New and old fractures are very different! How to accurately diagnose and treat osteoporotic vertebral compression fractures?

Author: Su Qingjun, Chief Physician, Beijing Chaoyang Hospital, Capital Medical University

Reviewer: Zhang Zhihai, Chief Physician, Guang'anmen Hospital, China Academy of Chinese Medical Sciences

Osteoporotic vertebral compression fracture is a common bone disease, especially in the elderly, which brings great pain and inconvenience to patients. With the intensification of the aging trend of the population, the prevention and treatment of this disease is particularly important.

Faced with this challenge, how to promptly and accurately diagnose the fracture type, select the most appropriate treatment plan, and take effective preventive measures has become a common focus for doctors and patients.

1. Importance and methods of distinguishing new and old fractures

Osteoporotic vertebral compression fractures can be divided into old fractures and fresh fractures according to the time of fracture. There are significant differences in the imaging manifestations between the two, which is crucial for the formulation of treatment plans.

Old fractures have often healed, and patients may only show varying degrees of vertebral height reduction, but it is difficult to observe obvious fracture lines on X-rays or CT scans. Fresh fractures can clearly show fracture lines on X-rays or CT scans, but some patients may not be able to directly observe them due to special circumstances. At this time, magnetic resonance imaging (MRI) becomes a key means of diagnosis. MRI can not only clearly distinguish old fractures from fresh fractures, but also clearly show the high signal of fractures on fat-suppressed sequence images, thereby providing more accurate diagnostic information.

Figure 1 Original copyright image, no permission to reprint

II. Treatment of osteoporotic vertebral compression fractures: old and new, different strategies

Different treatment strategies are adopted clinically for osteoporotic vertebral compression fractures in different situations.

For old fractures that have healed and do not cause obvious symptoms such as pain, kyphosis or nerve compression, no special treatment is required, but anti-osteoporosis treatment must be continued to prevent further deterioration of the condition. However, if the old fracture causes severe kyphosis, compresses the spinal cord or nerves, and causes corresponding symptoms, spinal osteotomy and decompression surgery are required to relieve the symptoms.

Fresh fractures usually require active treatment. Conservative treatment includes bed rest, bracing, and medication, but for patients with severe pain or failure of conservative treatment, minimally invasive surgery such as vertebroplasty and kyphoplasty becomes the first choice.

Although the two are slightly different in principle - kyphoplasty is performed by placing a balloon for dilation and then injecting bone cement, while vertebroplasty is performed by directly injecting bone cement. However, a large number of prospective studies have shown that there is no significant difference in the treatment effect of the two surgical methods, and both can effectively relieve pain and promote early recovery. The advantage of kyphoplasty over vertebroplasty is that it can restore part of the vertebral height and reduce the risk of bone cement leakage. However, when actually choosing a treatment method, factors such as the patient's specific situation and the availability of medical resources must also be considered comprehensively.

3. Prevention and daily management of osteoporotic vertebral compression fractures

The prevention and management of osteoporotic vertebral compression fractures is a systematic project involving lifestyle adjustments, drug treatment, physical exercise and other aspects.

First of all, adjusting lifestyle is the basis for preventing osteoporosis and fractures. Patients should consume foods rich in calcium, low in salt and moderate in protein, and ensure sufficient outdoor activities to enhance sunlight exposure and promote the synthesis of vitamin D. In addition, quitting smoking, limiting alcohol, and avoiding drinking a lot of coffee are also important measures to prevent osteoporosis.

Secondly, drug therapy plays an important role in the prevention and treatment of osteoporosis. Anti-bone resorption drugs such as calcitonin and alendronate, as well as bone formation promoting drugs such as parathyroid hormone, can effectively increase bone density and reduce the risk of fractures. At the same time, bone health supplements such as vitamin D and vitamin K should also be supplemented in appropriate amounts to promote calcium absorption and utilization.

Figure 2 Original copyright image, no permission to reprint

Finally, physical exercise is also important for preventing osteoporotic vertebral compression fractures. Patients should choose appropriate exercise methods according to their own conditions, such as aerobic exercise, muscle strength training, balance and flexibility exercises, etc. These exercises can not only enhance muscle strength and improve body coordination, but also stimulate bone formation and inhibit bone resorption, thereby effectively preventing the occurrence of osteoporotic vertebral compression fractures.