CHART NOTE
Followup for the complications of osteoporosis as they affect the spine. She had a 6-month history of progressive, disabling back pain visibly associated with progressive kyphotic deformity of the thoracolumbar spine, with an attendant cervical lordosis. While the cosmetic deformity was certainly very significant, it was rather her back pain in the midthoracic area that primarily precipitated her visiting me and requesting this consultation. She advised me that for many, many years she had had a
tea-and-toast diet with a very poor protein intake and admitted to not having consumed milk for many, many years. Also, because of attendant foot and left knee problems, she had a markedly diminished level of physical activity in the past year and a half, on many occasions being confined to the house for long periods of time. She also had the habit, as do many patients with osteoporosis, of lying down a great deal during the day to cope with her back pain before finally seeking medical attention. She advises that she was referred to the osteoporosis center at a nearby hospital where bone densitometry studies were done, and a diagnosis of osteoporosis involving the spine was made, but without evidence at that time of compression fracture. She was started on calcitonin and vitamin D complex in addition to oral calcium supplements. This went on for approximately 12 weeks. At the end of that time, the vitamin D and the calcitonin were discontinued, as is usual, but she was continued on oral calcium and elevated levels of activity.
tea-and-toast diet with a very poor protein intake and admitted to not having consumed milk for many, many years. Also, because of attendant foot and left knee problems, she had a markedly diminished level of physical activity in the past year and a half, on many occasions being confined to the house for long periods of time. She also had the habit, as do many patients with osteoporosis, of lying down a great deal during the day to cope with her back pain before finally seeking medical attention. She advises that she was referred to the osteoporosis center at a nearby hospital where bone densitometry studies were done, and a diagnosis of osteoporosis involving the spine was made, but without evidence at that time of compression fracture. She was started on calcitonin and vitamin D complex in addition to oral calcium supplements. This went on for approximately 12 weeks. At the end of that time, the vitamin D and the calcitonin were discontinued, as is usual, but she was continued on oral calcium and elevated levels of activity.
On physical examination, the patient demonstrated the aforementioned cervical lordosis and thoracic kyphosis. She was markedly tender over the lower thoracic spine and upper lumbar spine area. Axial weight loading, particularly with spinal extension forces added, markedly precipitated her pain. Her neurologic examination in the lower extremities was normal.
We did x-rays of the thoracic spine today even though they were done just 12 weeks ago. These new films now reveal a
third-degree compression fracture of T11 and a second-degree compression fracture of L1 of the upper lumbar spine. I advised the patient of this eventuality and that such compression fractures, even without trauma, not uncommonly are complications of underlying osteoporosis as severe as hers.
third-degree compression fracture of T11 and a second-degree compression fracture of L1 of the upper lumbar spine. I advised the patient of this eventuality and that such compression fractures, even without trauma, not uncommonly are complications of underlying osteoporosis as severe as hers.
We are going to place her in a Jewett hyperextension brace, provide analgesics, and continue the same anti-osteoporosis measures afforded. She will return in 4 weeks’ time for x-ray and further followup.
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