Physiotherapy Management of Osteoporotic Fractures

Compression fractures of the spinal column are increasingly common clinical presentations with the increase in the elderly age groups as the population ages. Compression fractures may result in hospital admissions and can be extremely costly in personal and economic terms. Suffering an osteoporotic fracture is often non-symptomatic but some suffer very significant pain which can cause a degree of disability and functional loss. Patients can be treated with painkillers, restrictions of activity, physiotherapy and in some cases bracing. The new procedure of vertebroplasty is a minimally invasive technique which has good results if conservative treatment is not helpful.

In spinal compression fractures the front part of the vertebral body collapses down in response to direct loading or loading when flexed forward and once this has occurred in more than one vertebra a thoracic kyphotic curve can result with loss of height. Once an area has suffered fractures this converts the area into a region which is more likely to suffer further fractures as the forces through the spine are moved forwards by the developing deformity. There are consequences in terms of quality of life and an increase in mortality compared to women the same age without osteoporosis.

Compression fractures of the spinal column occur more frequently in women after menopause with men affected to the same degree about a decade later and at about thirty percent of the rate of change shown in women. If a persons suffers over a couple of inches weight loss, even if they do not complain of pain symptoms, they should be investigated for reduced bone density and vertebral compression fracture. Onset of pain is typically sudden during a non-vigorous activity such as bending forwards or reaching and a fall may have been suffered in the recent past. Pain is worse in standing or flexing and better lying down and resting.

Physiotherapy management of osteoporotic spinal fractures includes a structured individual exercise programme to increase the strength of the spinal musculature, particularly the muscles which help resist spinal flexion against gravity. This involves training the back extensor muscles and the physio will get the patient up from resting as soon as pain allows to minimise the chances of complications occurring due to being immobile. Weight bearing exercises are taught as this stimulates bone maintenance and growth and physiotherapists often teach Pilates techniques to patients which are controlled and challenging. Long term maintenance of an appropriate exercise regime is essential.