Osteoporotic vertebral fractures

Due to a demographic increase in patients with osteoporosis the epidemiology of vertebral fractures changes. Osteoporosis is characterized by low bone density, microarchitectural deterioration of bone tissue and impaired bone strength, which leads to an increased bone fragility and susceptibility to fracture. Asymptomatic vertebral deformity was found to be associated with subsequent risk of symptomatic fractures, particularly vertebral fracture, and increased risk of mortality after a fracture. After the first osteoporotic fracture at any site the risk for further fractures increases dramatically. Osteoporosis represents, besides the origin of such vertebral fractures and impaired bone healing, a problem in osteofixation and implant stability in fracture treatment in orthopedic surgery. Two new treatment strategies of percutaneous vertebroand kyphoplasty have gained worldwide attention in the treatment of osteoporotic vertebral fracture and short-term observational studies and case-control studies indicate that the results are favorable, regarding both pain relief and functional status. Actually, it cannot be decided whether the internal application of bone cement to the vertebral body is effective in the long run. Special attention has to be given to the underlying osteoporosis in order to reduce the incidence of further fractures in the patients at risk. Diagnosis and treatment of osteoporosis have to be part of the treatment concept of osteoporotic vertebral fractures. Thus, it is important that orthopedic surgeons identify, assess and treat patients with fragility fractures for osteoporosis according to the currently available treatment protocols. © Urban & Vogel.