A procedure to repair fractures in osteoporosis-weakened spines

Kyphoplasty, or spine augmentation, is an option for some patients suffering pain from vertebral compression fractures in bones made brittle by osteoporosis.
July 1, 2022
More than 10 million Americans have osteoporosis, which causes brittle bones. Susan Alfson opted for kyphoplasty, a minimally invasive procedure involves the use of bone cement to repair fractures in the spine. Photo courtesy Susan Alfson.
More than 10 million Americans have osteoporosis, which causes brittle bones. Susan Alfson opted for kyphoplasty, a minimally invasive procedure involves the use of bone cement to repair fractures in the spine. Photo courtesy Susan Alfson.
Five years ago, Susan Alfson learned she had osteoporosis, a condition common for people, especially women, as they age. It affects some 10 million people in the United States. The disease causes bones to weaken and become brittle and increases the risk of fractures, especially in the spine and hips.

This year, Alfson, now 73, also learned she is one of the 1.5 million women who suffer an osteoporosis-related fracture each year. The disease made the bones in her spine fragile, and they cracked in two places, an injury called a vertebral compression fracture (VCF). The fractures triggered pain that became a regular presence in her life and confined her to a wheelchair.

Unsurprisingly, the VCF problems took a toll on Alfson’s everyday life. She had to cancel quarterly dinner and game nights with her nieces and nephews that she relished. She postponed regular appointments for teeth cleanings, eye exams and clinic visits and had to put aside driving.

Movements as routine as getting out of bed shot Alfson’s pain meter to a 9. “It was not constant as long as I was being still,” Alfson said. “But if I had to sit up for any length of time, it was quite extreme and debilitating.”

For some time, Alfson didn’t know the source of her pain, only that whatever it was put considerable stress on her immediate and long-range plans.

“It prevented me from doing the things I would have liked to do and inhibited my mobility,” she said.

Susan Alfson benefited from kyphoplasty surgery that repaired vertebral compression fractures caused by osteoporosis. Photo courtesy of Susan Alfson.
Susan Alfson benefited from kyphoplasty surgery that repaired vertebral compression fractures caused by osteoporosis. Photo courtesy of Susan Alfson.

Compression fracture addressed through technology and teamwork

Today, Alfson is on the mend, thanks to a minimally invasive repair procedure called kyphoplasty that uses bone cement to fill VCFs and stabilize the weakened spine. Alfson’s back is pain-free a couple of months after the kyphoplasty, performed by Dr. George Zlotchenko, medical director of Radiology and Interventional Radiology at UCHealth Highlands Ranch Hospital.

More on the procedure later. Alfson’s care and recovery are a testament to the importance not only of technology but also to teamwork in managing a complex case in which osteoporosis was only one of a cast of clinical characters.

In 2014, Alfson was near the end of a long and successful career, mostly in the oil and gas business, which included starting and owning her own business. Then a breast cancer diagnosis derailed what had seemed a smooth transition to retirement. She recovered after chemotherapy, a lumpectomy and six weeks of radiation therapy. However, the chemo and radiation caused collateral damage. In 2017, she was diagnosed with osteoporosis following a bone density scan that showed that the amount of calcium and other key bone-strengthening minerals had dangerously dwindled.

Severe consequences of osteoporosis

Dr. George Zlotchenko performed the kyphoplasty surgery that relieved Susan Alfson’s vertebral compression fractures. Photo by UCHealth.
Dr. George Zlotchenko performed the kyphoplasty surgery that relieved Susan Alfson’s vertebral compression fractures. Photo by UCHealth.

The consequences of the diagnosis further cascaded and disrupted her life. The cancer treatments also affected Alfson’s lungs, and 60 days after beginning her chemotherapy, she had to use oxygen full-time. In May 2021, she fell and broke the femur in her right leg when a tube from her oxygen tank wrapped around her feet. The injury required orthopedic surgery to place a plate in her leg, five weeks of rehab and work to transition from a wheelchair to a walker in the fall of 2021. She fully healed from the fall and leg surgery, but the ordeal wasn’t over.

Early in 2022, back pain forced Alfson back to a wheelchair and sent her to the emergency room several times. She was diagnosed with shingles, but her primary care physician, Dr. Anne Safley, an internal medicine specialist at UCHealth Primary Care – Greenwood Village who manages Alfson’s health care, suspected the shifting pain in Alfson’s back had another cause. Safley ordered an imaging test that showed two VCFs in the spine. She also referred Alfson to Zlotchenko, who discussed with her the kyphoplasty procedure option.

Zlotchenko said he tests for “point tenderness” at the spot where the imaging tests show the compression fracture. He also administers a questionnaire to evaluate the extent to which the fracture limits an individual’s ability to do everyday activities like getting out of bed. In Alfson’s case, pain disrupted her ability to perform half of the 28 activities listed. Zlotchenko described the kyphoplasty procedure, its relatively low risks and high success rate – better than 90%, he said – and gave Alfson literature to review. She decided in favor of the surgery.

Kyphoplasty procedure is a treatment option for vertebral compression fractures

Alfson had her kyphoplasty in early March. Zlotchenko describes the procedure as something like bolstering a house’s foundation. Under moderate or sometimes general anesthesia, he inserts a needle into a pedicle, the hard bone that extends out from the vertebrae, at the level of the compression fracture. Guided by imaging, he advances the needle into the fracture, then inflates a small balloon to create a space that he fills with quick-setting bone cement. The strengthened spine can thus much better support the stress of standing and moving about without pain, but the benefits for patients can go farther, Zlotchenko said.

“They don’t have to lie around debilitated, which can lead to deconditioning, pneumonia, and deep vein thrombosis,” he said.

Kyphoplasty isn’t for everyone, Zlotchenko stressed. It repairs acute fractures, like Alfson’s, not chronic breaks that failed to heal over many months. Although he’s not seen the bone cement deteriorate in his patients, he prefers not to use the procedure on younger patients in order to avoid that long-term possibility. Patients should also consider the relatively small risks of nerve or spinal cord injury and of minute amounts of the cement releasing and causing blockages in the blood and lungs.

Osteoporosis care continues after kyphoplasty procedure

Alfson said her condition after the kyphoplasty was “like night and day.” She was able immediately to sit up straight on the edge of the bed painlessly. “I hadn’t been able to do that for some time,” she said. “The pain was completely gone. I walked straighter and stood taller. It was one of the best decisions I’ve made.” She has retired her wheelchair and is walking with only the support of a cane.

She also continues to manage her osteoporosis with the help of Safley and Dr. Karin Hickey, an endocrinologist with the UCHealth Diabetes and Endocrinology Clinic – Cherry Creek. Hickey explained that preventing bone breaks caused by osteoporosis in older adults is important not only because they limit their activity. Fractures also decrease their lifespan, and one break increases the risk of another, she said.

The battle against bone loss that Hickey discussed with Alfson and many other patients includes taking vitamin D and calcium supplements, performing weight-bearing exercises and also considering a range of medications designed to counteract an imbalance caused by osteoporosis.

The bones are dynamic structures that are “in a constant state of remodeling,” Hickey said. Cells called osteoblasts build new bone, while counterparts called osteoclasts remove old bone. “These two types of cells should always be in balance,” she added. When they are not, osteoporosis results. Medications called antiresorptives aim to block the osteoclasts from robbing bone, while other agents spur osteoblasts to build bone and help heal fractures.

For Alfson, Hickey prescribed Evenity, an FDA-approved medication designed to both build bone and slow bone loss. She called Evenity “the newest and strongest medication” to prevent fractures in osteoporosis patients. It’s administered in once-monthly injections for a year only, after which patients transition to an antiresorptive therapy to continue to slow bone loss, Hickey said.

Collaboration benefits osteoporosis care

Alfson credits the collaborative support of Hickey, Safley, Zlotchenko and providers in orthopedics for smoothing the rocky road that followed her cancer treatment. Safley, she added, was particularly instrumental in recognizing the signs of a compression fracture and quickly addressing it with an imaging order and referral for further evaluation.

“It’s absolutely been a team effort and I have been extremely comforted by the fact that it has not just been one physician trying to do everything,” Alfson said.

Safley also voices her support for the commitment to collaboration that Zlotchenko and Hickey showed.

“They are truly caring physicians who provide excellent care to my patients every day,” Safley said. “I am so grateful for their expertise and guidance with Susan’s care as well as the care of many other shared patients.”

For more on kyphoplasty procedures, call Dr. Zlotchenko at the TCU Medicine Interventional Radiology – Highlands Ranch Specialty Care Center: 720.516.3064.

About the author

Tyler Smith has been a health care writer, with a focus on hospitals, since 1996. He served as a writer and editor for the Marketing and Communications team at University of Colorado Hospital and UCHealth from 2007 to 2017. More recently, he has reported for and contributed stories to the University of Colorado School of Medicine, the Colorado School of Public Health and the Colorado Bioscience Association.

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