New Spine Fractures:
Ways to Cement a Recovery
The majority of spine fractures are silent. You are not even aware that a fracture has happened. One clue may be loss of height. However, other common causes of height loss with aging include changes in your posture and decreases in the disc spaces, which are the cushions between your vertebrae. Silent fractures are discovered with some types of imaging like an x-ray or a DXA scan of the entire spine.
On the other hand, a fracture may be painful. However, back pain can have many other causes and it may be hard to sort out whether the pain is the result of a fracture or some other cause. Do not ignore back pain and think it will just go away. See your doctor. Get an evaluation ASAP.
LOCATION OF SPINE FRACTURES
There is a tendency for fractures to occur in the midback (T7-T9) and at the junction between your mid and lower (Tl1-Ll) regions of the spine. As you can see on the diagram, these levels correspond to the areas between the shoulder blades and at the waistline in the small of the back. Do not ignore pain in those regions of your back; that is how some fractures may get missed. Talk with your doctor about getting an x-ray (or he may use the DXA machine in his office for a vertebral fracture assessment) as part of your evaluation of the pain.
Tim Gunther, gunthergraphics.biz
Back pain caused by a fracture usually starts suddenly. The fracture may occur following a fall or after lifting a heavy object. Many times it just happens spontaneously and no precipitating cause is identified. The pain is localized to a spot over the area of the back where the fracture occurred. Then the area of pain tends to expand, as the muscles next to the spine become tight and go into spasm. The intensity of pain varies from person to person. It may start as “take your breath away” pain and then ease with time. Typically, the pain is made worse when standing up and when trying to work with your arms in front of your body, as in lifting a heavy pot or doing dishes.
MANAGING ACUTE PAIN
The priority first and foremost is to feel better. Pain relief can be a challenge. Multiple approaches may be needed to achieve the goal of eliminating pain.
Conservative measures. Your doctor may prescribe pain medicines and muscle relaxants. Be careful while taking these medicines. The risk of falling is increased while taking prescription pain medicines and muscle relaxants. You do not need another fracture. Lessen your risk of falling by taking your time when changing positions. Sit down if you feel lightheaded and ask for assistance if you need it. You may not tolerate the combination of pain and muscle relaxant medicines as well as when you were younger. Lower the dose if needed to keep your wits about you and your balance steady. Pain medicines also tend to cause constipation. Take a stool softener or fiber product along with plenty of water to prevent constipation. A trial of calcitonin by shot or nasal spray may be worthwhile. If it works, pain usually diminishes within five to seven days.
Additional therapies your doctor may recommend include physical therapy, acupuncture, electrotherapy with a “TENS” unit, and local anesthetic administered at a pain clinic. Sometimes the pain does not respond to these measures and a short hospital stay is needed to control the pain.
Cement Reinforcement. If the pain is too severe for control by conservative measures, another option may be cement reinforcement. The injection of special bone cement into the fractured bone stabilizes it like an internal splint and may even reinflate the bone. The majority of patients get pain relief that can be immediate because the cement prevents movement of the bone while it heals.
There are two types of these procedures: vertebroplasty and kyphoplasty. Many times they are lumped together, but they are distinct. Both techniques are controversial, as there is some uncertainty as to whether they help alleviate or actually create problems.
The procedures can be done on an outpatient basis in the radiology department or operating room. Under x-ray or CT guidance, cement is injected into the center of the broken bone in the back. Local or general anesthesia is used. You are allowed to go home as soon as two hours after the procedure.
Does cementing make a difference? Orthopedic studies tend to be short-term not long-term. My own back pain sojourn taught me that it is necessary to look at a longer time frame in evaluating any procedure. The initial reports of good pain relief are tempered by reports of fractures after the procedures. Several randomized trials using placebo comparison showed no effect. This additional information paints a not-so-rosy picture.
What is the difference between kyphoplasty
and vertebroplasty?
Vertebroplasty. The bone cement is injected under pressure, and it basically “freezes” the bone. Usually, it is not possible to increase the height of the broken vertebral bone. A common problem is the leaking of cement from the bone into surrounding tissue during the procedure. Cement leakage typically does not cause any symptoms, but has the potential for side effects.
Kyphoplasty. The company Kyphon developed this newer technique, hence the name. Kyphon is now part of Medtronics. The aim is to restore some height to the collapsed bone before putting in the cement. A balloon is inflated inside the bone (vertebral body) to create a space for the cement to be injected. Therefore, less pressure is needed to push the cement in. The lower pressure plus the creation of a space makes the cement more likely to stay in the confines of the bone and not leak out. The drawing depicts the vertebral body before and after a kyphoplasty. The height of the bone is increased. The angle of forward flexion is lessened, which helps restore the spine's center of gravity.
SOURCE: Adapted with kind permission from Springer Science and Business Media: Gaitanis IN et al. European Spine Journal 14 (2005): 250-60, figures 6a-b.
In studies comparing those who had cement with those who received conservative therapy, both types of procedures reported good pain-relief results in the short term. Compared with patients treated conservatively, those treated with either vertebroplasty or kyphoplasty experienced prompt reductions in pain and improvements in physical functioning within a day after either procedure. Many of the cement-treated patients were able to stop their pain medicines within twenty-four hours of the procedure. However, when a longer horizon was examined, no differences in pain were seen between groups at one year.
The real proof comes from a comparison of treated and placebo groups. To do this type of study, one group has to actually have the same procedure but with no injection of cement. Two small randomized trials done in that manner with vertebroplasty found no difference in pain relief or quality of life benefit. In both studies, patients with painful osteoporotic spine fractures underwent either vertebroplasty or a simulated procedure without cement. No difference in overall pain improvement was observed between the groups at the one-month mark in one study and at the three-month mark in the other. A larger European study that is planned to last at least one year is currently recruiting subjects with acute pain due to fracture.
As you can imagine, recruitment of participants for a study of this sort, which uses a sham procedure, is difficult. In addition, it raises ethical issues. Selecting the right individuals who may benefit is another challenge. Fortunately, most people improve spontaneously with no intervention. However, those with acute severe pain that is not relieved from conservative measures may benefit from a cementing procedure. The goal of retaining height and posture is also desirable.
A randomized two-year trial called the Fracture Reduction Evaluation (FREE) study compared kyphoplasty with nonsurgical treatment in three hundred subjects who had experienced fractures with acute pain due to osteoporosis. As expected, those with kyphoplasty experienced relief of pain and improved quality of life earlier than the nonsurgical group. However, by the end of twenty-four months, no differences were observed between treatment groups except for a small statistical difference in the ten-point back pain score, with the kyphoplasty group reporting a greater reduction in pain (-0.8 points).
Do Cement Procedures Cause New Spine Fractures?
After several case reports of new spine fractures occurring soon after a vertebroplasty, the Mayo Clinic in 2006 published its experience of all patients who had the procedure. Twenty percent of the 432 patients had new fractures. Subsequent studies reported the same rate. Are new fractures a result of underlying fragile bone or are they the result of the recent cementing procedure?
Fractures in the level above or below the cemented fracture, which happened about two months after the vertebroplasty procedure, were thought to be a result of the cementing. In contrast, fractures in other levels of the spine not next to the cemented level occurred later and were not thought to be due to the procedure.
However, later studies of biomechanics suggest that the cementing procedure may have more than just a local effect. The newly cemented vertebral body is harder than the adjacent ones. Not only are the local mechanical properties changed but the loading of the spine may be different. So it may take less force to cause a fracture anywhere in the spine.
In addition, once one level in the spine has fractured, one is at high risk for subsequent fractures. In the FREE study, almost half of those in both the kyphoplasty and nonsurgical treatment groups had new fractures identified by spine x-ray in the twenty-four-month-follow-up. The majority of the new fractures occurred in other levels of the spine not adjacent to the original fracture.
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Factors Associated with New Fractures after a Cement Procedure
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Research into improved cement materials may help to solve the problem of adjacent-level fractures. New cements are being formulated with the main mineral components of bone. The goal is to find cement that more naturally mimics the composition of bone. The combination of cement and a titanium implant device, called OsseoFix®, has been approved for sale in Europe and is under investigation in the US.
An evaluation of Mayo Clinic patients after vertebroplasty showed fewer refractures in those who participated in a rehabilitation exercise program. The instruction incorporated isometric muscle strengthening of the back extensors that support the spine, as well as postural retraining. A structured therapy program after any fracture with or without cementing is a good idea.
YOUR STORIES…
Laurie, age sixty-two, and her husband were making a move to a smaller place a few miles away. They were downsizing because their youngest child had graduated from college and had taken a job out of state. Laurie's husband quipped that the move was to ensure “no room at the inn” for boomerang children. In the middle of packing, Laurie picked up a box and had stabbing pain in between her shoulder blades. The pain immediately took her breath away.
Over the course of the next several days, the pain became unbearable. She had her husband take her to the emergency room. A fracture of the eighth thoracic vertebra (T8) was found. Her pain was decreased in the emergency room to a tolerable level. She was sent home with pain medicines and a muscle relaxant.
However, the next day the pain returned with a vengeance. She went to see her primary doctor, who suggested another regimen for pain and put in a referral for physical therapy. In addition, he reviewed the DXA scan report that had been done about a year and half earlier. At that time, her bone density was reported as “osteopenia,” with a lumbar spine T-score of -2.
Unfortunately, pain medicine and therapy was not helping to break the pain cycle. One night, when she couldn't even get comfortable lying down, she had her husband take her back to the emergency room. She was admitted to the hospital for pain control. A spine surgeon saw her in consultation and ordered an MRI and doctors from the pain clinic were helping manage her pain. The spine surgeon recommended proceeding with a kyphoplasty. At that point, she wanted to do anything to get rid of the pain. The kyphoplasty was performed and she had immediate relief of pain. She was discharged from the hospital later the same day.
She and her husband finally finished the move into their new home. Her physical therapy continued for two weeks, where she learned exercises and proper body mechanics. In the meantime, she read up on the options her doctor offered her to prevent a future fracture. She had another DXA scan, which showed that the lower two lumbar vertebrae actually had arthritis changes that falsely elevated her bone density scores. When only the first and second lumbar vertebra (L1 and L2) were used for analysis, her spine T-score was in the osteoporosis range, at -3.2.
Two years later…
Laurie's big incentive was to avoid pain ever happening again. She had had no more fractures at the two-year mark. She went all out to improve her bones and overall health. She and her husband joined the local YMCA and now go most days of the week. They do a combination of aerobics and weight exercises. Calcium and vitamin D are regular supplements. She cooks healthier foods and no longer stops at the fast-food places. She took Forteo for two years without problems and is now on generic alendronate. Her bone density after completing Forteo therapy showed an 11 percent increase using the total of L1 and L2, while her hip remained stable.
IF A SPINE FRACTURES HAPPENS,
BE AGGRESSIVE TO PREVENT ANOTHER
The initial enthusiasm for the use of cement procedures after spine fractures has waned. Although the initial pain course may be shortened, over the long term it does not appear to make a difference. Afterward, the problem is that the strongly cemented vertebral body may overpower the rest of the other fragile vertebral bodies and cause new fractures. Different, more natural cements are being studied, as are other devices. In the meantime, the jury is still out. However, a small subgroup of patients with debilitating pain from a recent fracture may benefit from the procedures.
You still have a high risk for fracturing again in the natural course, even without cementing. Make sure there is no other cause of your fracture. Reassess every relevant detail of your life to look for ways you can make improvements; small changes can make a big difference. Consider a two-year course of Forteo. It is the only option that builds bone and reestablishes broken connections. Of note in the pivotal fracture trial, back pain was lower in the Forteo-treated group. Be aware of your body movements. Build up your back muscles and improve your posture in physical therapy. Learn to keep your back neutral and not bent forward as you go through your everyday activities.
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The Bare Bones If a painful fracture occurs…
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Hip Fracture: What to Expect
The risk of hip fracture is a clear and present danger for an eighty-year-old person. On average, a hip fracture occurs within five or six years after reaching that age milestone. An estimated one-third of Caucasian women who reach age ninety will suffer a hip fracture. That is a large number! However, the overall lifetime risk of hip fracture for Caucasian women is lower—14 percent—because many women will die earlier of other causes. About 17 percent of Caucasian men surviving to age ninety will sustain a hip fracture. If you are long-lived, you are at high risk. By educating yourself and your family, and by taking the appropriate measures now, you can make a difference: Hip fractures are not inevitable.
I hope neither you nor your loved ones ever suffer a hip fracture. But if you or they do, things happen quickly, so you must be prepared. In this section, I write from the perspective that the person who has sustained a hip fracture is one of your parents. Because the typical hip fracture occurs in an eighty-something woman, who is living at home, “your mother” will be the patient.
Your mother falls at home and can't get up. She activates her medical alert necklace that dials 911. An ambulance responds to the call and takes her to the nearest emergency room.
EMERGENCY ROOM
In the emergency room, the diagnosis of the fracture is confirmed by x-ray. Making your mother as comfortable as possible is the immediate goal. She will be given pain medicine, fluids by vein (IV fluids), and oxygen. The admitting physician will be contacted to come to the emergency room to evaluate your mother and admit her to the hospital. Depending on the hospital setup, the admitting doctor may be the orthopedic surgeon, a hospitalist (doctor based in the hospital), or her regular doctor. Some hospitals have a designated team organized to handle patients with hip fractures. Others may have set protocols that help deliver a consistent quality of care.
More often than not, the admitting physician is someone who does not know your mother. Giving an accurate picture of your mother's normal functioning status and medical history is critical to her management. With pain medicines on board, she may not be the best historian. You may need to help provide her medical history, or at least direct hospital doctors to her regular internist, family doctor, or specialist, who will be able to fill in the gaps.
Medicines. The medicines that your mother takes will matter greatly to the medical staff caring for her. I cannot stress this enough! Unfortunately, it is often the case that not all medicines are accounted for or specified correctly. Incomplete information can have disastrous (and I emphasize disastrous) outcomes.
I do not want you to just bring a list. You need to gather up all of her medicines and supplements from home. Check the bathroom, the kitchen, and her bedside table to be sure you have them all. On average, women in their eighties take ten to twelve different medicines and supplements. Put all the medicines and supplements in a bag and take them to the hospital. Doctors call review of the medicines “the brown bag assessment.” They will thank you for taking this extra step to ensure complete information.
Do not take the medicines home until each of the treating physicians has physically seen what is inside the bag. A common medical error is not continuing your mother's regular medications. The medicines she takes at home tend to get lost in the shuffle between the emergency room and the hospital floor, and eventually the rehabilitation center or nursing home.
Even if you tell the emergency room staff, the information may not be correctly transmitted to the admitting physician, anesthesiologists, or anyone else responsible for her care. The ball can be dropped in a big way. Think of the childhood game “Telephone,” and you will understand. The first person whispers a sentence or phrase to the next. Each player thereafter whispers the message as he or she heard it. The last player announces the statement, which usually differs significantly from the original. This is amusing if you are playing the game. In real life, such errors can be dangerous.
Critical decisions will be based on her regular medication regimen. If the doctors do not have the whole picture, that may contribute to a poor outcome.
Okay, you have gotten the message about the bag of medicines. Now, it is time to get her admitted to the hospital and up to a room. (If your mother is relatively healthy and has not eaten recently, sometimes she will go directly to surgery from the emergency room.)
PREPARING FOR SURGERY (PRE-OP)
In the hospital room, the bed may be set up with traction (a small amount of weight) to temporarily stabilize the fracture. Pain control is a balance between too much and too little. In order to reduce the chances of blood clots, special stockings will be placed on each of your mother's legs. These stockings will intermittently inflate and deflate to keep the blood flowing. She will continue with oxygen, IV fluids, and get nothing to eat or drink.
The ideal timing for surgery to repair the hip fracture is within twenty-four hours of admission. This does not provide much time to get “tuned up” for the operation. The medical doctors (hospitalists, internists, and cardiologist) may be involved in optimizing your mother's medical status prior to the surgery. Her underlying chronic medical problems will be taken into consideration for planning the type of surgery and anesthesia that will be used. Juggling a complex combination of medical conditions can be very challenging. The last time your mother ate or drank, as well as the medicines she is taking, will also be part of the decision-making.
Some situations may delay surgery beyond twenty-four hours. For example, if your mother was taking Coumadin to thin her blood, it may take several extra days before it is safe to operate because of the risk of bleeding. Once her blood's ability to clot is closer to normal, then the surgery can proceed.
Meeting with the anesthesiologist. The sage chair of surgery during my medical school training, Dr. Hiram C. Polk, taught us that the most important factor in a successful surgery is the anesthesiologist, not the surgeon. The anesthesiologist assigned to your mother's case will also see her before surgery. He will take a history, perform a physical examination, and review laboratory tests, electrocardiogram (EKG), and other records. Based on that information, the doctor will discuss the options for anesthesia.
What Are the Options for Anesthesia?
Plan A: Spinal Anesthesia. The first choice for anesthesia is a spinal, but it is not appropriate for everyone. Many people just want to be “put out.” However, your mother should be assured that she will be kept comfortable and that she will be drowsy but most likely won't remember anything. This approach decreases the risk of complications involving the brain and heart. In addition, less blood loss will occur because blood pressure will be more stable during the operation.
Plan B: General Anesthesia. General anesthesia is necessary in certain situations. The most common reason spinal anesthesia cannot be used is blood thinners like Coumadin (warfarin), Plavix (clopidogrel), and Effient (prasugrel). Your mother may be on blood thinner if she has stents in her heart or legs, irregular heart rhythm called atrial fibrillation, a history of a clotting problem, peripheral vascular disease, or has had a stroke or temporary stroke (TIA). Use of Coumadin may delay the surgery for several days, since her blood's normal clotting function will have to be restored in the absence of Coumadin. If she has taken Plavix or Effient within the last seven days, she must have general anesthesia because of concerns about bleeding.
Another common problem is a heart valve problem called aortic stenosis. The narrowing of the aortic valve requires higher blood pressure and precise fluid management during surgery, which is better managed under general anesthesia. Previous back surgery in the low back area may also prevent the use of spinal anesthesia.
Meeting with the surgeon. By the time you have a chance to sit down with the surgeon, you will probably feel as if you are a character in the movie Groundhog Day. You will think: But I have already told this story to ten people, and I have already given the bag of medicines to at least half that many! Take a deep breath and rewind again. This will not be the last time you recount the information. After going through the same scenario with the surgeon, you will get a different response. He will explain where the fracture is and how he intends to repair it. The options are based on the location of the fracture and whether or not it is displaced (no longer lined up correctly). The surgeon may use nails, plates, or screws to hold the pieces of the broken bone together and allow it to heal. If that is not possible, more involved surgery, which includes replacing the hip, may have to be performed. If there are arthritic changes in the hip joint, a total hip replacement, including the socket may be necessary. The location of the fracture and what has to be done surgically determine the recovery process. Procedures requiring less surgery, such as inserting screws to secure the neck region of the hip, allow for a faster recovery; a total hip replacement involves a longer, tougher recovery.
What the Surgeon Is Talking About: Parts of the Hip and Types of Fractures
The “femoral neck” is the narrowest section of the hip. It lies between the ball and bony projections called trochanters. The major hip muscles attach to the trochanters. The greater trochanter can be felt on the lateral side of your hip. If you have little padding, that area is particularly vulnerable when a fall to the side occurs. The lesser trochanter is internal to your inner thigh. The area between the two trochanters is called the “intertrochanteric” region. Below that is the “subtrochanteric” area—meaning “below” the trochanters.
In addition to the parts of the bone, the blood supply is also shown. Many people are surprised to see these blood vessels because they do not think about the blood flow to and from the bone. The old saying “dry as a bone” is a misnomer. Though it would make the orthopedist's job a lot easier if bone were, in fact, “dry,” the truth is that it's not.
If the blood supply is interrupted, the hip will need replacement. This happens when the broken parts of the bone are “displaced”; that is, when they are not lined up anymore. Also, the location of the fracture may be associated with a greater risk of blood loss. This is particularly true for breaks across the subtrochanteric area.
Fortunately, subtrochanteric fractures are uncommon. Of the three major types of hip fractures in older persons, subtrochanteric fractures account for less than 10 percent. The majority of hip fractures are split about equally between femoral neck and intertrochanteric fractures.
The best-case scenario is a femoral neck fracture that is not displaced. In such cases, a small incision of less than two inches will be made so that the surgeon can insert about three screws to stabilize the fracture. The surgery will take only thirty to forty-five minutes.
SURGERY
Less than a day has gone by and your mother has most likely already been to the operating room. The duration of the surgery was dependent upon which type of surgical repair was performed. The risk of blood loss was related to the location of the fracture, the repair, and the anesthesia.
With spinal anesthesia, the anesthesia slowly wears off and small amounts of pain medicine are gradually increased. In contrast, after general anesthesia a patient will wake up and immediately experience pain, so pain management will require larger doses of medicine right away. Unfortunately, pain medicine and older age are not a good combination. Quite often, patients wake up confused or entirely disoriented.
After the surgery is completed, the surgeon will come out to the waiting area. He will give you a brief description of what was done and how your mother did during surgery. Once she has awakened in the recovery room and the activity has quieted down, the recovery room nurses may invite you to go to her bedside. Otherwise, you will meet her back in the hospital room.
AFTER SURGERY CARE (POST-OP)
Control of chronic medical problems and prevention of postoperative complications are both key to a smooth recovery. A respiratory therapist or a member of the nursing staff will provide breathing treatments every two to four hours to prevent pneumonia. Control of your mother's pain and her reaction to pain medicine tends to be “a wild card.” Also, factor in sleep deprivation, the trauma of surgery, waking up in a strange place, and constant poking and prodding.
All of these may contribute to confusion and disorientation. If there were pre-existing memory loss issues, they may be heightened during this time. Unfortunately, sometimes the confusion never clears. Patients who have had general anesthesia are at even higher risk of permanent memory problems. It is imperative for you or a designated person to stay with your mother in her hospital room, if at all possible.
Which brings me to an important point: You need to take care of yourself and get some rest. You cannot be there twenty-four hours a day. Inquire about using “sitters” during the night, particularly if confusion and disorientation are a problem. Sitters are usually trained health aides, who will sit by your mother's bedside with a watchful eye and tend to her needs. They will also ensure her safety.
Management after surgery focuses on mobility as soon as possible. This is a good predictor of long-term success. The day after surgery, the physical therapist will start to work on getting your mother moving. If she had screws or nailing of the fracture, she will not be able to put weight on her repaired leg for four to six weeks. If she had a hip replacement, a physical therapist will get her standing right away.
The energy expended in physical therapy is sometimes much more than the energy expended during one's physical activity prior to surgery. Heart problems may be unmasked, such as angina (chest pain) or even a heart attack or congestive heart failure.
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Common Problems after Surgery
Later problems
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Discharge planning. Preparing for the next step, rehabilitation, starts almost as soon as your mother is admitted to the hospital. Length of stay depends on the extent of the surgery and how smoothly the recovery goes. A person who specializes in discharge planning will meet with you and will explain your mother's options. You will usually have more than one choice of rehabilitation facilities. Some are located in skilled nursing facilities (SNFs) and others are dedicated rehabilitation facilities, which are typically staffed by physiatrists, who are physicians that specialize in rehabilitation medicine. Be sure to visit each facility during the day to see the staff in action. You can schedule appointments with the admissions coordinators at each rehabilitation site. Talk to whomever you can during your visit: patients, their family members, the therapists, etc.
It is natural to feel overwhelmed by all of this. You may feel as though you need to be in more than two places at once, so schedule some help—family, friends, or professionals—to cover for you at the hospital.
REHABILITATION
In rehabilitation, the focus is not only on therapy for the hip but also on optimizing care for chronic problems. Medicines may need to be modified and adequate vitamin and mineral supplements need to be put in place. Often times, nutrition falls by the wayside. Supplementation of the diet with protein may be helpful to boost healing and recovery of strength.
Fall Prevention. Risk of falls is high following hip surgery and preventing them will require vigilant attention. Vitamin D plays an important role in fall prevention, not only for the bone but also for muscle function. The vitamin D blood level needs to be above 30 ng/ml. Improved muscle function will decrease the risk of falls. Fear of falling is also a common problem. The physical therapist and staff will help ensure safe mobility by teaching your mother to use a walker or cane and by building her confidence. Hip protectors that cushion the hip to decrease the blow of a fall are a great concept. However, in clinical trials so far, the materials used do not prevent hip fractures. In addition, they are bulky and difficult to put on, so people do not like using them.
Consider Reclast. The risk of another fracture within a short period of time is quite high. Increasing bone density in a short period of time can make a difference in lowering risk. Only one medicine, Reclast, has been tested in a clinical trial of patients after a hip fracture. Not only did the patients receiving Reclast have fewer fractures, their death rate over three years was 28 percent lower. This is more than an added bonus of its use, considering the high rate of death after hip surgery. Reclast is given by vein once a year.
When should the first annual dose of Reclast be given? Giving the first dose of Reclast any time from two to twelve weeks after hip fracture shows effectiveness in decreasing risk of fracture and death. Because of the cost, the nursing home may not want to administer it during the rehabilitation phase. You can make arrangements after that time period, if necessary. You may consider other medicines, but this is the only one tested in this situation. However, reduced kidney function may prohibit its use.
Medicare Part A. Medicare covers the cost of rehabilitation up to a total of one hundred days, as long as progress is being made in therapy (the clock starts with the day of admission to the hospital). Many frail patients simply cannot meet the therapy requirements, so therapy is stopped and they are forced to transition to another facility before they have reached their full rehabilitation potential. Unfortunately, this is a common scenario.
THE NEXT STEPS
Recovery will be dependent both on your mother's level of function prior to the fracture and on the progress she made in the hospital and during rehabilitation. Be prepared to plan for a change in her living situation. Most likely, your mother will not be able to live independently. In less than two months, both your mother's life and your life will have drastically changed. A seemingly neverending series of decisions will have been made in a short period of time. These changes are stressful. Be on alert for depression in your mother and for your own sheer exhaustion. It will be a difficult and challenging time. Keep your wits and stamina by getting plenty of help and support from your family and friends. By talking about it, you will discover others who have been down the same road with one of their parents, which will provide important information, as well as comfort and support. You will find that you are not alone.
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The Bare Bones Hip fracture is an all-too-common event for women and men in their eighties. Here is some essential information for getting your parent through the ordeal:
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