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Spine frracture pada

osteoporosis
Tutuko radite p n
Pembimbing dr nidaul khasanah sp
Rad

Vignette
• A 72-year-old woman presents with a 2-month history
of increasing pain in her lower back, which has not
improved with ibuprofen and is causing difficulty with
walking and dressing. She reports having lost about 5
cm (2 in.) of height since she was a young woman. On
examination, there is mild kyphosis in her lower
thoracic spine but no point tenderness. A lateral spine
radiograph reveals that the L2 vertebra is biconcave in
appearance, a finding that is consistent with a
vertebral fracture (Fig. 1).
• How should this case be managed?

Normal Height T12 Normal Height L1 * Loss of Height L2 L3 •A poorly defined dense (white) fracture line is visible with a detached fracture fragment (asterisk) •L2 has lost height anteriorly and there is disruption of the anterior column only .

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Atkinson EJ. thoracolumbar transition zone or mid thoracic region 4. . The worldwide problem of osteoporosis: insights afforded by epidemiology. Identically with backpain 3. J Bone Miner Res 1992. Bone 1995. Less to clinically diagnosed 1. Incidence of clinically diagnosed vertebral fractures: a populationbased study in Rochester. Riggs BL. 1985-1989. Melton LJ III. O’Fallon WM.Verterbrae Fracture 1.17: Suppl:505S-511S. 2. Cooper C. The most place are. Melton LJ III. 2. deformities of the vertebral bodies identified with imaging of the lateral spine and characterized according to shape — are the most common manifestation of osteoporosis. Minnesota.7:221-7.

7:449-56. Milavetz DL. Contribution of vertebral deformities to chronic back pain and disability. Fink HA. . Palermo L. J BoneMiner Res 1992. Black DM. Nevitt MC. et al. Ettinger B. 4.Goals likelihood of back pain: • Increase the quality of life • clinical diagnosis increase with the severity and number of fractures • Prevent Fracture-related disability may also be greater among patients with lumbar fractures than among those with thoracic fractures 3.20:1216-22. et al. What proportion of incident radiographic vertebral deformities is clinically diagnosed and vice versa? J Bone Miner Res 2005.

.Evaluation • A woman’s first vertebral fracture usually occurs well past menopause. or dowager’s hump). especially among patients with multiple anterior wedge fractures of the thoracic spine. • Physical examination may reveal excess sagittal convexity of the thoracic spine (hyperkyphosis.

with the prevalence among white women rising from 5% to 10% between the ages of 50 and 59 years and to 30% or more at 80 years of age or older. .Prevalention The prevalence and incidence of radiographic vertebral fractures increase with age.

history of one or more falls 3. current smoking. low body-mass index.clinical risk factors for incident vertebral fractures : 1. certain chronic medical conditions 7. use of systemic glucocorticoids 6. . Inactivity 4. Prior fracture 2. 5.

Bone mineral density • Measured by x ray absorbtiometry (DEXA) • > 1-3rd of postmenopausal women with prevalent radiographic vertebral fractures have T scores (spine and hip) > −2.5 • The prevalence of radiographic vertebral fractures among women 60 years of age or older with low bone mass has been reported to range from 14 to 18% .

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• Lateral thoracic and lumbar spinal radiographs continue to be the standard for assessment .Diagnosis • medical history and an examination may confirmed with a spinal imaging study.

uncertain regarding fracture. or posterior vertical dimension to grade a vertebral body as normal. or characterized by a mild. moderate. or severe fracture . middle.Genant et al • The method uses the qualitative features of vertebral shape and degree of reduction in vertebral height in the anterior.

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Treatment • • • • • Pain management Rehabilitation Vertebroplasty and Kyphoplasty Calcium and Vitamin D Pharmacotherapy .

Treatment • • • • • Pain management Rehabilitation Vertebroplasty and Kyphoplasty Calcium and Vitamin D Pharmacotherapy .

Treatment • • • • • Pain management Rehabilitation Vertebroplasty and Kyphoplasty Calcium and Vitamin D Pharmacotherapy .

Treatment • • • • • Pain management Rehabilitation Vertebroplasty and Kyphoplasty Calcium and Vitamin D Pharmacotherapy .