Health

Breaking a bone is often painful and frightening. Recovery can take months, and a break can threaten your ability to perform simple everyday tasks such as carrying groceries, making your own meals, or cleaning. But there is a lot you can do to recover from a fracture and prevent future breaks. The first step may be as simple as reaching out for help. Physical therapists, occupational therapists, and support groups can assist you.

Getting enough calcium and vitamin D, performing weight-bearing exercises regularly, taking steps to prevent falling, and using an osteoporosis medication can help guard your bones. Here is more information on how to mend your bones.

Living with vertebral fractures

Spinal fractures, which often take two to four months to heal, can be very painful. The most common way to treat pain is with over-the-counter medications such as acetaminophen (Tylenol), aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn). Sometimes doctors prescribe stronger medications for pain, such as short-term narcotics. But be careful, as these medications may cause drowsiness, confusion, and a drop in blood pressure — which can increase your chances of falling.

Another staple of treatment is short-term bed rest. Your doctor may also recommend that you use ice or heat packs to ease pain. Massage, acupuncture, biofeedback, and the use of a lumbar corset or back brace may also help.

Two techniques — vertebroplasty and kyphoplasty — that use medical cement to support compressed vertebrae and alleviate pain have generated interest. But they are not widely performed (see "Two procedures for vertebral fractures").

Two procedures for vertebral fractures There is growing interest in two procedures to stabilize compressed vertebrae and alleviate the pain associated with this type of fracture. Vertebroplasty and kyphoplasty are geared toward patients who haven't responded to traditional measures such as bed rest and pain medications. However, these techniques are still not commonly performed in the United States, and there is some concern about side effects. Vertebroplasty, developed in France in the 1980s, is done on an outpatient basis and takes less than an hour. After the patient is given mild sedation, the physician inserts a needle into the affected vertebra, using an x-ray as a guide. Then bone cement, called methylmethacrylate, is injected into the compressed vertebra, filling the holes and crevices. The cement hardens in about 15–20 minutes, stabilizing the vertebra, creating a support that helps prevent any further collapse, and alleviating pain. While side effects are uncommon, complications can include infection, bleeding, and compression of adjacent nerve tissue. Some small studies have been done on vertebroplasty, and the results indicate that in most patients the procedure significantly reduces pain and helps prevent another collapse. Even newer on the scene is kyphoplasty (see illustration), a refinement of vertebroplasty. Like vertebroplasty, this procedure is aimed at stabilizing compressed vertebrae and relieving pain. But it also restores the height of the vertebra and reduces deformity in the spine. Kyphoplasty was developed to address the weaknesses of vertebroplasty, including the risk for cement leakage and the procedure's inability to restore the height loss caused by compression fractures. Like vertebroplasty, kyphoplasty takes less than an hour, although the patient may need to remain in the hospital overnight. In this procedure, after the patient receives mild sedation, a physician inserts a small tubelike instrument into the affected vertebra, using a special viewing device called a fluoroscope as a guide. Once the instrument is correctly placed, a balloon is inflated, creating a cavity in the bone. The balloon is then deflated, and the physician injects surgical cement into the void. The creation of this hollow minimizes the risk of the cement leaking and pushes the vertebral endplates apart, restoring some height. While data on kyphoplasty are limited, in one study it provided significant pain relief in more than 95% of patients. Generally, complications are uncommon, but if the bone cement leaks into the bloodstream or spinal canal, serious problems can occur. In 2002, the FDA warned that soft tissue damage, nerve root pain and compression, pulmonary embolism, and respiratory and cardiac failure have been reported among some patients undergoing these procedures. According to the FDA, not enough information is available to assess the safety and effectiveness of the different bone cements used or the overall risks and benefits of these procedures. If you are considering these procedures, it's wise to keep in mind that more research is needed to clarify their benefits and potential side effects. Technique to relieve pain Technique to relieve pain Kyphoplasty is one of the most recent advances in treating the pain associated with vertebral compressions. This technique also restores the height of the treated vertebra. First, a tube is inserted into the vertebra (A). Then a balloon at the end is inflated and deflated, leaving a hollow in the bone (B). Finally, surgical cement is injected into the cavity, shoring up the vertebral endplates. This procedure is not being done extensively, and more research on it is needed.

You may want to enlist your physical therapist's help in selecting a walking aid if you need one. He or she can assess your needs and help you choose the type of cane or walker that best suits your purpose.

Simple changes can pay off

An exercise program should be on your agenda, too. Your routine should include weight-bearing exercise, which can build bone, and balance and flexibility exercises, which can make future falls less likely (see "The importance of exercise").

You may also find that you need to make a few practical changes around your house that will make it easier for you to maintain your self-sufficiency. An occupational therapist can give you expert advice. For example, if you can't reach the top shelves of cabinets any longer, he or she can suggest a number of solutions, from tools to help you reach or grasp objects to ways of reorganizing your kitchen.

Clothing may also become a concern as your body changes. If you have had several vertebral fractures, you may notice that your ribcage has moved closer to your hipbones. With this shift in your body, your clothes may not fit properly anymore. Many women find that their garments don't fit at the waist, but a large size is too baggy in other places. Some women solve this problem by buying maternity clothes. The elastic panels in slacks and skirts are roomy in the front without giving too much in the back, and the loose-fitting tops are well suited for accommodating spinal changes.

Low-heeled, comfortable shoes that offer adequate support are also essential. There are many styles of "walking shoes" that fill the bill. If you have difficulty finding shoes that fit properly, you may want to have orthotic devices — supportive insoles that affect the distribution of weight — fitted by a podiatrist or orthopedic surgeon.

Living with a hip fracture

After a hip fracture, proper rehabilitation can spell the difference between returning to active life and requiring long-term care. Physical and occupational therapists can be very helpful.

Physical therapists can teach you exercises to strengthen your hips, improve your coordination and balance, and increase your flexibility. An exercise routine should get you up and moving again and help condition your body to reduce the risk of falling.

You should also schedule a home visit with an occupational therapist to eliminate potential hazards in your home — such as electrical cords and loose rugs in pathways, poor lighting, or a lack of handrails or grab bars. Also, talk to your doctor about other factors that can lead to falls, such as alcohol consumption or the use of certain medications. Simple measures you can take on your own, such as wearing hip pads, may spare your bones if you fall.

Support groups

Osteoporosis doesn't affect only your bones. It can leave you feeling depressed, anxious, or afraid. You may worry about breaking a bone or losing your independence. Or perhaps you're overwhelmed by pain or upset by changes in your appearance.

A support group may help you cope with these feelings and move ahead with your recovery. Talk to your doctor about finding a program, or check with your insurer, local hospital, or the National Osteoporosis Foundation (see "Resources").

Source: from Harvard Health Publications, Copyright © 2008 Harvard University. All rights reserved. Harvard Medical School does not endorse products.
Used with permission of StayWell.
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