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Osteoporosis

Surgery for osteoporosis

Many of those we talked to have had fractures before and after their diagnosis of osteoporosis and several have had surgery to help decrease the pain associated with spinal compression fractures; to mend a broken femur, or repair a wrist that could not be mended with a cast alone. Here people talk about their experiences.
 
Percutaneous Vertebroplasty and Balloon Kyphoplasty
Percutaneous Vertebroplasty and Balloon Kyphoplasty are procedures used to help decrease pain associated with spinal compression fractures. However, surgery is not suitable for the majority of people with spinal fractures. They are considered for people whose spine fractures haven’t healed properly and who continue to have severe pain. Percutaneous Vertebroplasty and Balloon Kyphoplasty do not improve bone strength or reduce fracture risk so should given along side drug treatment. These procedures are approved by NICE (National Institute for Health and Care Excellence) and are available in some specialist hospitals in the UK.
 
These procedures are minimally invasive treatments a very small cut is made in the skin at the site and a hollow needle is inserted through the skin into the collapsed vertebrae. During surgery, image-guided x-ray assists doctors when directing the needle through the skin into the spinal bone and then a special orthopaedic cement mixture is injected into the fractured vertebra. In balloon kyphoplasty, a balloon is first inserted through the tube and into the fractured vertebra where it is inflated to push the bone back to its normal height and shape. The balloon is then removed and the cement is inserted into the cavity created by the balloon. Both procedures usually take place as day surgery. These procedures are more likely to be effective in the early months after fracture but most compression fractures heal without intervention within 6-8 weeks with improvement in pain, so Percutaneous Vertebroplasty and Balloon Kyphoplasty are not generally considered as a treatment option until after this time.
 
With both procedures, there is the risk of the cement-like paste ‘leaking’ or moving out of place and a possible increase in risk of fracture to vertebrae above or below the site of the procedure. As with all surgery, there are other risks including infection, nerve damage and paralysis and reactions to anesthetics.

Noreen and James talked to us about their experiences of having balloon kyphoplasty and percutaneous vertebroplasty. Both  experienced severe pain following their spinal fractures. The severity of it made any daily activities such as getting in and out of bed, bending and getting up from a chair very difficult. So after having an MRI scan and an assessment with a specialist consultant, both were happy to have surgery to get rid of the pain. Noreen remembers that during her first consultation she was ‘pleased’ to hear the osteoporosis nurse describing her pain to her. But James - who waited for almost a year to have his MRI scan – wondered why he was referred as a non-urgent case by his GP (vertebral fractures can easily be picked up on an ordinary x-ray of the spine).

 

It took a long time for James’s collapsed vertebrae to be diagnosed because his GP referred him...

It took a long time for James’s collapsed vertebrae to be diagnosed because his GP referred him...

Age at interview: 82
Sex: Male
Age at diagnosis: 81
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I suppose when they discovered that there were the collapsed vertebrae it would need treatment and they could give treatment, I did begin to wonder what the condition had to be for the doctors to pick this up earlier and get a referral to the hospital before it actually happened in my case.
 
How long were you going to the, to the GP complaining about back pains, before he referred you to the hospital?
 
It could have been over a comparatively short period perhaps two or three months but because he didn’t indicate that he considered it anything urgent the response from the hospital was that because the doctor hadn’t indicated that it was an urgent case they couldn’t fit me in for an MRI scan and it took several months before that happened.
 
It wasn’t until the November that I then got another call from the hospital to go back for an MRI scan. By that stage I was in a lot of difficulty getting in and out of bed was very difficult, my back was going into spasm, getting in and out of bed, getting up from a chair was just as difficult sometimes. And it was then that they realised that there was a more serious problem and the assessor sent my name to Mr [consultant’s name] for his assessment. And then from the MRI scan which I had, the collapsed vertebrae were diagnosed.
 
 
 
James and Noreen had their procedures done in different hospitals and in different parts of the UK but both said that specialists doctors and nurses discussed with them all the information they needed to know about the procedure and the possible risks involved. Noreen pointed out that after her MRI scan things preceded fast and there was no time for her to worry. Percutaneous vertebroplasty and balloon kyphoplasty are usually successful at alleviating the pain caused by a vertebral compression fracture, but only where usual treatments to control pain have failed, but in the cases of Noreen and James the damage caused by osteoporosis had been done before diagnosis and before treatment. Besides, both had to wait for a few months to have surgery. These procedures are only suitable for a small number of patients as, in the majority of patients with vertebral fractures, the pain settles after about eight weeks.
 

Noreen’s kyphoplasty took place later than the recommended time after a fracture so her operation...

Noreen’s kyphoplasty took place later than the recommended time after a fracture so her operation...

Age at interview: 77
Sex: Female
Age at diagnosis: 75
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However, all back operations are treated as severe, or words to that effect, and but because I was, with this kyphoplasty it should be really done immediately after the bone has broken. Mine was say in six months, and the bone had, had healed wrongly in this wedge shape. So they couldn’t get this procedure in, which they had to drill.
 
Now I should tell you what they do in the beginning. I was given a general anaesthetic and it’s a big procedure in the theatre apparently, lots of MRI scans and lots of all these things.
 
Anyway, they couldn’t get, first of all they put a rod, a very small rod, into one side of your vertebra, the broken one and then they insert a balloon which they blow up and that makes a nice space, they remove the balloon and they put some bone cement in there, which makes the bone the right shape again.
 
With me, it took longer, because it had all healed and there was no space for this little rod to go in. So they drilled, they had to drill, which for me, it took, I think it took over two hours, where it should have just taken about an hour. But you know, that’s not going to happen to everybody. You know, if you are sent straightaway, you know, that should only be a small procedure.
 
I was in hospital over night. Yes, I was just in hospital overnight. I was in a special ward. I can’t remember the name of it, but in a special ward, looked after very well, and came home.
After his percutaneous vertebroplasty James said that he felt more comfortable, there was no serious pain and was able to walk more easily but his improvement was short-lived because a third vertebra collapsed. Another percutaneous vertebroplasty was performed but it had to be stopped because the cement-like paste began to leak. He is due to have it done again soon. Despite this set back James recommends percutaneous vertebroplasty to others because he was able to appreciate its benefits after his first two collapsed vertebras were repaired. This illustrate that these two procedures should be complemented by drug treatment for osteoporosis as they do not reduce risk of fractures at other sites.
 

James has had two vertebroplasty to repair collapsed vertebras.

James has had two vertebroplasty to repair collapsed vertebras.

Age at interview: 82
Sex: Male
Age at diagnosis: 81
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I went into hospital in April for two collapsed vertebrae which they proceeded to fillwith the paste with the treatment or the procedure as they choose to call it. And for a little while after that I was relatively comfortable. There was no serious pain, spasm. I could walk more easily and more comfortably. Things began to go wrong again and so I was sent back for another MRI scan and they discovered there was yet another collapsed vertebrae. That was dealt with in June of this year and at first for just about a week, it seemed very much better again. The back pain was less and I was able to walk more freely again. But when they discovered a third vertebrae had gone I’ve had to go back for the for the third treatment and they had to stop the procedure because the paste began to leak so that any benefit from that third filling didn’t last very long. And the result is that I have to go back now on the ninth of September. They hope then to complete the filling of that third collapsed vertebrae and I think it’s a question of seeing that through.
 
Now, would you recommend this procedure to other patients.
 
Yes, certainly, yes. Well, when you’re in pain and difficulty you need whatever support or help is recommended and I don’t have a problem about going into hospital. If that kind of help is available I’m extremely glad to take it. And in addition to that of course I for short times after the procedure I’ve derived some benefit. My, my walking has improved. Unfortunately, it didn’t last very long but that was only because there was a collapse of the third vertebrae. And I’m hoping that when I have it done again in September that will be corrected.
 

Noreen recommends kyphoplasty to others because although she is not pain free, her spine is more...

Noreen recommends kyphoplasty to others because although she is not pain free, her spine is more...

Age at interview: 77
Sex: Female
Age at diagnosis: 75
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Saw the consultant, I think it was a fortnight afterwards and had the, there were only two stitches. I didn’t see it of course, I couldn’t see it. And then although I did have less pain, it wasn’t, it wasn’t, I wasn’t pain free. A lot of people are pain free after it, because it just takes it from that, you know, the nerve ending. And but I have got a lot of pain, because I have got a lot of wear and tear. I had no idea that I would have had all this wear and tear, which is arthritis in my spine. So I am still getting a tremendous amount of pain underneath my shoulder blades and shoulder blades and right round my middle, my ribs.
 
However, I saw, I have seen the surgeon a few times, and I saw him last February which is a year after, and he was very pleased with my actual spine, sorry about the pain, but he said, you know, you will with your condition, you are going to get pain. But my spine was more stable. Because this bone that was in a wedge shape was now the proper shape and made my spine, instead of my spine toppling over and may be having a, a bump, a hump eventually, that shouldn’t happen, unless I have another break.
 
Well through this, I would have certainly had another break had I not had this operation, I’d certainly had another break. So, so I am all for this, you know, it’s a really good procedure.
Two of the people we talked with were offered these procedures but did not want to have surgery. Sheila declined her consultant’s suggestion of having balloon kyphoplasty and Ann who has lost height, would not consider having percutaneous vertebroplasty. As a nurse Ann knows that it is the only procedure that may help restore height to her vertebras, hence reducing the curvature of her spine. Both have concerns about the risk of the paste leaking and migrating to other organs, especially the lungs which would be fatal.
Other surgical procedures
Surgery may be required to repair some osteoporotic fractures. Most peripheral fractures (e.g. wrist fractures) can be healed with the use of cast alone. But some may require surgery. Hip fractures almost invariably need surgery. These procedures are very successful at repairing fractures, reducing pain and increasing mobility or function.
Anyone over the age of fifty who sustains a low trauma fracture should be investigated for osteoporosis when attending a fracture clinic. The experiences of those we talked to differ and some were referred for a DXA scan and in other cases there was no further investigation (see also Being diagnosed with osteoporosis).
People who had a wrist fracture were usually put in a cast and recovered within a couple of months. Joan had had several falls that have resulted in Colle’s fractures and on one occasion she fractured both wrists at the same time. And Joan has needed wrist and arm surgery to correct fractures that could not be corrected by casts alone.
 

The surgeon has told Joan that if she fractures her right arm again, he would not be able to...

The surgeon has told Joan that if she fractures her right arm again, he would not be able to...

Age at interview: 73
Sex: Female
Age at diagnosis: 69
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So yes. I’d broken both my arms...

 

Several times by?
My left arm was a complicated Colles’ in that I now have still the plate and screws in and I had a bone graft on the little finger side. Bone taken out of my hip, and put in the right arm. I lost the head of the radius, that’s completely shattered and gone. And about, it’s a funny shape, about four fractures along here and a plate and you can see it doesn’t quite go straight again and it hurts still.
 
I think certainly when I broke both of my arms. [name surgeon] said I had, I certainly had osteopenia and start taking and you probably need to be checked.
 
Did they check you? What did they do?
 
No they didn’t then. I think they were. I was. No. I mean life was quite difficult for me I must admit when I got home certainly. But at that time it was just one operation after another to be honest.
 
And things really didn’t start happening until I’d broken both my arms and my [surgeon] said said that he, I had osteopenia. I think it was a matter of putting my arms together because he has told me I’m not, not to go out now when it’s slippery and my right arm, he probably wouldn’t be able to put it back together so that it works as well as it does now [laugh]. 
 
Elderly people are particularly susceptible to hip fractures. The elderly tend to lean slightly backwards or sideways when they walk hence they are more likely to fall on the hip and fracture it. A hip fracture occurs at the top part of the femur. For a hip fracture the surgical procedure is done either to stabilise the hip joint with metal plates and pins or to replace the hip completely. Sydney who is age eighty-six sustained a hip fracture three years ago when getting off his bike for no apparent reason. The surgical procedure he had done was to stabilise the hip joint. Elderly and frail patients are more at risk of developing complications and their stay in hospital after hip surgery can be for two or three weeks. Sydney said that he had no infection or any other complications.
The hospital experience
People who have recently spent time in hospital because of surgery or recovering from disabling fractures praised NHS hospitals. In particular people talked about the support, expertise and care they received, the extra nursing staff, new ward arrangements and help given during mealtimes. Christine commented on the kindness shown to her by the nurses while she spent two months in a community hospital recovering from a fracture. Beryl. has been in hospital a few times and said about nurses ‘I can’t fault them. I don’t think, they’re, given enough praise, you know, most nurses’. And James describes the consultant who has done his percutaneous vertebroplasty procedures ‘first rate and very thorough’ (see also Communicating with health professionals).
 

Sydney was most impressed with the improvement his local hospital had undergone since the last...

Sydney was most impressed with the improvement his local hospital had undergone since the last...

Age at interview: 86
Sex: Male
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And how was the after care at that time three years ago?
 
Well it was, it was improvement when I came out of the assessment ward as they called it, went into the trauma ward that was a big improvement but that was, not as it should be you know. Because you had the airbeds in there and it was all modern but it was a big improvement from the assessment ward.

 

And, and they, the change in there was more like a hotel than, than anything else and there’s so much improvement and instead of one big ward with all the machinery going on, you’re, you are in a small department, about four, groups of four something like that or six, you know, kind of, according to the doings andit’s changed no end.
 
And even the staff and that was improved they had more time for you and it was to, at, well you know, and the company you met and the staff you had time for everything, and it was so, such a great improvement and I just went round and thanked them all and I go away, and the changes was unbelievable and believe me, and I told the doctor what I thought you know?
 
Yes it was beautiful and the food was quite good, you know, and I had a quite, I mean I know is not like having a package like you would at home but it was adequate and it, and even those were, they brought it to you it was so different, they had more time and they, and that was it, you know the staff was well more staff as well.
 
More staff and more time?
 
Yes, yes it was yes and the nurses they [eh], they could sit, they had time to come and sit and treat you and sit to have a chat you know like, it, in a normal way, and I appreciated everything that they done for me, and the improvement. 
 

Christine was impressed by the way she was treated by the nurses when she couldn’t do anything...

Christine was impressed by the way she was treated by the nurses when she couldn’t do anything...

Age at interview: 68
Sex: Female
Age at diagnosis: 61
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The main thing about is, it is just so humiliating not being able to do anything for yourself. I found one of the most humiliating times of my life, mostly because my underlying condition when it came on so suddenly it left me totally paralysed down one side. But at least one half of me was functioning. But when I broke my only good wrist then nothing of me was functioning. It was disgusting, but they were very kind to me in the [city] hospital, very kind. So...
 
So it must have affected you emotionally not to be able to do those things for yourself?
 
Oh terribly.
 
Because it seems to me like you are quite an independent person.
 
Yes, that was, that is what I said when I said it was so humiliating. That really did affect me very badly.
 
When you say that the staff at the hospital were kind can you elaborate a little bit more?
 
Well what I meant about kind, was kind and practical. Although I had to have everything done for me nobody there made me feel that I was any less a person because of this. Even when they were having to wipe my bottom and bath me. I did not, was never made to feel that I was anything but a real person. So I was impressed with that. Very impressed with it.
 
And did they seem to have the time for you...
 
Yes, yes I felt that they really did.
 
OK, so they were not…
 
I mean everybody was very busy but it did not feel as if they could not do things because they were so busy.
 
And you stayed there for how long?
 
Two months. 
 
 
 
However, Sydney thinks that he was discharged too soon after having surgery for a broken hip. He felt that he was still not fit enough to cope on his own at home.
 

Sydney who lives alone felt he was discharged too soon after his surgery.

Sydney who lives alone felt he was discharged too soon after his surgery.

Age at interview: 86
Sex: Male
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No they did, they sent me out too soon and that was the only thing that they had done. I had three, two, well three trips with the physio on the stairs, well one day give me a stick I think it was and I couldn’t… my legs crossed and I was useless on the first day, because I had a frame you see to start with obviously, and I got nowhere the first day whatsoever, the second day I improved, and then I think it was the third day I went up and down with the aisle, you know, kind of thing so you couldn’t fall, and he took me on the stairs with another nurse, two of them, took me on the nurse.
 
And he said, “You’re ready to go out home it’s a weekend on the Friday”. They got some equipment like little table that I got and the thing to go over the toilet thing and they said, “We can get you home but we can’t get this”. I had two of me nephews, well a nephew and a niece came in at the same time and of course they brought me home and I wasn’t fit, I  got home, got into this chair [laughs] and I was puffing and blowing like and got into the chair, the neighbour, one of the neighbours knew I was going, two doors away an elderly lady, she was banging on the door and I couldn’t get out of the chair [laughs]. I rang the, the nurse and I said, I said to Doctor [name], don’t worry I give you his same word that he gave me and I said, I said, “I had a hell of a job to get out”. He said, “I wasn’t fit to come out but I didn’t realise that you’re on your own, left on your own.”

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Last reviewed June 2017.
Last updated June 2017.

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