Fractures

Question 1

A 65-year-old postmenopausal woman presents following the sudden onset of mid-back pain after sneezing. She has no history of fever, common night sweats, or unexpected weight loss, nor a family history of osteoporosis. Her physical exam is unremarkable. You suspect thoracic vertebral compression fracture (VCF).

List five risk factors for VCF.

Answer 1

Osteopenia
Osteoporosis
Older age
A history of VCFs or falls
Inactivity
Use of corticosteroids (> 5 mg daily for three months) Weight less than 117 lb (53.1 kg)
Female sex
Consumption of more than two alcoholic drinks per day in women or more than three per day in men 
Smoking
Vitamin D deficiency

Ref: CFPC Self-Learning Module Vol 32.2 (April 2017)

Question 2

A 65-year-old postmenopausal woman presents following the sudden onset of mid-back pain after sneezing. She has no history of fever, common night sweats, or unexpected weight loss, nor a family history of osteoporosis. Her physical exam is unremarkable. You suspect thoracic vertebral compression fracture (VCF).

What imaging can be helpful in making the diagnosis?

Answer 2

Plain film X-ray
MRI
CT

NB.
Magnetic resonance imaging (MRI) can help distinguish benign from malignant fractures and determine the timing of the fracture, because recent fractures display edema. MRI or computed tomography are useful for identifying suspected retropulsion, fractures extending to the posterior column, and spinal cord involvement. Computed tomography or MRI should also be considered in patients who do not improve with conservative care and in those with progressive symptoms.

Question 3

A 65-year-old postmenopausal woman presents following the sudden onset of mid-back pain after sneezing. She has no history of fever, common night sweats, or unexpected weight loss, nor a family history of osteoporosis. Her physical exam is unremarkable. You suspect thoracic vertebral compression fracture (VCF).

Images reveal an anterior wedge compression fracture at T8, the area of most discomfort. The radiologist reports 20% loss of vertebral height. List three strategies for managing acute VCF.

Answer 3

Pain management with medication
Early mobilization
Physical therapy
Calcitonin

Question 4

A 65-year-old postmenopausal woman presents following the sudden onset of mid-back pain after sneezing. She has no history of fever, common night sweats, or unexpected weight loss, nor a family history of osteoporosis. Her physical exam is unremarkable. You suspect thoracic vertebral compression fracture (VCF).

When should vertebroplasty or kyphoplasty be considered?

Answer 4

If there is no significant functional improvement,

MRI-confirmed acute fracture, and debilitating pain after at least three weeks of conservative therapy.

Question 5

A 65-year-old postmenopausal woman presents following the sudden onset of mid-back pain after sneezing. She has no history of fever, common night sweats, or unexpected weight loss, nor a family history of osteoporosis. Her physical exam is unremarkable. You suspect thoracic vertebral compression fracture (VCF).

What additional lifestyle changes should be considered for optimal treatment?

Answer 5

Weight-bearing and muscle-strengthening exercise
Smoking cessation
Avoiding excessive consumption of alcohol
Risk assessment for falls.