (Miacalcin)
What effects on osteoporosis does intranasal calcitonin-salmon (Miacalcin) have?anti-osteoporosis effects
Why do some organizations recommend against use of intranasal calcitonin-salmon (Miacalcin) in men?due to a potential association with progression of prostate cancer
Other analgesics may be used in acute compression fractures, but care must be taken in older patients with what?co-morbid conditions when using NSAIDS (cardiovascular disease, GIi bleeding) and opioids (hx of cognitive impairement)
Comment on what the American Academy of Orthopedic Surgeons (AAOS) has stated that the evidence supporting the use of braces in vertebral compression fractures and physical therapy?1) braces = inconclusive 2) physical therapy = inconclusive (although it can aid in muscle strengthening to prevent falls and future fractures)
If conservative therapy is chosen, patients should be treated for what?osteoporosis
What medications are effective for secondary prevention of vertebral fractures but do NOT decrease pain associated with compression fractures?bisphosphonates
Why is DEXA scanning to assess for osteoporosis is unnecessary?because a compression fracture is pathognomonic for the disease
What 2 reasons would necessitate follow-up imaging of the fracture?1) neurological symptoms develop 2) pain does not improve
Monitoring of the ______ of osteoporosis treatment is recommended?effectiveness
Open surgical repair of a vertebral compression fracture is indicated in what scenario, but is associated with significant morbidity?development of neurological symptoms
List 2 minimally invasive procedures that have been studied for the treatment of compression fractures?1) Vertebroplasty 2) Kyphoplasty
What is Vertebroplasty?1) injection of PMMA (polymethylmethacrylate) into the fractured vertebral body under radiography guidance
What is Kyphoplasty?a balloon is first percutaneously inserted into the vetebral body and expanded; PMMA is then injected in order to maintain the vertebral height
Which of the two procedures (vertebroplasty vs. kyphoplasty) restores vertebral height but the other does not?Kyphoplasty restores vertebral height but vertebroplasty does NOT
*** In 2009 study, patients were randomly assigned to undergo Veretebroplasty or a simulated procedure. One month later, what was comparison as to pain or disability scores between the 2 groups?there was NO difference between the 2 groups
*** Did a 2015 Cochrane review find support for Vertebroplasty (moderate evidence)? Why?1) no 2) numbers were too small to adequately assess adverse effects
In randomized trials, which of the 2 procedures (vertebroplasty vs. kyphoplasty) has been shown to reduce pain when compared to nonsurgical therapykyphoplasty
The AAOS (American Academy of Orthopedic Surgeons) recommends AGAINST __________( vertebroplasty vs. kyphoplasty) as a treatment for compression fractures, but states that ________ (_( vertebroplasty vs. kyphoplasty) is an OPTION for patients with compression fractures on imaging, correlating clinical signs and symptoms, and no associated neurologic deficits?1) Vertebroplasty 2) Kyphoplasty
*** SUMMARY = Give the definition of radiographic findings of compression fractures?1) 20-25 % reduction in height 2) 4 mm absolute reduction in height when compared to previous radiographs
*** SUMMARY = Patients should be encouraged to remain ______ (active vs non-active)?active
*** SUMMARY = List the 3 adverse effects of prolonged bed rest?1) skin breakdown 2) venous thromboembolic disease 3) loss of function
*** SUMMARY = What would necessitate follow-up imaging of the fracture?neurological symptoms or the pain does NOT improve