Living with spinal fractures caused by the ‘silent disease’

Osteoporosis can affect many different at-risk groups. Sarah Leyland from the Royal Osteoprosis Society (ROS) and Dr Emma Clark from North Bristol NHS Trust explain the nature of this condition, its physical and emotional effects and what treatments and self-management techniques are available to you called ‘vertebral fracture assessment’ which may be performed as part of your DXA scan to identify any fractures in your spine.

What is osteoporosis?

Osteoporosis is a medical condition that causes bones to lose strength and become weaker or more fragile. As a result, they break more easily. It is these broken bones (fractures) that cause the symptoms and pain associated with osteoporosis. Osteoporotic fractures are often described as ‘low trauma’ or ‘fragility fractures’. However, if bones lose a lot of strength, then they can break after a minor bump or fall. Older people are most commonly affected and these fractures, especially hip fractures and broken bones in the back (spinal fractures), can lead to long term disability, loss of independence and reduced life expectancy.

Bones are made up of a strong outer shell with an inside scaffolding, or honeycomb-like structure. Bone tissue consists of a protein base strengthened by minerals such as calcium. It is a living structure constantly renewing itself throughout life, remaining healthy and strong. With osteoporosis, this remodelling of bone has become out of balance. More bone tissue is worn away than is replaced, the outer shell and inner scaffolding within the bone get thinner and eventually break down. Bones lose their density and strength, and are more likely to break.

What are spinal fractures?

Although any bone can break when bones lose strength, wrists and hips are common sites for fragility fractures to occur if you fall over.

Spinal (vertebral) fractures can also occur with osteoporosis. Spinal bones become squashed or compressed rather than cracking or breaking as other bones would.

One or more fractures can occur in the spine, and once you’ve had one you are unfortunately more likely to get another. They are usually a clear sign that bones have lost strength and you may be given a diagnosis of osteoporosis if they are identified. Usually, a bone density scan would be performed as well to confirm low bone density, alongside blood tests to ensure fractures weren’t caused by a different condition.

Who is at risk of spinal fractures?

Older age is not the only factor that increases the risk of osteoporosis and fractures. Medical conditions like early menopause and rheumatoid arthritis can also be risk factors, as well as some medications which weaken bones such as ‘steroids’ (glucocorticoids) and some breast cancer treatments. Further risk factors include low bodyweight, smoking and excessive alcohol intake, as well as genetic factors, but there are no specific tests available. Although men and women can both be affected, women are more at risk because bone is lost more rapidly during the menopause, when oestrogen levels fall.

What are the signs and symptoms of spinal fractures?

The experience of spinal fractures varies. Sometimes a fracture happens after an awkward movement or without an obvious cause, resulting in sudden and acute back pain. Some people have a fracture that is painless and causes no symptoms at all. For others, there is no sudden pain, but they notice that they are getting shorter, or that their back is more curved (a ’kyphosis’), or they may have a back pain or pain radiating around into their chest. This pain may be constant and grinding. Some people with spinal fractures describe back pain which gets worse with activity, building up until it is so bad, they need to stop what they are doing.

How are they diagnosed?

Spinal fractures are usually diagnosed from a normal back X-ray. Your doctor will refer you for one if you have signs and symptoms, especially if you have risk factors or a previous osteoporosis diagnosis. Sometimes a fracture might be identified from a bone density (DXA) scan if the fracture is in the part of the spine being scanned. There is also a new technology called ‘vertebral fracture assessment’ which may be performed as part of your DXA scan to identify any fractures in your spine.

How do spinal fractures affect you?

Physical effects

Spinal fractures take the same length to heal as any broken bone – six to eight weeks – although, it can take longer. If you have experienced severe pain, then it gradually decreases as the bone heals. Although the fracture heals, the bone remains in a compressed or wedged shape and this can result in more persistent long-term pain problems. Changes in posture can create nerve trapping, ligament strain and muscle spasm as the surrounding structures try to adapt to the changed shape to your spine. Further symptoms are sometimes caused by a shortening of the trunk – between your shoulder and your waist – with less space for all of your internal organs. Often people describe having a protruding tummy and discomfort. They may also experience breathlessness, discomfort after eating or pressure on the bladder. Occasionally, changes in body shape can result in the rib cage pressing down on the pelvic rim, causing severe discomfort.

Emotional effects

It isn’t everyone’s experience but, for some people, especially those with multiple fractures, the psychological effects of spinal fractures can be significant. Long-term pain problems, as with any condition, can be debilitating, especially because healthcare professionals often underestimate the seriousness of the pain of osteoporotic spinal fractures. Coping with the physical changes to your body shape and body image can also be distressing.

In addition, there can be fear associated with spinal fractures. This is often a fear of future spinal fractures, especially whilst exercising or increasing physical activity. Fear can be exacerbated by the terminology used to describe spinal fractures. They are often described by health professionals as ‘crushed’ or ‘collapsed’ vertebrae and consequently there is a fear of paralysis or serious spinal collapse. These are not outcomes with osteoporotic spinal fractures as they are ‘stable’ fractures and don’t interfere with the spinal cord, although, this is a common misconception.

What treatment is available?

Spinal fractures get better on their own. You don’t need to have an operation or wear a brace and you don’t need to keep still. In fact, keeping mobile, at least after any very acute pain has been resolved, is important to prevent you developing other problems like chest or urine infections and aids recovery generally.

Medication, practical measures and other measures

Adequate pain-relieving medications as well as practical measures like applied heat or cold; ‘pacing’ your activities, relaxation and distraction techniques, TENS machines and self-management courses can all play a part. Physiotherapy, hydrotherapy and complementary therapies may all be useful. If pain isn’t resolving, then a referral to a pain clinic or a pain management course may be appropriate. Talk to your GP and other health professionals, as communication with them will be key to getting the help you need if pain problems continue.

Exercises

Persistent pain problems may be helped by specific exercises to strengthen back muscles, in order to support the spine and help with posture. The Royal Osteoporosis Society (ROS) has a range of factsheets to help with pain and symptoms and living well with spinal fractures. They also have a series of factsheets focusing on how exercise can help.

Preventing further fractures with medications

It will also be important to discuss with your doctor your need for an osteoporosis medication such as alendronic acid. These won’t help with pain, but they will reduce the risk of having another spinal fracture and further pain and symptoms in the future. This risk of another broken bone increases significantly after you have had one spinal fracture, especially in the first year. So, it’s worth discussing a medication as soon as you can.

What other help is available?

Find out more about managing pain or call the free ROS Helpline on 0808 800 0035, Monday to Friday 09:00-13:00 and 14:00-17:00.

Listen to the accompanying Airing Pain programme from Pain Concern.

Article reproduced from Pain Matters Magazine Issue 78 with the permission of Pain Concern.