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OREO COOKIE FRACTURES

OREO COOKIE FRACTURES

 

Osteoporosis is a common malady to see in the clinic. Most patients diagnosed with the bone weakening disease don’t know much about the disease. I would think that if a patient was diagnosed with cancer, then they would want to know how to beat it…I don’t tend to get that same sense of urgency from my patients initially. Like the old commercial…”the more you know…” and the patients seem to want to know everything once they hear the basics.

 

  1. “Osteoporetic fractures, including vertebral compression fractures are associated with significant mortality, morbidity, and low quality of life”

 

Osteoporosis is the gradual demineralization of bone, typically seen in elderly women. Fractures due to this condition are called osteoporetic fractures. The most common areas of fracture are thoracic spine, hip and wrist. When the bones are so weak, they start to crumble due to the weight that they have to hold.

 

Think of a compression fracture as an Oreo cookie. The cream filling is the disc and the cookie is the bone of the spine, known as vertebra. If you squeeze the cookie together just to the outside of the filling (because we all know that the little circular filling is never the same size as the cookie) the cookie breaks. This is the same type of predicament that happens to patients with osteoporosis. Their cookie breaks. Mmmm…cookie.

 

  1. “…physical therapy-related treatment that emphasize exercises to reduce fall risk, back strengthening exercises, and proprioceptive postural training”

 

If your bones are weak and you fall, to cite Robbie O’Shea, “bummer for you”. You are looking for a fracture and the ground will help you find it. Weak bones don’t like to be jostled. If we can prevent a fall, we can at least prevent a fracture caused by a fall.

 

Why do we want to give back strengthening exercises? Think hunchback of Notre Dame. That’s what many patients with osteoporosis look like over time. The thoracic spine develops so many fractures that the patient is now looking at the floor for money all day long. The spine loses it’s “normal” curve and now the patient is unable to look at the stars or reach into high cabinets. No good.

 

  1. “Up to 67% of OVCF’s (osteoporetic vertebral compression fractures) are asymptomatic and the associative pain pattern in patients with symptomatic conditions is often inconsistent”

 

In a previous post, I noted that problem with imaging. The image can only tell you what the abnormal issue is, but can not tell you what is causing your pain. I had a patient once that had multiple compression fractures…some old and some new…but prior to this new fracture had never experienced pain. Not all fractures cause pain. This is an interesting concept to me because if something is so far off that it breaks, I expect pain to be present. This is another case in which what we believe to be true…isn’t.

 

  1. “Clinical findings or clusters of findings may improve the manual physical therapist’s ability to indentify OVCF before treatment and when imaging is unavailable”

 

In therapy, we want to know when it is safe for us to treat you. If you have a history of osteoporosis, we are traditionally taught to stay hands-off of the patient. We run a risk of actually causing additional fractures. Of course, there is evidence to counter this, but traditionally speaking we are taught to treat you like you have the plague. If we can predict which patients may have osteoporosis, we can make a more informed decision as to whether we should touch you.

 

  1. “The most diagnostic combination included a cluster of: (1) age > 52 years; (2) no presence of leg pain; (3) body mass index </= 22; (4) does not exercise regularly; (5) female gender…a finding of two of the five positive tests demonstrated the lowest LR-, providing value to rule out an osteoporosis compression fracture or wedge deformity. A combination of four of five tests yielded a LR+ of 9.6…Five of five was always associated with a fracture.”

 

If the patient does not meet at least 2 of the 5 scenarios, then the patient likely (Likelihood Ratio negative) does not have a compression fracture. If the patient has 4 of 5 of the scenarios, then the odds of the patient having a compression fracture increase from 2.4% to 20%. This number is still small, but applying the above scenarios allows the therapist or patient to have a better idea of the chances of a vertebral fracture.

 

EXCERPTS TAKEN FROM:

 

Roman M, Brown C, Richardson W, et al. The development of a clinical decision making algorithm for detection of osteoporotic vertebral compression fracture or wedge deformity. JMMT.2010;18(1):44-49.

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