Is Your Doctor Screening for Silent Fractures?
If you've read about osteoporosis, you've undoubtedly heard of vertebral fractures and how two-thirds of 700,000 spinal fractures annually go undiagnosed (Kyphon International, 2008). This figure represents more than the total of hip and wrist fractures combined. Why is this number so high? Are we forgetting some diagnostic testing, along with a DXA, that would identify a fracture?
Some DXA's incorporate a vertebral fracture assessment test (VFA) which measures the height of each vertebra in your spine to detect abnormal shape and fractures; but some insurance companies don't pay for this additional test, and some DXA's don't include this technology, so many of us are not routinely checked for spinal fractures. If your DXA doesn't include the VFA, you could ask for spinal X-rays instead.
The International Society of Clinical Densitometry on vertebral fracture assessment tests.
Why are they called silent fractures?
Generally compression fractures occur when the vertebral body compresses during an injury. When external force is applied to the spine, like carry a heavy object, the vertebra may collapse under the weight of the action because it no longer has the strength to handle the external load. These types of fractures can cause intense pain or little to no pain. The lack of pain and symptoms, with many spinal fractures, explains the name silent fracture. Since many of us have existing back pain caused by arthritis or degenerative disc, we deal with back pain on a daily basis anyway. Due to this pain, would you know if you sustained a fracture? If you have new pain, would you attribute it to the worsening of your existing problem and pass it off as a normal side effects from a condition in your spine, or think that it's something new, like a fracture? Don't let your current spinal problems mask new injuries; screen yourself for spinal fractures just like you do for other health related problems, like cancer and heart disease.
Are all fractures silent?
Not all fractures are silent. Some fractures causes pain if you have the type where the bone is protruding into the spinal canal or is pressing on a nerve causing nerve pain. You may also have a fracture that causes little to no pain, which is the silent type. These fractures can go undiagnosed, and are usually found on routine X-rays done long after the fracture occurred. Because these types of fractures can cause loss of height and a dowager's hump, we need to be more aware of our spinal health. You can monitor your spine by having the VFA with your DXA, or have your Doctor order spinal X-rays.
Types of fractures:
Compression fractures are common with osteoporosis. When the weakened bone can no longer handle sudden force, it may compress or break. If the vertebral body is compressed, from a fracture, you'll see a reduction in vertebral height. Compression fractures may occur from something as simple as a cough or sneeze, if your bone density is considered low.
A wedge fracture is a type of compression fracture where the vertebra collapses in one area of the vertebra causing the bone to look like a wedge. The wedge type of fracture is serious if there is a 50 percent wedging, causing a forward spinal curve, or there is neurological involvement.
There are other types of fractures, but usually they occurred from impact injury and therefore wouldn't fall into the silent or fragility fracture category.
To combat this problem of undiagnosed fractures get a VFA with your DXA; if your DXA doesn't have the VFA technology, then ask your Doctor to order spinal X-rays with your DXA. If we routinely screen for fractures, use VFA's or X-rays, maybe we could lower the two-thirds percentage of spinal fractures that go undiagnosed.
If these fractures cause a forward spinal curve, height loss or impaired daily living, it's important to have them treated. Identifying and treating these fractures greatly increases the patients' ability to complete normal daily living tasks, plus it improves the patients' quality of life.
Next time we'll discuss the options of repair for these types of fractures, and how important it is to seek help early.