Spinal fracture

Question 1

Risk factors for osteoporotic fractures

Answer 1

Advancing age

Previous history of fragility fracture

Frequent or prolonged use of glucocorticoids

History of falls

Family history of hip fracture

Alternative causes of secondary osteoporosis (cushing’s, hyperthyroid, chronic renal disease)

Low BMI <18.5

Tobacco smoking

High alcohol intake

Question 2

Presentation of osteoporotic vertebral fracture

Answer 2

Asymptomatic: may be diagnosed through an incidental finding on xray

Acute back pain

Breathing difficulties: changes in shape and length of vertebrae lead to compression of organs

GI problems: due to compression of abdominal organs

Minority will have history of fall/ trauma

Question 3

Signs

Answer 3

Loss of height: compression of the spinal vertebrae

Kyphosis

Localised tenderness of palpation of spinous processes

Question 4

Investigations

Answer 4

Xray of spine: first investigation ordered and may show wedging of the vertebra due to compression of bone

May show old fractures (sclerotic appearance)

Question 5

Other investigations

Answer 5

CT spine: more detailed view of bone structure; visualise extent/ features of fracture more clearly

MRI spine: differentiating osteoporotic fractures from those caused by another pathology