04/19/2010 - Questions and Answers

Fracture and no rest

By: Mark Castleden

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Question

I have an osteoporosis-induced vertebral fracture which keeps me awake at night because of the pain. Resting during the day to heal the fracture is making my night-time insomnia worse. What can I do?

Answer

Osteoporosis is a common metabolic bone disease which contributes to fractures because there is a reduction in the amount of bone per unit volume (without a change in its composition). It is important to recognise that although you have had a vertebral fracture, and it is too late to stop yourself from getting osteoporosis, you can still slow further bone loss and increase the calcium in your bones. This may be achieved through increased exercise, additional calcium, hormone replacement therapy if appropriate and cyclical etidronate. New bone formation can also be stimulated by sodium fluoride. These measures work because in older people, especially women, osteoporosis is related to changes in hormone levels, increased age and reduced mobility, while contributory factors which accelerate bone loss are endocrine disease, chromosomal disturbances, excessive smoking, alcohol consumption, lack of exercise, early menopause and excessive thinness. The relative importance of some of these factors is not clear.

In view of all this, you will understand our concern about your wishing to rest to heal the fracture. The pain is often quite marked but the fracture is stable in most cases, and therefore progressive displacement because of activity is unlikely. Of course, your own doctor and orthopaedic consultant will advise on this point and should there be any doubt about the stability of the joint, then of course it must be kept still. It is frequently necessary to keep a patient in bed for a week or two until the pain subsides, but spinal exercises are encouraged from the outset. Once you get up, a corset may give additional comfort and security. Adequate painkillers are necessary to ensure comfort and these may help you to sleep. Certainly, if you sleep during the day you are less likely to sleep at night.

Overall, our advice is that vertebral fractures require initial investigation and the causes should be delineated and treated. Initially a period of bed rest may be necessary, and painkillers should be given as needed. However, because immobility and lack of exercise aggravate osteoporosis, we advise exercises in bed and mobilisation as soon as possible.

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Created on: 05/24/2000
Reviewed on: 04/19/2010

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Anonymous wrote 1 year 34 weeks ago

You better check out this advice because the most recent studies show that, while fluoride increases bone mass, it also increases bone fragility.