Osteoporosis and Vertebral Fractures

A client with osteoporosis has sustained a spontaneous vertebral fracture. This type of fracture occurs without significant trauma due to weakened bone.

Advanced age is a primary risk factor, as bone density naturally decreases with age.
Being female increases risk, especially after menopause due to decreased estrogen levels.
Low body weight can contribute, as there is less bone mass to begin with.
Family history of osteoporosis or fractures suggests a genetic component.
Prior fractures increase the risk of future fractures.
Long-term glucocorticoid (steroid) use can significantly weaken bones.
Rheumatoid arthritis is associated with increased bone loss.
Malabsorption syndromes (e.g., celiac disease) interfere with calcium and vitamin D absorption.
Excessive alcohol intake impairs bone formation.
Smoking reduces bone density.
Low calcium and vitamin D intake deprives the body of essential building blocks for bone.
Sedentary lifestyle reduces bone stimulation.
Certain ethnicities, such as Caucasian and Asian, have a higher risk.

Sudden onset of back pain, often described as sharp or stabbing.
Pain that worsens with standing or walking.
Limited spinal mobility due to pain and muscle spasm.
Gradual loss of height over time.
Development of kyphosis (dowager's hump), an exaggerated curvature of the thoracic spine.
Difficulty breathing if the fracture is in the upper thoracic spine.
Abdominal distention or constipation due to compression of abdominal organs.
Neurological symptoms (rare) such as numbness, tingling, or weakness in the legs if the spinal cord is compressed.

Medical history focusing on risk factors, prior fractures, and current medications.
Physical examination assesses posture, spinal mobility, and neurological function.
X-rays of the spine can reveal vertebral fractures.
Bone densitometry (DEXA scan) measures bone mineral density (BMD) to assess the severity of osteoporosis.
MRI or CT scan may be necessary to evaluate for spinal cord compression or other complications.
Vertebral Fracture Assessment (VFA) is a low-dose x-ray performed during DEXA to identify vertebral fractures.
Blood tests to rule out secondary causes of osteoporosis, such as hyperparathyroidism or vitamin D deficiency.

Pain management is a priority, often involving analgesics such as acetaminophen, NSAIDs, or opioids.
Muscle relaxants can help alleviate muscle spasms.
Short-term bed rest may be necessary for severe pain, but prolonged inactivity should be avoided.
Bracing with a spinal orthosis can provide support and reduce pain.
Physical therapy to improve posture, strengthen back muscles, and increase mobility.
Calcium and vitamin D supplementation to promote bone health.
Bisphosphonates (e.g., alendronate, risedronate) are first-line medications to increase bone density and reduce fracture risk.
Denosumab is a monoclonal antibody that inhibits bone resorption and can be used as an alternative to bisphosphonates.
Teriparatide is a parathyroid hormone analog that stimulates bone formation, used for severe osteoporosis.
Calcitonin is a hormone that inhibits bone resorption, but is less effective than other osteoporosis medications.
Vertebroplasty involves injecting bone cement into the fractured vertebra to stabilize it and reduce pain.
Kyphoplasty is similar to vertebroplasty but involves creating space in the vertebra before injecting cement to restore height and reduce kyphosis.

Pain assessment using a standardized pain scale.
Administering analgesics as prescribed and monitoring for side effects.
Encouraging regular, gentle exercise to maintain mobility and prevent stiffness.
Teaching proper body mechanics to avoid further injury.
Providing assistive devices such as walkers or canes as needed.
Educating the client about osteoporosis risk factors and prevention strategies.
Ensuring adequate calcium and vitamin D intake through diet and supplements.
Promoting smoking cessation and limiting alcohol intake.
Monitoring for complications such as constipation, pneumonia, or pressure ulcers.
Referring the client to physical therapy and occupational therapy.

Understanding osteoporosis and its risk factors.
Importance of calcium and vitamin D intake.
Safe exercise and fall prevention strategies.
Proper body mechanics.
Medication management, including potential side effects.
Importance of follow-up appointments with healthcare providers.
Resources for support and information, such as the National Osteoporosis Foundation.

Removing tripping hazards in the home, such as loose rugs and clutter.
Ensuring adequate lighting.
Using assistive devices such as grab bars in the bathroom and handrails on stairs.
Wearing supportive shoes.
Regular vision and hearing checks.
Addressing balance problems through exercise and physical therapy.
Reviewing medications that may cause dizziness or lightheadedness.

Calcium intake should be 1000-1200 mg per day from diet and/or supplements.
Vitamin D intake should be 800-1000 IU per day.
Good sources of calcium include dairy products, leafy green vegetables, and fortified foods.
Good sources of vitamin D include fortified milk, fatty fish, and sunlight exposure.
Limiting caffeine and sodium intake, as they can increase calcium excretion.
Ensuring adequate protein intake for bone health.

Weight-bearing exercises such as walking, jogging, and dancing can improve bone density.
Resistance training with weights or resistance bands can strengthen muscles and improve balance.
Flexibility exercises such as stretching and yoga can improve range of motion and reduce the risk of falls.
Low-impact exercises such as swimming and cycling are good alternatives for those with joint pain.
Consulting with a physical therapist to develop a safe and effective exercise program.