Learning Objectives     1. Discuss the recovery process from a vertebral fracture.     2. Define kyphosis and describe the treatment to minimize the curvature.     3. Describe the lifestyle changes that may be necessary following a vertebral fracture.

Osteoporosis is a disease that causes bone to become weak and easily broken. Osteoporotic fractures can result from a fall, the lifting of a heavy object, or a sudden twisting motion. Sometimes an activity that is not considered stressful or dangerous, such as bending over to pick up a newspaper, sneezing, turning a key in a lock, or receiving an affectionate hug, can result in a fractured vertebra, a broken wrist, or a cracked rib.

When Mr. Johnson, 72, broke 2 vertebrae, he had many questions about what to expect. Would there be a cast or a brace put on his back? How long would it be before he could resume gardening and his other hobbies? Mr. Johnson's doctor scheduled a special appointment with Mr. and Mrs. Johnson to answer their questions about what they could expect in the next several months. This is what he and his wife learned:

Mr. Johnson: How long will it take for me to recover from these broken bones?

Dr. Smith: A fractured vertebra can take anywhere from 6 to 8 weeks for the bone to set and up to 12 weeks to heal completely. But recovery from a vertebral fracture goes beyond healing the bone. Recovery becomes an ongoing process to enable you to regain strength and mobility and to resume your daily activities.

Everyone experiences a slightly different recuperation. You may find your posture changing and have some nagging pain. This is because a vertebral fracture results in a deformity of the vertebra itself, which affects the muscles, tendons, ligaments, and nerves near the fractured bone. Fortunately, there are steps you can take to minimize these consequences of vertebral fracture.

Will I need surgery to correct the fracture?

No, surgery is not required with a vertebral fracture.

Will I have to stay in bed the whole time?

Bed rest for the first 2-3 days following a fracture is important. The body has suffered a trauma_a broken bone — and needs time and rest in order to heal. How long you stay in bed depends on how much pain you feel and how long you can be up before your back starts hurting again. In general, we encourage people to be active as soon as pain permits.

During the healing period, you may find that you need help doing things you ordinarily do for yourself, like dressing, bathing, getting in and out of bed or chairs. It's okay to ask for help during this time. Just remember, you won't remain in this dependent condition if you give yourself time to heal and take the proper steps toward recovery.

While it's important to rest after you've had a vertebral fracture, it is also important to get up and around as soon as you can. Bones and muscles respond well to movement and activity and, in the long run, you'll improve more quickly if you are able to slowly ease back into your usual routine. If you have access to a pool, walking in the water is a great way to maintain and use your muscles without putting stress on the bone that is healing.

What medications will I be taking now?

You will be given pain medication and a different medication to prevent further bone loss so you'll be less likely to fracture again. For pain control, we'll start you on simple, over-the-counter analgesics. We'll also use heating pads, ice packs, and gentle massage to alleviate the pain. If the pain does not subside with these methods, you may be given prescription pain-killers. The duration and intensity of pain is different for every person and often depends on how many vertebral fractures one has had.

To prevent further bone loss, you may be given calcitonin, which is a medication used for the treatment of osteoporosis in women and men. It is administered by injection or as a nasal spray. Women have other options: they can take estrogen and/or Fosamax, a drug that was recently approved by the Food and Drug Administration for the treatment of postmenopausal osteoporosis.

You should take 1,500 mg per day of calcium and at least 400 IU of vitamin D each day.

Will osteoporosis cause my back to curve over? I would like to avoid developing stooped posture if I can.

The back curvature you refer to is called kyphosis. Kyphosis is the result of physical changes in the spine and adjacent muscles, tendons, and ligaments that occur after vertebral fractures. The degree of kyphosis varies with the number of fractures and muscle strength. To minimize the curvature, you will need to learn flexibility and strengthening exercises for your back and torso. I know a rehabilitation clinic with specialties in physical medicine and rehabilitation who can work with you on these exercises. You probably won't start the therapeutic exercise for about two to four weeks after the fracture, depending on how you're feeling. You'll start out slowly at first; the therapy can be painful, but in the long run you will have the benefits of a stronger back, increased flexibility, and straighter posture.

Should I wear a back brace?

A back brace or support may be beneficial during the healing period for several reasons: 1) it helps the patient avoid strenuous bending; 2) it provides some pain relief by supporting the spine; and 3) it helps reduce the degree of kyphosis. If a brace is used too much or for too long a time, the back muscles will weaken, which is actually worse for spinal osteoporosis because strong muscles help support the spine. Physical therapy, in the
form of exercises to strengthen the back and torso, can be performed even while the individual is wearing the brace.

There are several different types of braces to choose from. If you find that your pain persists or if your posture starts to stoop drastically, we can fit you with the appropriate brace.

Another type of support you might find useful is a cane or walker. While you are recovering from the fracture, you may be a little unsteady on your feet and a cane or walker will give you better balance. Also, these devices take weight off of your spine, which can ease some of the pain you feel in the first few weeks.

Will I have to buy a special mattress to protect my back?

A very firm mattress is best for people with spinal osteoporosis. For comfort, you can cover it with synthetic sheepskin or an egg crate mattress pad. If you have a very soft mattress, you may have to buy a new one. But before you do that, try putting a piece of plywood on top of the box spring beneath the mattress. This may provide the support your spine needs.

What kinds of changes will I have to make in my life? My wife and I have plans to do some traveling.

You will be able to resume nearly all of your normal activities with minimal change to your routine. You can still travel and garden. In fact, being active is beneficial to your health.

The changes you do have to make involve the way you move and the safety of your environment. For example, no more bending from the waist to pick something up. You'll have to learn to bend your knees. Activities that require a twisting motion of the torso, such as golf, put a heavy strain on the spine and should be avoided. And no lifting of anything heavier than a light bag of groceries, depending on the severity of the osteoporosis.

You should fall-proof your home to minimize the chances of tripping and falling. Be careful when taking medications that might make you dizzy, and be aware of the effects of alcohol on your balance.

I'm usually not the kind of person to talk about my troubles, but this osteoporosis is pretty serious and I'm worried about it. Is there a group of people I could get together with to discuss some of these changes?

Attending a support group is a great way to share information and discuss feelings as you learn to cope with these changes. The nurse can give you the name and phone number of the osteoporosis support group leader in the area. Many of my patients and their family members attend meetings regularly. Quite often a speaker comes to the meetings to present information on different aspects of osteoporosis prevention and treatment. I have spoken at a couple of the meetings myself.

Source: National Osteoporosis Foundation

Reprinted with permission