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American Journal of Physical Medicine & Rehabilitation:
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Thoracic Osteoporotic Fracture Without Upper Back Pain

Huntoon, Elizabeth MD; Sinaki, Mehrsheed MD, MS

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From the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.

This is a case study of a 66-yr-old woman with osteoporosis and thoracic kyphosis who had been receiving alendronate for 8 yrs. Her chief complaint was her stooped posture that was “getting worse.” She had had frequent chiropractic “adjustments” for occasional back pain but was pain-free at the time of her evaluation at our institution. Neurologic examination was within normal limits. Lumbar spine radiographs were negative for vertebral compression fractures. No thoracic spine radiographs had been obtained before her referral to the Rehabilitation of Osteoporosis Program–Exercise (ROPE), despite the location of her thoracic deformity.

Before the patient’s entry into the ROPE program, thoracic spine radiographs were obtained, and these showed a compression fracture of a midthoracic vertebral body and moderately severe thoracic hyperkyphosis (Fig. 1). A proper back exercise program for strengthening the back extensors, postural exercises, and a weighted kypho-orthosis were provided to the patient, along with instructions to avoid straining her spine. Pharmacotherapy including antiresorptive agents and proper intake of calcium and vitamin D were reviewed with the patient.

Figure 1: Left, radi...
Figure 1: Left, radi...
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This case illustrates the need for a thorough evaluation with radiographs before initiation of an exercise program. Despite ongoing pharmacotherapy for osteoporosis and the lack of significant back pain, this patient had a compression fracture that, if left undiagnosed, could have progressed into a more serious condition during the course of her physical therapy or her chiropractic manipulations.

Vertebral compression fractures are common and can be insidious in the osteoporotic population. Although fractures generally are associated with pain, it is important to consider the possibility of vertebral involvement in this population, despite the absence of discomfort, particularly when there is obvious progression of kyphotic deformity. Patients with previous vertebral fractures are at risk for further vertebral fractures. They also have an increased risk of falls and mortality. Exercise is an integral part of the management of patients with osteoporosis and has been associated with improved physical ability, bone mineral density, and decreased pain.

Elizabeth Huntoon, MD

Mehrsheed Sinaki, MD, MS

From the Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.

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SUGGESTED READING

Sinaki M: Prevention and treatment of osteoporosis, in Braddom RL (ed): Physical Medicine and Rehabilitation, ed 2. Philadelphia, W.B. Saunders, 2000, pp 894–912

Sinaki M, Itoi E, Wahner HW, et al: Stronger back muscles reduce the incidence of vertebral fractures: A prospective 10 year follow-up of postmenopausal women. Bone 2002;30: 836–41

Bonner FJ, Sinaki M, Grabois M, et al: Health professional’s guide to rehabilitation of the patient with osteoporosis. Osteoporos Int 2003;14(suppl 2):S1–22

Sinaki M: Critical appraisal of physical rehabilitation measures after osteoporosis vertebral fracture. Osteoporos Int 2003;14:773–9

Cited By:

This article has been cited 3 time(s).

Pm&R
Exercise for Patients With Osteoporosis: Management of Vertebral Compression Fractures and Trunk Strengthening for Fall Prevention
Sinaki, M
Pm&R, 4(): 882-888.
10.1016/j.pmrj.2012.10.008
CrossRef
Rheumatology
Lateral back pain identifies prevalent vertebral fractures in post-menopausal women: cross-sectional analysis of a primary care-based cohort
Clark, EM; Hutchinson, AP; McCloskey, EV; Stone, MD; Martin, JC; Bhalla, AK; Tobias, JH
Rheumatology, 49(3): 505-512.
10.1093/rheumatology/kep414
CrossRef
American Journal of Physical Medicine & Rehabilitation
Spinal Cord Injury Associated with Thoracic Osteoporotic Fracture
Demir, SÖ; Akn, C; Aras, M; Köseoglu, F
American Journal of Physical Medicine & Rehabilitation, 86(3): 242-246.
10.1097/PHM.0b013e31802ef5a0
PDF (334) | CrossRef
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© 2004 Lippincott Williams & Wilkins, Inc.

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