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Clinical osteoporosis treatment The first vertebral fracture changes everything

Issue 01/2017

Once a vertebral fracture occurs, the risk of other fractures occurring increases substantially. Neurosurgeon Dr Torsten Roediger would like to address this problem at an early stage – and orthoses are a component of his approach here.

Neurosurgeon Dr. Torsten Roediger believes multimodal osteoporosis treatments should be used at the earliest possible stage.
Neurosurgeon Dr. Torsten Roediger believes multimodal osteoporosis treatments should be used at the earliest possible stage.

Dr. Roediger recently had to once again explain to a patient that surgery made no sense in her particular case. The patient in question had already suffered numerous compression fractures. “That was really a big blow for her,” says Roediger. Nevertheless, surgery is not always the best option for helping patients with osteoporosis – in terms of a risk-benefit calculation as well. For example, the very poor bone quality of patients in advanced stages of osteoporosis can lead to subsequent breaks or material weaknesses after surgery, and these might make it necessary for the attendant physician to perform additional and even more extensive operations. For this reason, a great deal of thought must go into the treatment approach for each patient , particularly with regard to whether surgery should also be considered as an option. Roediger, who works at the Clinic for Orthopedics and Trauma Surgery at St. Joseph’s Hospital in the Tempelhof district of Berlin, occasionally has to deal with an orthopedic surgeon’s worst nightmare: “Bones as soft as butter – I can sometimes penetrate a highly osteoporotic bone without much effort using a normal surgical penetration needle. I would need a hammer to do that with a healthy bone.”

Surgery and multimodal treatment

One thing is needed more than anything else if vertebral fractures are to be properly treated and permanently healed: a solid bone foundation. Surgical procedures such as filling vertebral fractures with cement (vertebroplasty/kyphoplasty), or stabilizing affected areas with a screw-rod system, have to be based on specific concepts that will be effective over the long term as well.
“When you look at post-surgical x-rays, you often see a good result ,” says Roediger. “The question is: How long will it last?” One thing is therefore clear for Roediger: “Multimodal osteoporosis treatment should be started as soon as possible.” Medication for strengthening bones and thus preventing further fractures is the key here. Indeed, as Roediger points out: “By the time patients come to us, it’s often too late.”

Flexible orthosis for a complex system in motion

Once a vertebral fracture occurs, the risk of other fractures occurring becomes extremely high. Orthoses can play a major protective role in such situations, according to Roediger. “External stabilization is a very reliable system,” he explains, adding that straightening and flexible orthoses can be easily integrated into patients’ everyday lives and have also proved their worth in post-surgical settings. “I can effectively use orthoses that allow movement at an early stage after surgery,” Roediger explains. “The spine is a complex moveable organ that can be supported very well with a flexible orthosis in a manner that builds up muscles while at the same time ensuring additional stabilization.

Regaining one’s previous quality of life

Orthoses are used quite often in clinical settings to treat osteoporosis patients who have suffered vertebral fractures. “However, studies on the therapeutic effects of orthoses have also increased their acceptance among physicians in private practice even further,” Roediger points out. Good communication between physicians in private practice and their colleagues in hospitals, as well as continual examinations of bone density in short intervals, are absolutely essential for creating a solid foundation for the prevention of osteoporosis and thus fractures as well. “We are an ageing society,” Roediger explains, “but that doesn’t mean that we have to accept age-related diseases.”

Images: Bauerfeind, Anika Büssemeier