CC May 2016 Vertebral Compression Fractures

echoecho's version from 2016-07-04 17:47


Question Answer
With an aging population in the USA, there is an increased incidence of what?osteoporosis
The most common osteoporotic fracture is what?vertebral compression fracture
Vertebral compression fractures acount for about half of the ___million osteoporotic fractures seen every year1.5
The lifetime risk of vertebral compression fracture is estimated to be ____% for women and ____% for men?18; 11
Do some osteoporotic compression fractures occur over time and may be asymptomatic?yes
Describe how a vertebral compression fracture may occur?presents with sudden, severe, bak pain in the thoracic or lumbar regions that may occur associated with activities as benign as coughing or bending
Despite these characteristics, can it be difficult to clinically distinguish compression fx from the other common causes of back pain in older patient (DDD or malignancy)?yes
Describe the physical exam to be done to try to dx a compression fx?direct palpation of the spine which may elicit tenderness and a neurological exam of the lower extremities
What is recommended to be done initially?imaging
*** The American College of Radiology recommends what imaging? Comparison with traditional radiographs?1) DXA (dual-energy x-ray absorptiometry) with veretral fracture assessment (DXA with VFA) 2) which has a lower cost and lower radiation exposure than traditional radiographs of the spine (appropriateness rating 9/9)
What is another advantage of VFA (vertebral fracture assessment)?VFA can be done at the same time as the DXA becasue VFA utilizes data from the DXA to assess for prevalent (fx that exists at a discrete point of time) and incident fxs (fx that occurs between 2 points in time). The addition of VFA to DXA enhances fracture identification
Define the radiographic findiings of compression fractures?1) 20-25% reduction in height OR 2) 4 mm absolute reduction in height when compared to previous radiographics
When is an MRI used?1) if radiographis are EQUIVOCAL OR 2) to distinguish new from old compression fractures
Is CT recommended, and why or whynot?1) no 2) involves high radiation exposure
What type of patient can be managed conservatively?1) those with stable fractures 2) those with controllable pain 3) those who have ability to perform activities of daily living
Advise patients to do what?1) remain as active as possible 2) don't have prolonged bed rest because it is associated with skin breakdown, venous thromboembolic disease and loss of function
What can be used to reduce the pain from vertebral compression fracture AFTER 1 week of use?intranasal calcitonin-salmon (Miacalcin)
Miacalcin has what effects?anti-osteoporosis effects
Why are some saying not to use Miacalcin in males?potential association with progression of prostate CA
Other analgesics may be used in acute compression fractures, but care must be taken in what types of older patients?1) co-morbid conditions when using NSAIDs (cardiovascular dse, GI bleeding) ANDD 2) opioids (hx of cognitive impairment)
Bracing is sometimes used, however the American Academy of Orthopedic Surgeons (AAOS) states what?the evidence supporting the use of braces is INCONCLUSIVE
Comment on physical therapy and the American Academy of Orthopedic Surgeons (AAOS)'s opinion?1) PT can aid in muscle strengthening to prevent falls and future fractures 2) as with bracing, PT has inconclusive evidence
If conservative thearpy is chosen, what is the treatment?treatment of osteoporosis
Benefits of bisphosphonates and disadvantage?1) secondary prevention of vertebral fractures 2) do NOT decrease pain associated with compression fractures
Why is a DX scan to assess for osteoporosis unnecessary for a vertebral compression fracture?unnecessary since a compression fx is pathognomonic for the dse
When are follow-up imaging of the fracture needed?in those with neurological symptoms that develop or the pain does NOT improve
Monitoring of the effectiveness of osteoporosis treatment is recommended, true or false?true
Comment on open surgical repair?indicated for unstable fractures and for those associated wtih neurological ymptoms, but is associated with significant morbidity
List two minimally invasive procedures that have been used for the treatment of compression fractures are?1) vertebroplasty 2) kyphoplasty
Define vertebroplasty?injection of polymethylmethacrylate (PMMA) into the fractured vertebral body under radiographic guidance
Define kyphoplasty?a balloon is first percutaneously inserted into the vertebral body and exapanded; PMMA is then injected in order to maintain the vertebral height
Which of the two procedures retores vertebral height; which does not?Kyphoplasty RESTORES vertebral height BUT vertebroplastly does NOT
*** In a 2009 study, patients were randomly assigned to undergo vertebroplasty or a simulated procedure; one month later, what were the findings? there was no difference in either pain or disability scores between the 2 groups
*** A 2015 Cochrane review found no support for ________ (moderate evidence); numbers were too small to adequately assess adverse effects? vertebroplasty
In randomied trials, kyphoplasty has been shown to reduce ____ when compared to nonsurgical therapy?pain
What is the recommendations from the AAOS (American Academy of Orthopedic Surgeons) on vertebroplasty?1) AGAINST vertebroplasty as a treatment for compression fractures 2) kypohoplasty is an option for patients with compression fracture on imaging, correlating clinical s/s and NO associated neurologic symptoms
*** SUMMARY = Radiographic findings of compression fracture include ___% to ____% reduction in height or a ___ mm absolute reduction in height when compared to previous radiographs?20; 25' 4
*** SUMMARY = Patients should be enouraged to remain _____ as possible? Why is prolonged bed rest discouraged?1) active 2) it is associated with skin breakdown, venous thromboembolic disease and loss of function
*** SUMMARY = follow-up imaging of the fracture is NOT needed unless what develops? neurological symptoms develop OR the pain does not improve