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    Old 01-31-2007, 10:58 AM   #1
    osteoblast
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    Fracture?

    Since my osteoporosis diagnosis a few months ago, I have started an exercise regime. In addition to my regular walking program, I added stretching and weight lifting. All of this was done with dr's approval and review of weight lifting program by physical therapist. I had not done weight lifting before, so advanced very slowly with very low weights. Approximately 2 weeks ago I developed tightness in my back with pain on certain moves like getting into/out of bed and sitting down and getting up. There was no specific start point of this pain/tightness. No immediate pain when lifting something or anything like that. I stopped all of the exercise program. Started using hot pack on back for several days without much change. I called the physical therapist who recommended use of a cold pack . The cold pack made a big difference. Most pain on getting up and down is gone.

    Because my bone density in the spine is -3.4(I am on forteo), I am concerned about a fracture. Of course, hoping all this was something else like a pulled muscle. I have an appointment to see osteo specialist on Monday. So, I am sure the dr. will do as needed. When I had my initial diagnosis , complete x-rays of spine and hip were performed along with the dexa. No fractures were visible then.


    I am new to all this and very puzzled by fractures with osteo! I see that some people are found to have several compression fractures and had no idea until quite some time later. Is it that compression fractures are not painful? I think it was Desertbloom that said she knew someone who fractured reaching into a drawer-so, I guess they knew when they fractured.

    I would be most interested if people with experience with fractures of the spine could comment on whether fractures are very painful and you know exactly when it happened and how long the pain lasts. Also if anyone has a comment on the phenomena of the unnoticed fracture that is only later discoverd. I probably went on too long with my personal story, but I do think that sharing on this important topic would be of benefit to many board members with osteo.

    Also, the osteo I am seeing at the University of Washington is head of the dept. and their dept. is heavily involved in research. Additionally they were at the forefront of the movement questioning the efficacy and safety of the bisphosphonates. I haven't been to this dr. before but am hoping to find both expertise and concern. I have heard good things. Anyway, I am going
    to ask about treatment after forteo. I'll ask about strontium ranelate as well
    as asking about any other potential breakthrough drugs(denosumab?) in the
    pipeline.

     
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    Old 01-31-2007, 12:07 PM   #2
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    Re: Fracture?

    Hi Osteoblast: It's good you're going to see someone next week, if only to rule *out* a fracture. Has your pain ever gone away completely, or do you still have some?

    I haven't had a vetebral fracture, but have had 6 bone fusions fracture into many pieces. I would imagine the pain is about the same with stabbing pain in the immediate area, and possibly radiating down your leg through the buttocks, if the sciatic nerve is involved.

    Unfortunately two-thirds of all fractures go undiagnosed, which is something that really bothers me. I've had lumbar x-rays done recently, but no others like full spine, or hip. I had the x-ray specifically to check on the rods and screws I have in my back to make sure they are still in place, because I had plates and screws fall out of the bone years earlier, which I'm convinced is from osteo; I also wanted to check for any lumbar fractures, and luckily none were found. The reason these can go undiagnosed, is that so many people have existing back pain anyway that some tend to ignore it or treat with bed rest, ice/heat and don't go to the dr. Another reason they can go undetected is that some of them don't show up on x-rays, and you need to do a cat scan or mri. I meet someone that didn't find out about their fracture until after having all 3 tests, and it didn't show up until they reached the mri. Drs say that it is best to treat a fracture within 6 months, because once the bone heals over it's hard to do the khyphoplasty and vertebrolplasty, but not necessarily impossible. My grandmother had severe kyphosis, and I know she was not aware of any fractures even though her spine was really curved forward, and she lost a lot of height. She is just another example of someone who probably didn't have horrific pain, and just ignored it until it healed over in the bent position. She eventual had a hip fracture and died shortly after that from a stroke.

    I did mention a story about a lady at my drs office who fractured ribs, reaching into a drawer, and of course she knew immediately where the fracture was located.

    I'm having a problem with my neck-moderate pain, unable to move it completely-and this isn't getting any better. I'm seeing my neuro surgeon in 2weeks to check it out, because I also have noticed that my posture is getting worse, and my shoulders are slumping further forward. I'm hoping I don't have a fracture in my neck, because neck fractures are usually the thing that starts kyphosis (curved spine) so I'm a bit worried. My pain is constant, but varies in degrees, so that's why I asked about yours.

    If you are having trouble understanding fractures with osteo you could try thinking about it like this. Have you ever seen wood that has been eaten by termites? If you have, it looks similar to our bone with all the open spaces and holes. Wood that has been eaten like this breaks in two real easily with the slightiest amount of pressure, or it just disentegrates into dust. Maybe this image might help to explain how osteoporotic bone fractures so easily-I hope

    Good luck at the drs and let us know what they find out.

    Last edited by DesertBloom; 01-31-2007 at 12:32 PM.

     
    Old 01-31-2007, 12:33 PM   #3
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    Re: Fracture?

    Quote:
    Originally Posted by DesertBloom View Post
    Hi Osteoblast: It's good you're going to see someone next week, if only to rule *out* a fracture. Has your pain ever gone away completely, or do you still have some?

    I haven't had a vetebral fracture, but have had 6 bone fusions fracture into many pieces. I would imagine the pain is about the same with stabbing pain in the immediate area, and possibly radiating down your leg through the buttocks, if the sciatic nerve is involved.

    Unfortunately two-thirds of all fractures go undiagnosed, which is something that really bothers me. I've had lumbar x-rays done recently, but no others like full spine, or hip. I had the x-ray specifically to check on the rods and screws I have in my back to make sure they are still in place, because I had plates and screws fall out of the bone years earlier, which I'm convinced is from osteo; I also wanted to check for any lumbar fractures, and luckily none were found. The reason these can go undiagnosed, is that so many people have existing back pain anyway that some tend to ignore it or treat with bed rest, ice/heat and don't go to the dr. Another reason they can go undetected is that some of them don't show up on x-rays, and you need to do a cat scan or mri. I meet someone that didn't find out about their fracture until after having all 3 tests, and it didn't show up until they reached the mri. Drs say that it is best to treat a fracture within 6 months, because once the bone heals over it's hard to do the khyphoplasty and vertebrolplasty, but not necessarily impossible. My grandmother had severe kyphosis, and I know she was not aware of any fractures even though her spine was really curved forward, and she lost a lot of height. She is just another example of someone who probably didn't have horrific pain, and just ignored it until it healed over in the bent position. She eventual had a hip fracture and died shortly after that from a stroke.

    I did mention a story about a lady at my drs office who fractured ribs, reaching into a drawer, and of course she knew immediately where the fracture was located.

    I'm having a problem with my neck-moderate pain, unable to move it completely-and this isn't getting any better. I'm seeing my neuro surgeon in 2weeks to check it out, because I also have noticed that my posture is getting worse, and my shoulders are slumping further forward. I'm hoping I don't have a fracture in my neck, because neck fractures are usually the thing that starts kyphosis (curved spine) so I'm a bit worried. My pain is constant, but varies in degrees, so that's why I asked about yours.

    Good luck at the drs and let us know what they find out.

     
    Old 01-31-2007, 12:55 PM   #4
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    Re: Fracture?

    Hi DesertBloom- Sorry to hear about your neck pain. I hope that your appointment with the neuro surgeon goes well. What made you or your doctor decide on an appt. with the neuro surgeon? I ask because I would have thought of returning to my osteo dr. who is also an endo.who is in a bone and joint department.

    My pain has nearly gone away. Maybe one time a day I get up from a chair or getting out of the car and feel a short sharp pain.Then it's over. Also since starting the weight lifting I often have a warmth over my shoulder area but I chalked that up to using muscles that hadn't had much stimulation for a long time.I haven't been subject to much back pain in my life so this is new to me.
    I'm going to check it out ,but wonder how you deal with this in the long run. It seems like you can't go have x-rays everytime your back hurts. And as we get older( now54) seems like there are more aches and pains.This is why I am
    intersted in hearing from those with previous spinal fractures as to whether the pain is severe and just doesn't go away.

    It is unfortunate that 2/3rds of fractures go undiagnosed. It sounds like your theory is that there is pain that people just attribute to general back pain.But, if it continued to really hurt , I would think that people would go to their doctor. This is what I find so puzzling.

    Again, I'll be hoping the best for you when you see your dr. next week.

     
    Old 01-31-2007, 04:41 PM   #5
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    Re: Fracture?

    Hi Osteoblast: I'm seeing a neuro surgeon because he is the one that would diagnose a fracture if I had one. My osteo dr is not a surgeon (mineral metabolism), nor can she treat a fracture so I'm returning to the surgeon who did my last back surgery, on her recommendation. Both drs are at the same University Med Center, so they coordinate my care back and forth between one another, along with several other drs. If I were to ever need kyphoplasty or vertebrolplasty, the neuro would have to diagnose it then order the procedure to be done by their radiologist. This surgeon has warned me over an over again to watch for fractures and to contact him immediately if something should happen, but I'm not the type to go around thinking about this constantly, and because I have constant pain in my back anyway it makes it real difficult to determine if there is a new problem or just my old ones flaring up that I have to live with

    I also have another problem going on with my lower back, which would also require this neuro surgeon as well. I have a small tissue mass growing near my spine, and am hoping it can be removed because it hurts really bad. I had several tests done on it, and they say it's Not cancer, so that's a great relief, but it's killing me in addition to my neck problem and low back problems, making it really hard to sit, stand and walk for very long because those movements, for some reason, pull on that lump and it feels like someone is plunging a butcher knife into the lump. The only reason they even considered cancer with this growth was because my calcium level has been elevated which is a definite symptom of many different cancers, and sarcoidosis (sp) among other thinds. This lump is sitting right on my sciatic nerve and if it could be removed a neuro would have to do it since he has the most expertise in the area. I need this dr for this because it would be so easy to accidentally cut the nerve if done by an ortho or someone else. Whenever you have nerves involved with something you need a Neuro to do it to free up the nerve very carefully without causing further damage. Sorry my explanation went on so long

    I'm glad your pain seems to be dissipating, but see the dr anyway just to be safe. As far as fractures go, there are compression fractures that don't hurt that bad, and others that are killers, so this would explain why someone might ignore it until it goes away which it can in several months, especially if they have intermittent back pain anyway which just about describes everyone I know. I hope you hear from someone with a vertebral fracture, but from all I've heard, and that's a lot, they can vary in intensity from minor pain that goes away, in several months, to severe pain that doesn't go away, it just depends on the severity of the fracture-like hair line fractures can be bearable. If you should ever start to get the problem I have with your posture, don't wait around to treat it even if it doesn't hurt. You know what the dowagers hump looks like right? That's the start of kyphosis and fractures which is what causes you spine to slump forward. It also causes problems with breathing because the spine is compressing the lungs and also in the lower back it feels like your abdominal organs are being pushed forward, causing a real bloated/stuffed feeling and gas, which I also have, in my lumbar area. So this dr needs to check out all these different things.

    I must admit, I've never heard of an Endo or Osteo dr that could treat a fracture. They probably could diagnose it with test, but do nothing else since they aren't an ortho, neuro surgeons, or radiologist which do the different plasty surgeries with the cement or balloon and cement.

    Good luck again and let us know.

    Last edited by DesertBloom; 01-31-2007 at 05:46 PM.

     
    Old 01-31-2007, 06:11 PM   #6
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    Re: Fracture?

    DesertBloom: When I asked why neuro surgeon it was because I was thinking that as this pertains to osteo the osteo specialist would be "the diagnoser" ( like "the decider" ha ha). Then send you on your way as need be to the appropriate next specialist. Sounds like you've got your specialists all lined up ,and your team is assembled. Mine is not yet assembled, so I am starting out with the osteo specialist in the bone and joint department-I was told today the x-ray equipment is right there on the same floor .

    I am so sorry to hear of your additional complications. I am impressed by your strength and focus, as well as your compassion for others.

     
    Old 01-31-2007, 07:09 PM   #7
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    Re: Fracture?

    I had the experience of being completely unaware of multiple compression fractures and then having one which completely incapacitated me, sent me to the ER in an ambulance. You never know. My T scores are only in the -2.6 range. (Had two parents with numerous compression fractures.) Pain is much better since 10 level fusion surgery but now I am horribly kyphotic and looking at additional surgery to straighten me up a bit. Good luck to you!

     
    Old 01-31-2007, 09:38 PM   #8
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    Re: Fracture?

    Hi Osteo: I don't really know if I'm helping others?? But it really helps to keep my mind off of all this. Even when I'm in bad pain, and shouldn't be sitting, like now, I'll come back to this computer to respond because I feel it's more important than what I'm doing. May sound nuts, but it really does help me, so I sure hope it's helping others.

    TurtleLady: Your explanation of the fractures, is "exactly" what I was trying to explain, but I may have done a bad job at it. Some fractures can go unnoticed and others definitely not!! Are you going to have kyphoplasty or vertebroplasty for the khphosis? I had heard, but don't quote me, that if you have fusions, any nerve damage, disc disease or stenosis, that these surgeries may not work. Have you heard that? I'm fused only from L1-S2, but the stenosis keeps reoccuring further up each time they fix it. Were your fusions from fractures or disc, canal, facet, or spondy problems? My fusions just cracked into many pieces and it had to be the osteo causing the disintegration because this has been going on for 29 years, and that's the only explanation.

    Good luck to you both...

     
    Old 02-01-2007, 09:41 AM   #9
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    Re: Fracture?

    DesertBloom: You are amazing! Many thanks. You ask a number of excellent questions to which I have very few answers. I am kind of new around here and just learning what I should be asking the Dr. I was fused because of the fractures and accompanying stenosis. Not certain what sort of surgery awaits. Still getting more x-rays and c-t scan. Hadn't heard of the contraindications you mentioned. I have been remarkably uninformed (understandable while I was on high doses of pain meds - no excuse any more). Trying to correct that. Comforting to know how much company we've got in this.
    For the record, I am turtlelady because I've always loved turtles. I have three of them as pets and hundreds of figurines. Now I have become one myself, between the curvature of my spine and my "shell" (large brace I'm in for a year).
    God bless you all!

     
    Old 02-17-2007, 09:21 PM   #10
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    Question Re: Fracture?

    Hello. I'm new here, but not new to spinal fractures caused by osteoporosis. I wasn't officially diagnosed with this condition until around 2000 but was warned nearly 20 years before this that I had the condition. Unfortunately, I couldn't find a doctor willing to do the investigations necessary for many years. I have now had 6 spinal fractures, 2 of them being current. I have also had rib fractures. I have always had a lot of pain with all of these, and am currently taking Oxycontin slow release pain medication. The 2 current fractures are in L2 and L4 and both are classed as large fractures. I have no idea what caused them. The first upper spinal fracture I had was caused by just reaching up to an overhead power point to turn on an airconditioner. The first lumbar fracture I had happened when I bent to put on underwear. I have no idea what caused any of the others, including the current ones. I also have no idea if I have had other minor fractures which haven't caused any pain. The tests I had showed a score of -3.5 and I really don't know what that means except that I have been told it is severe. I do know that the pain I have had with all the fractures that I know about has been very severe, with several periods of hopitalisation involved. During the current episode I required ambulance transport as I was unable to stand or walk. I don't know many people who have this condition so don't know whether a lot of pain is normally experienced.

    My major problem is trying to obtain treatment for the condition. I live in a remote town in the Northern Territory of Australia, and our local hospital, wonderful though it is, can only provide pretty basic services because of the lack of facilities and staff. It is proving unbelievably difficult to even get an appointment to see a specialist. I will probably have to travel to Adelaide or Melbourne for quality treatment. At the moment, I cannot drive and even travelling as a passenger lying down causes extreme pain. There are no air services here, and the nearest airport is 500 kilometres away. I am going to try and get the local doctor to find out if I would be a suitable candidate for vertebroplasy or kyphoplasty. Most doctors I have spoken to about it seem to have heard of the procedures but don't have much actual knowledge of them. So my queries here are mainly about those two procedures and any other treatments available for the condition. Does anyone know about what is involved, and what the longer term problems or advantages may be? The only treatment I am on at present, apart from the pain killers, are Actonel one a week tablets and the usual calcium and vitamin D supplements. I also take other supplements, which my doctor is aware of and these are certainly helping with my general health. I don't want my life to be totally controlled by this condition, although obviously it is having a major impact. I really want to try and find some feasible way of managing it without creating other problems which may be just as bad or even worse to deal with.

    I hope the information about the pain is useful to the person who asked in the first post. And thank you in advance to anyone who can help me with any information.

     
    Old 02-18-2007, 09:07 AM   #11
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    Re: Fracture?

    Hi Bushbaby: Sorry about all your problems, have you tried to contact Kyphon International to see if they have a dr in your area that does kyphoplasty? Usually there are some links on this board to their web site but I don't see them today. If you get to their site you can enter your city-country and find out if there is anyone doing this procedure near you.

    Good Luck, many people have great success with this procedure. You could also call around to see if any drs know who might do vetrebroplasty or kyphoplasty.

    I found drs in Syndey, Melbourne, Perth, and Victoria, with 21 physicians listed, but I have no idea how far away that is for you.

    If your fractures are major, you need to have someone look at it. I'm not sure what alternatives there are to the procedures above other than some form of fusion. But I would try and find someone that does the vetrebro, or kyphoplasty if you can.

    Good Luck...

    Last edited by DesertBloom; 02-18-2007 at 12:38 PM.

     
    Old 02-19-2007, 05:59 AM   #12
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    Smile Re: Fracture?

    Thanks for your reply DesertBloom, and many thanks for doing a search. I know I'll have to go to one of the southern states to find treatment. There are no specialists in this field in the Northern Territory. It's a long trek if we need specialised treatment :-( The closest big City with good medical facilities is Adelaide in SA and thats about 1500 kilometres away. Pretty close by Australian standards though. My husband had to go 3500 kilometres for heart surgery a few years back.

    I have an appointment to see my doctor tomorrow to try and get him to find someone for me, and I found a 2006 article about vertebroplasty in the Medical Journal of Australia to take along in case he doesn't know anything about the procedure. Hopefully I'll be able to get something moving.

    I found the Kyphon International site and contacted them as well, to see if they could give me any information about doctors in Australia who are trained in kyphoplasty. They don't have any institutions here but I saw that they have trained a lot of doctors. I'm hoping to hear back from them very quickly.

    I'm so glad I found this site. I felt as if I was just banging my head up against a wall until I came across it. I'd already done all the usual searches for vertebroplasty and kyphoplasty, and had only come across medical articles here, most of which were pretty old and not very promising. Then I thought of putting medical forums into Google and up came this one! It was an eye opener.

    Thank you everyone who contributes here. I am so grateful to all of you.

     
    Old 02-19-2007, 06:58 AM   #13
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    Re: Fracture?

    Hi: There is a Dr. Mc Donald in Adelaide SA not sure if he does kyphoplasty, but you could find out.

    ~~Good Luck to you and your husband...

     
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