Business Matters Fall 2018 - Page 17

One such condition that is particularly pernicious is fragility fractures. Most people are of the understanding that spinal fractures are the result of high-energy injuries. For instance, the types of injuries sustained in motor vehicle collisions, or from traumatic falls from buildings, or perhaps a rough landing during a sky dive, or from collisions sustained during sports like football, rugby or roller Derby, or wiping out while racing down a ski slope on an otherwise perfect Colorado morning. This is all true; however, if the quality of bone becomes compromised--weaker, osteoporotic-- with its capacity to be resilient under even lighter loads and forces no longer possible, then the vertebral bodies will fail and fracture even with forces that are associated with routine activities of daily living and not with trauma. Fragility fractures commonly occur in older osteoporotic individuals doing those things they enjoy the most, such as gardening, performing household chores, or simply attending to their own custodial needs. The first problem is actually recognizing that you, your loved ones or friends may be experiencing pain from such a fragility fracture. Many individuals who have such pain in the upper or lower back recollect that they have had similar pain in the past and assume that it is related to a soft tissue muscle strain or an exacerbation of some underlying spinal degenerative disease or arthritis. Indeed, those would be considered statistically the most common reason for an older individual to experience short time fluctuations and/or exacerbations of minor, temporary axial (midline) spinal pain. The red flag is when the pain is atypical--more severe, more debilitating, persistent, and not improving. At this point, it is typically best for such an individual to visit with their primary care physician or healthcare provider for an evaluation which of course would include a physical examination and when there is a high index of suspicion, x-rays of either the thoracic or lumbar spine. Unfortunately, many individuals are turned away by their health care professionals and misdiagnosed with soft tissue sprains/strains or underlying lumbago with dorsalgia as exacerbations of degenerative disease. Under these circumstances, individuals are typically prescribed analgesics and hope that the pain will subside, as it normally should, without additional medical intervention. In some patients with very nominal fractures who are under-diagnosed, this is exactly the case––a missed diagnosis that nevertheless results and no long-term harm to the patient. On the other hand, these fragility fractures have the propensity to continue to collapse in spite of a person’s normal physiologic mechanisms to attempt to heal the fracture. This is exactly the case with osteoporosis, wherein, the bone still has the capacity to heal, but it is so weak that the patient's weight and normal forces of loading with activities of daily living result in the bone continuing to fail and collapse with continued persistent and frequently incapacitating pain.