European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society
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The costs of vertebral fractures are less well defined than the costs of hip fractures. Large studies are urgently needed. ⋯ These new data on the cost of vertebral fractures will have an impact on health economy calculations. In the future it may be be cost-effective only to prevent vertebral fractures.
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Osteoporosis is the most common contributing factor of spinal fractures, which characteristically are not generally known to produce spinal cord compression symptoms. Recently, an increasing number of medical reports have implicated osteoporotic fractures as a cause of serious neurological deficit and painful disabling spinal deformities. This has been corroborated by the present authors as well. ⋯ Surgery is indicated as a primary treatment when neural compression is secondary to pathologic fractures, dislocations, spontaneous epidural hematoma, syringomyelia, platybasia, or sarcomatous transformation. Five classes of drugs are available for the treatment of PD. Bisphosphonates are the most popular antipagetic drug and several forms have been investigated.
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Osteoporotic vertebral compression fractures (VCFs) are associated with a series of clinical consequences leading to increased morbidity and even mortality. Early diagnosis and therapeutic intervention is desirable in order to remobilise patients and prevent further bone loss. ⋯ In cases of acute fractures, kyphoplasty has the potential to reduce kyphosis and restore the normal sagittal alignment of the spine. The complex nature of systemic osteoporosis, coupled with the intricate biomechanics of vertebral fractures, leads to a clinical setting which is ideally treated interdisciplinarily by the rheumatologist and spine surgeon.
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Lumbar spinal stenosis is a common condition in elderly patients and also one of the most common reasons to perform spinal surgery at an advanced age. Disc degeneration, facet degeneration and hypertrophy, and ligamentum flavum hypertrophy and calcification usually participate in the genesis of a stenotic condition in the elderly. These changes can lead to symptoms by themselves or decompensate a preexisting narrow canal. ⋯ Various conditions can lead to a narrowing of the neural pathways and differential diagnosis with vascular troubles, also common in the elderly, can be challenging. The investigation of stenotic symptoms should be extremely careful and thorough and include a choice of technical examinations including vascular investigations. This is of utmost importance, especially if a surgical sanction is considered to avoid disappointing results.
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Recent advances in both the pharmacological and surgical treatment of osteoporosis and vertebral compression fractures offer exciting new options for elderly patients. However, these treatments should be considered only with an indepth knowledge of osteoporosis as a metabolic disorder with complex effects on bone, its homeostatic regulation, and vertebral strength. ⋯ The strength of a vertebra is directly influenced by the amount and relative proportions of its components, with bone mineral density a useful measure of fracture risk. The purpose of this article is to discuss these issues, among others, in order to offer the reader a better understanding of the pathophysiology of osteoporosis and the determinants of bone strength as they relate to the aging skeleton.