What are the common causes of compression fractures treated with percutaneous vertebroplasty and kyphoplasty?

Updated: Jul 29, 2020
  • Author: Jeffrey P Kochan, MD; Chief Editor: Felix S Chew, MD, MBA, MEd  more...
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Answer

Answer

The fractures may be as a result of bone weakened by osteoporosis, trauma, or tumors such as metastases, multiple myeloma, and hemangioma. Osteoporosis, however, accounts for most fractures. The disease accounts for an estimated annual incidence of 700,000 fractures per year; of these, approximately 260,000 are vertebral compression fractures. Once a vertebral compression fracture occurs, the risk of additional fractures in adjacent vertebrae increases 5-fold.

Fractures are identified in 26% of women aged 50 years or older and are radiographically present at a rate of 500 cases per 100,000 persons in patients aged 50-54 years and 2,960 cases per 100,000 persons in patients older than 85 years. [3] Vertebral compression fractures are twice as common in females, [4] occurring in 153 females per 100,000 compared with 81 males per 100,000. Prevalence rates in North America for White women ≥ 50 years are 20–24%, with a White/Black ratio of 1.6. [5] For reasons not clearly understood, only one third of spinal compression fractures are painful; most of these are refractory to medical management. The remaining patients report a history of significant spinal pain in the past or do not have pain at the time of diagnosis.

Dozens of diseases and conditions predispose individuals to osteoporosis and secondary vertebral compression fracture. Examples include the following:

In addition, certain drugs are also associated with osteoporosis, as follows: [6]

  • Glucocorticoids

  • Proton pump inhibitors

  • Antiepileptic drugs

  • Medroxyprogesterone acetate

  • Aromatase inhibitors

  • GnRH agonists

  • Serotonin selective reuptake inhibitors

  • Thiazolidinediones

  • Calcineurininhibitors

  • Heparin

  • Warfarin

Patients with compression fractures typically present with a sudden onset of intense back pain, often after a relatively benign activity. Many patients refer to intractable pain after a sneeze or a cough. The pain tends to be debilitating. Patients find it difficult to find a comfortable position, and therefore, they have difficulty sleeping. Many patients refer to sleep in a seated or semireclining position.


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