Is everything fine after osteoporosis fracture surgery?

This is the 3377th article of Da Yi Xiao Hu

I just arrived at the outpatient clinic on Tuesday morning and saw a familiar face. Two months ago, Grandma Wang came to our hospital because of sudden severe back pain for 2 days and was diagnosed with lumbar osteoporotic fracture. After admission, she was given percutaneous vertebroplasty, and the pain was basically gone after the operation. When she was discharged from the hospital, she praised the good effect of the operation. She came in pain and left happily. When she was discharged from the hospital, she was advised to take anti-osteoporosis treatment, and the patient agreed. Today, I saw the patient's painful expression again, and a thought flashed through my mind that she might have broken her bone again.

When the family members carefully asked whether the patient had received regular anti-osteoporosis treatment, they said that because everyone was too busy, the old lady could not take the medicine on time. This morning, she accidentally sprained her waist and suddenly felt unbearable pain. They quickly asked for leave to send the old lady here. They quickly arranged for a lumbar MRI examination, and the results showed that another vertebral fracture was arranged for hospitalization again. The patient's family members were very confused: the last operation was very effective, how could it be fractured again?

As the aging of my country's population continues to accelerate, the incidence of osteoporosis in the elderly has increased year by year and has become a common and frequently occurring disease in the world. Its incidence rate ranks third among chronic diseases, following cardiovascular disease and diabetes, and has become a silent "epidemic" and is known as a "silent killer."

According to a recent study by the Osteoporosis Foundation, the total prevalence of osteoporosis in my country is 6.6% to 19.3%, with an average of 13%. According to the data from the first national osteoporosis epidemiological survey in 2018, the prevalence of osteoporosis in people over 65 years old reached 32.0%. Currently, about 61 million people over 65 years old in my country suffer from osteoporosis. It is estimated that by 2050, the number of patients with osteoporosis or low bone density in China will reach 212 million.

Fracture is the most serious complication of osteoporosis and an important cause of disability in the elderly. It is estimated that half of the elderly women and one-third of the elderly men in the world will suffer from osteoporotic fractures, and the incidence of re-fractures after fractures is also significantly higher than that of patients with first fractures. According to statistics, one osteoporotic fracture occurs every 3 seconds and one spinal fracture occurs every 22 seconds in the world, which will seriously affect the physical health of the elderly, and also greatly increase the economic burden on society and families, causing serious harm.

After an osteoporosis patient suffers a fracture, the risk of another fracture increases significantly. The more fractures a patient suffers, the greater the risk of another fracture. The first year after a fracture is a high-risk period for another fracture.

Percutaneous vertebroplasty is effective for thoracolumbar osteoporotic vertebral compression fractures. Studies have shown that if effective anti-osteoporosis treatment is not performed after surgery, the incidence of re-fractures 3-4 months later is 4 times that of the first fracture. If regular anti-osteoporosis treatment is performed after surgery, the risk of re-fractures of the operated vertebrae can be effectively reduced.

Clinical research evidence shows that a variety of anti-fracture drugs currently used in clinical practice can effectively reduce the risk of re-fracture. The most commonly used drugs in clinical practice include bisphosphonates and denosumab.

In short, osteoporosis has become an important public health issue in my country. Although the surgical effect of the first fracture is good, if effective anti-osteoporosis treatment is not carried out after the operation, it is easy to re-fracture. Once a re-fracture occurs, the consequences will be catastrophic. Therefore, it is hoped that clinicians will conduct bone health assessments on patients with first osteoporotic fractures, give regular anti-osteoporosis treatment after surgery, intervene as early as possible, insist on treatment, implement standardized follow-up and monitoring of osteoporosis patients, improve treatment compliance, reduce the risk of re-fracture, and ultimately benefit patients. Is everything fine after osteoporotic fracture surgery?

Author: Department of Orthopedics, Tianjin Third Central Hospital

Guo ShuzhangChief Physician