History is Key
What is your Objective
To See or not To See
Treatment Considerations
More Treatment ??
Prevent Defense
100
what % of VCF are undiagnosed or discovered incidentally
what is two-thirds
100
Sorry Charlie
No points for this one
100
Nope,
Nuthin here
100
True or False
VCF = fragility fracture = osteoporosis
True
100
First line analgesics typically include NSAIDS and Tylenol. These three are the next medications FM can consider prescribing.
What are...
bisphosphonates
calcitonin
teriparatide
100
If a patient has a VCF, this is when they can stop supplementation with calcium and Vit D.
What is never
200
What are some common activities that may trigger a VCF?
Lifting light objects
Sneezing or coughing
Rolling over in bed
200
As part of your exam, visual inspection of spinal posture in a patient with a compression fracture may reveal this.
What is increased thoracic spine kyphosis or loss of lumbar spine lordosis
200
The initial imaging recommended for suspected VCF and the % is considered diagnostic for vertebral height loss
What is AP and lateral plain film xrays
What is 20% loss of height compressed vs normal portion
Anteroposterior Lateral
200
The three listed goals of treatment are...
what is...
regain function and mobility
mitigating pain
prevent future fractures
200
Orthoses should only be used for _____ duration because chronically, they may contribute to ________.
What are...
up to 8 weeks
weakening of the core musculature
200
The article recommends these two types of exercises to prevent VCF
What is weight bearing and resistance-training exercises.
300
the article lists common risk factors for VCF, of the 7 mentioned, list 3
-chronic corticosteroid use
-body weight less than 53 kg (117 lb)
-age older than 70 years
-excessive alcohol consumption
-smoking
-vitamin D deficiency
-depression
300
These are the three listed provocative tests.
Describe how do you perform them
What are...
closed fist percussion
supine sign
back pain inducing
300
Times to consider alternate testing if x-rays are negative. Are there any caveats to consider?
If suspicion for fracture remains high, CT or MRI.
If unable CT or MRI, consider xray with flexion/extension views
300
The article lists 5 modalities of conservative therapy for VCF, these three FM can utilize.
What are pharmacologic, bracing and PT?
300
These are the two surgical interventions listed.
How do they differ?
What is vertebroplasty and Kyphoplasty
300
Patients with VCF have a _______ fold increase in other VCF and _________ fold increase in fractures at other sites.
What is 5 fold and 2-3 fold
400
describe the mechanism of action as to why VCF don't commonly have neurologic compromise
Neurologic involvement is rare in vertebral compression fracture because the anterior vertebral body collapse moves the spine into flexion and opens the neural foramen.
400
Of the three provocative tests listed, which has the greatest specificity?
supine sign 93%
closed fist percussion 90%
back pain inducing 68%
400
After an x-ray shows a VCF, these are times to consider imaging with either CT or MRI
What is to differentiate acute/subacute/chronic
What is h/o malignancy (contrasted MRI)
400
Supportive bracing has been proposed to reduce pain, stabilize the spine and assist with mobility albeit mixed evidence.
These are the two discussed braces from the article.
What are three-point and Dynamic corset
400
Both procedures have similar short and long term _______ outcomes but ________ is more costly.
What is...
disability outcomes
Kyphoplasty $$$
500
From Table 1 in the article, name the 3 classes of medications we common use in Family Medicine that impact BMD via calcium or Vit D
500
Long-term sequelae from VCF often include decreased mobility or limited activities, chronic back pain, loss of vertebral height and kyphosis-name at least one other problem that can be attributed to VCF
What is...
decreased respiratory function
urinary retention
venous thromboembolism