Outsmarting Osteoporosis

From the WebMD Archives

March 28, 2000 (San Diego) -- Two new techniques are offering hope for patients suffering from the pain of 'dowager's hump' -- a characteristic of severe osteoporosis, say investigators at a radiology conference here. Osteoporosis afflicts 10 million Americans, 80% of them women, and causes 700,000 broken spines each year.

In the first technique, called vertebroplasty, a tiny nick is made in the skin of the back and a needle the size of a cocktail straw is inserted. With the help of sophisticated imaging equipment, the needle is fed into the broken vertebra, one of the segments that makes up the spine. Once the needle is in place, the doctor can apply bone cement to fill in the break, stabilize the bone, relieve pain, and help the patient stand up straighter. Patients require only light sedation and are discharged within two to three hours, says Gregg Zoarski, MD, who is presenting his research at the conference.

Zoarski tells WebMD that he and his colleagues have performed the procedure on approximately 450 patients to date with no complications. "Seventy percent of our patients were women. ... With one 89-year-old woman, her sons had tears in their eyes because she was able to get out of bed. We don't often see that kind of immediate benefit in the work we do, so it is very gratifying." Zoarski is director of interventional neuroradiology and associate professor of radiology at the University of Maryland in Baltimore.

At the conference, he presented a study of vertebroplasty in 30 patients with a total of 54 vertebrae fractures. The patients experienced "significant ... improvement in pain and disability" and expressed great satisfaction with their outcomes, Zoarski says.

Vertebroplasty allows patients to forgo the six weeks of bed rest typically prescribed to treat these types of breaks caused by osteoporosis, so they can avoid the associated risks of pneumonia and blood clots in the legs, Zoarski says.

It can also be used to treat certain kinds of tumors, including the bone marrow cancer known as myeloma and lung and breast cancers that have spread to the bone. In those cases, he says, "our main goal is the rapid elimination of pain, with stabilization of the fracture being a secondary benefit."

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The cement is strong and "fills the bad spot in the bone," he says. Some investigators now are trying to mix chemotherapy with the cement and administer them via vertebroplasty as a way of treating cancer in the bone. For patients with osteoporosis, calcium, hormones, or drugs may be added to the mix. The risk of complications or side effects is "extremely small when this is done by a properly trained doctor," says Zoarski.

The second procedure, spine balloon therapy, is similar to vertebroplasty, but before the cement is injected, a tiny balloon is passed through the needle and inflated, which further stabilizes the broken bone. It takes a little longer than vertebroplasty and requires general anesthesia, so it must be done in a hospital.

John M. Mathis, MD, chairman of the radiology group at Lewis-Gale Medical Center in Salem, Va., points out that this technique may be better suited for more severely ill patients who have suffered loss in height. He recommends that the procedure be done as soon after the break as possible, since the bone is more adaptable during this period.

People with osteoporosis may break vertebrae following a minor event such as coughing, rolling in bed, or simply "making a funny move." Because such occurrences don't stand out in the patient's mind, the fracture may go undiagnosed for several weeks. Mathis warns people who experience persistent pain and tenderness around the spine after a relatively minor trauma to see their doctor as soon as possible and be X-rayed. "If you do have a compression fracture, consider this as a possible therapy."

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