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Spine frracture pada

osteoporosis

Tutuko radite p n

Pembimbing dr nidaul khasanah spRad

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Vignette

• A 72-year-old woman presents with a 2-month historyof increasing pain in her lower back, which has notimproved with ibuprofen and is causing difficulty withwalking and dressing. She reports having lost about 5

cm (2 in.) of height since she was a young woman. Onexamination, there is mild kyphosis in her lowerthoracic spine but no point tenderness. A lateral spineradiograph reveals that the L2 vertebra is biconcave in

appearance, a finding that is consistent with avertebral fracture (Fig. 1).

• How should this case be managed? 

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Normal Height

•A poorly defined dense

(white) fracture line is visiblewith a detached fracture

fragment (asterisk)

•L2 has lost height anteriorly

and there is disruption of the

anterior column only

Loss of Height

Normal Height

*

L1

L2

L3

T12

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Verterbrae Fracture

1. deformities of the vertebral bodies identified

with imaging of the lateral spine and

characterized according to shape —  are the

most common manifestation of osteoporosis.

2. Identically with backpain

3. The most place are; thoracolumbar transition

zone or mid thoracic region

4. Less to clinically diagnosed

1. Riggs BL, Melton LJ III. The worldwide problem of osteoporosis: insights afforded by epidemiology. Bone 1995;17: Suppl:505S-511S.2. Cooper C, Atkinson EJ, O’Fallon WM, Melton LJ III. Incidence of clinically diagnosed vertebral fractures: a populationbased study in Rochester, Minnesota, 1985-1989. J

Bone Miner Res 1992;7:221-7.

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Goals

likelihood of back pain:

• Increase the quality of life

•

clinical diagnosis increase with the severityand number of fractures

• Prevent Fracture-related disability may also be

greater among patients with lumbar fractures

than among those with thoracic fractures

3. Fink HA, Milavetz DL, Palermo L, et al. What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res

2005;20:1216-22.4. Ettinger B, Black DM, Nevitt MC, et al. Contribution of vertebral deformities to chronic back pain and disability. J BoneMiner Res 1992;7:449-56.

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Evaluation

• A woman’s  first vertebral fracture usually

occurs well past menopause.

• Physical examination may reveal excess

sagittal convexity of the thoracic spine

(hyperkyphosis, or dowager’s  hump),

especially among patients with multiple

anterior wedge fractures of the thoracic spine.

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Prevalention

The prevalence and incidence of radiographic

vertebral fractures increase with age, with the

prevalence among white women rising from

5% to 10% between the ages of 50 and 59

years and to 30% or more at 80 years of age or

older.

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clinical risk factors

for incident vertebral fractures :

1. Prior fracture

2. history of one or more falls

3. Inactivity

4. current smoking,

5. use of systemic glucocorticoids

6. certain chronic medical conditions

7. low body-mass index.

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Bone mineral density

• Measured by x ray absorbtiometry (DEXA)

• > 1-3rd  of postmenopausal women with

prevalent radiographic vertebral fractures

have T scores (spine and hip) > −2.5

• The prevalence of radiographic vertebral

fractures among women 60 years of age or

older with low bone mass has been reported

to range from 14 to 18%

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Diagnosis

• medical history and an examination may

confirmed with a spinal imaging study.

• Lateral thoracic and lumbar spinal radiographs

continue to be the standard for assessment

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Genant et al

• The method uses the qualitative features of

vertebral shape and degree of reduction in

vertebral height in the anterior, middle, or

posterior vertical dimension to grade avertebral body as normal, uncertain regarding

fracture, or characterized by a mild, moderate,

or severe fracture

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Treatment

• Pain management

• Rehabilitation

•

Vertebroplasty and Kyphoplasty• Calcium and Vitamin D

• Pharmacotherapy  

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Treatment

• Pain management

• Rehabilitation

•

Vertebroplasty and Kyphoplasty• Calcium and Vitamin D

• Pharmacotherapy  

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Treatment

• Pain management

• Rehabilitation

•

Vertebroplasty and Kyphoplasty• Calcium and Vitamin D

• Pharmacotherapy  

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Treatment

• Pain management

• Rehabilitation

•

Vertebroplasty and Kyphoplasty• Calcium and Vitamin D

• Pharmacotherapy  

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