Osteoporosis: relieving the pain of spinal fractures
This research was completed on 30 April 2009
Published on 31 January 2007
Vast numbers of people are suffering fractures because of osteoporosis. A revolutionary new treatment, called vertebroplasty, provides immediate pain relief in 80-95 per cent of people who have fractured their spine1,2 but it may put them at risk of further fracture. Researchers are trying to work out why, so we can make vertebroplasty more successful.
What's the problem and who does it affect?
The misery of vertebral fractures
Recent statistics suggest that osteoporosis causes 120,000 vertebral fractures each year in the UK.3 Many people who sustain such a fracture go on to suffer long-term pain, disability and deformity, which can continue for the rest of their lives. Consequently, the total number of people affected at any one time is substantial and is likely to become greater as life expectancy continues to increase.
People often suffer fracture after fracture, causing the so-called ‘dowager’s hump’ seen in many older women and, increasingly, in older men. This can have marked effects on a person’s self-esteem and make it very difficult to get around. The associated reduction in physical activity often serves to further exacerbate the existing osteoporosis. All in all, vertebral fractures can significantly reduce sufferers’ quality of life. Indeed, many people end up losing their independence altogether.
Vertebroplasty is a new treatment, which can bring excellent pain relief, at least in the short-term. A type of bone cement is injected into a fractured vertebra to strengthen it. However, evidence suggests the procedure can increase the risk of fractures elsewhere in the spine, especially in neighbouring vertebrae. We urgently need to find out how to get the most out of this revolutionary new treatment without putting people at increased risk of further fractures.
What is the project trying to achieve?
How does vertebroplasty increase the risk of fracture?
The purpose of this project is to gain a better understanding of how vertebroplasty influences the mechanical function of the spine. Researchers are investigating how the procedure affects the forces acting on both fractured vertebrae, which have been strengthened with injected cement, and neighbouring, unstrengthened vertebrae.
The team is using sections of human spines along with specially designed equipment which simulates the stresses and strains of everyday movements, and monitors the response of the vertebrae. The team is assessing the importance of several factors that they suspect might influence the risk of someone suffering a further fracture after undergoing vertebroplasty. These factors include the placement and type of cement injected, the patients’ age and gender, the severity of the fracture that’s being treated, the degree of pre-existing osteoporosis and any degeneration in the discs in the spine.
What are the researchers' credentials?
|Project Leader||Dr P Dolan PhD|
|Location||Department of Anatomy, University of Bristol and Department of Neuroradiology, Queen's Medical Centre Nottingham|
|Grant awarded||31 October 2006|
|Start date||1 May 2007|
|End date||30 April 2009|
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The project team is at the forefront of spinal research in the UK. Dr Patricia Dolan and Dr Michael Adams are leading experts in spinal mechanics; Dr Deborah Annesley-Williams is one of only a small number of clinicians in the UK with expertise in performing vertebroplasty in patients. The grant-holders have been collaborating for more than three years on studies into the mechanical effects of vertebroplasty and this has resulted in several papers – one received an award from the British Orthopaedic Research Society.
The researchers’ laboratory is one of only two in the UK to develop and use a procedure called stress profilometry, which enables direct assessment of the loads acting on spinal tissues. The team has access to human vertebral tissue which negates the need to use animals in the research and increases the clinical applicability of the results.
Who stands to benefit from this research and how?
Getting the most out of vertebroplasty
Researchers hope their work will help patients get the benefits of vertebroplasty without being put at increased risk of suffering further fractures. Their work will provide key information to the clinicians who perform this exciting procedure. It will help them to select which patients are most likely to benefit. It will also provide them with information regarding the most appropriate cement to use and how to position it within the treated vertebrae.
Pain relief without increased risk of further fracture
Vertebroplasty has the potential to improve the lives of huge numbers of people. Around 3 million people in the UK are believed to suffer from osteoporosis4 and the numbers are rising. The risk of sustaining a vertebral fracture increases approximately ten-fold between 50-75 years of age3,5 and in many cases such fractures go undiagnosed and untreated.6 It’s thought that 80-95 per cent of people who undergo vertebroplasty receive immediate pain relief.1,2 If vertebroplasty can help our older population to maintain an independent lifestyle without increasing the risk of future fracture, the costs of care for such people in the longer term may be greatly reduced.
1. Diamond TH, Champion B, Clark WA (2003). Management of acute osteoporotic vertebral fractures: a nonrandomized trial comparing percutaneous vertebroplasty with conservative therapy. Am J Med 114: 257-65. 2. Hochmuth K, Proschek D, Schwarz W, Mack M, Kurth AA, Vogl TJ (2006). Percutaneous vertebroplasty in the therapy of osteoporotic vertebral compression fractures: a critical review. Eur Radiol 16: 998-1004. 3. Felsenberg D et al. [EPOS Study Group] (2002). Incidence of vertebral fracture in Europe: results from the European Prospective Osteoporosis Study (EPOS). J Bone Miner Res. 17:716-24. 4. “Health Encyclopaedia: Osteoporosis” NHS Direct website 5. Cummings SR, Melton, LJ (2002). Epidemiology and outcomes of osteoporotic fractures. The Lancet 359: 1761-67. 6. Torgerson DJ, Sykes D, Puffer S, Brown P and Cooper C (2004). Pharmaceutical treatment of symptomatic vertebral fractures in primary care. Ann Rheum Dis 63:853-56.