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Spinal fractures - linked to long term use of Prednisolone?


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#1 suze932

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Posted 19 May 2013 - 08:00 AM

Spinal Fractures - linked to long term use of Prednisolone?

 

Has anyone experienced spinal stress fractures following taking steroids for a long time? 

 

I have just got out of hospital having spent 5 days after fracturing 2 thoracic vertebrae whilst twisting and moving a window box, virtually no weight-bearing involved.  I was informed by the orthopods that this manoevre alone should not have caused such an injury and so the follow up apart from bed rest, no lifting, twisting  etc.etc. is to check whether I have osteoporosis as a result of long term (20 months) use of steroids for Scleroderma inflammation.

 

Any advice from anyone experiencing similar problems would be much appreciated.  A problem shared is a problem halved and all that stuff............

 

:thank-you:

 



#2 Joelf

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Posted 19 May 2013 - 12:38 PM

Hi Suze

 

Sorry to hear that you've fractured two thoracic vertebrae; my husband experienced a similar injury (nothing to do with taking steroids) and it was very painful!

 

I've included our Glucocorticoids, Steroids Warnings for Scleroderma for any new members reading this thread. I know that prednisolone can cause thinning of the bones as I've been taking it for the past four years and I have to take Alendronic Acid once a week and a Calcium and Vitamin D supplement daily to counteract the effect of it. I also have a bone scan every two years to check on my bone density (my mother suffers with osteoporosis and has been on steroids since about the year dot!!) I do have a little mild osteopenia in my hips and unfortunately I've found with steroids that the side effects don't really become apparent until after several months usage (I was unbelievably smug when I first started taking them as it appeared that I wasn't developing any side effects in the beginning and I foolishly thought I'd be able to carry on like that ad infinitum.......how dumb can you get?? :rolleyes: ;) )

 

I would imagine that you'd have a bone scan and perhaps your doctor can suggest a medication such as Alendronic Acid and a calcium supplement to help you. I do hope that your fractures improve very soon.

 

Kind regards,


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#3 suze932

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Posted 20 May 2013 - 02:59 AM

Thanks for such a rapid response.

 

The link was really useful as although I take a Calcium supplement to counteract the effect of the steroid I did have osteopenia at the last DEXA scan last year and am now due to have another DEXA soon.  Hope that whatever has caused the fractures can be got to grips with before too much damage is done as, as you say from your husband's experience, it is very painful and debilitating.  Highlighted by the fact of doing something REALLY stupid I caused the injury to myself! Superwoman I definitely ain't - more like a flipped turtle at the moment!

 

The support of the forum is so appreciated.

 

:thank-you-2:



#4 judyt

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Posted 20 May 2013 - 03:12 PM

Hi Suze,

 

I know just how you feel!!   I slipped off a stool - my own stupid fault entirely - in 2004 and crushed my T7 (I think) which is just between my shoulder blades.   I was picked up by an Ambulance crew who took me to an emergency facility not the hospital.   The hospital was overrun by Flu patients and the Ambos thought I would get treated quicker at the other centre! I was dealt with quickly but not correctly.  6 months later and still in pain my GP discovered that I had crushed my vertebra and it was too late to do anything much about it.   

 

I still have trouble with pain at the end of the day if I have been standing for very long and the only thing to do is lie down flat on my back for 30 mins or so.   Then I fall asleep of course and so it goes on.

 

I take the weekly  Alendronic acid therapy which helps the Osteopenia in my hips too and keep my fingers crossed that I don't do anything else so stupid.

 

In fact, for a couple of years I was well enough to go twice weekly to a Womens Fitness centre and my back responded to that very well, but now that I am not so well and I don't go there any more I am back to having to rest quite a bit.

 

Best wishes for your recovery,

 

Judyt



#5 Shelley Ensz

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Posted 05 June 2013 - 08:12 AM

Hi Suze,

 

Oh my goodness gracious. I am sorry you have some fractured vertebrae. 

 

When our bones are weakened, it really doesn't take anything at all for them to break, so try not to blame yourself for moving the window box. You know how they always report that so-and-so fell and broke their hip? Whereas in reality, most of the time the hip just plain broke and caused them to fall.

 

Unfortunately there are a lot of warnings against giving steroids to scleroderma patients. Steroids greatly increase the odds of sudden kidney failure and even of pneumonia, in scleroderma patients. And then of course there are the minor little details of all the usual steroid side effects, such as you may have encountered with osteoporosis. See Glucocorticoids, Steroids Warnings for Scleroderma.

 

This is something you can discuss with your doctor, to see whether or not you have any other treatment options. And of course, never discontinue steroids on your own and only with the supervision and directions from your doctor, because stopping steroids suddenly or inappropriately can be far worse than any side effects.  I know you wouldn't do that; that caution is just for others who may read this thread and get the horrible and even potentially deadly "great idea" to quit their steroids on the spot. Steroid discontinuation is never a do-it-yourself project!

 

How long will it take for you to recover from the fractured vertebrae?  What sort of limitations do you have while they are healing?

 

I hope you feel a little bit better, soon!

 

:emoticons-group-hug:


Warm Hugs,

Shelley Ensz
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#6 suze932

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Posted 09 June 2013 - 02:48 AM

Hi Shelley

 

Thanks for the good wishes.

 

Unfortunately at discharge from hospital I was only told to 'let nature do its thing' and no twisting and bending, lifting etc. but no idea as to how long I will be incapacitated.  Google was, as usual, worst case scenario of several months recuperation but at least I have learned to take this type of advice with a pinch of salt (low-sodium of course!)   I am doing as I'm told but still having a lot of pain. and just have to try to keep ahead of it with the painkillers I usually take for chronic back problems.

 

However,I have a local Rheumy appointment on Tuesday and will bring up the continued use of/gradual withdrawal of  steroids, (if possible)  and hopefully get an idea of when they will re-DEXA scan me to give an idea of the osteoporosis damage thus far.  At least I will know what I am up against. The wheels always seem to go round especially slowly when awaiting results, don't they!

 

Am currently on double crutches and getting about indoors. I know I should be exercising, such as gentle walks, but without medical guidance am frightened to do too much, too early - it's a month today since my accident - so a combination of lying down and movement seems to be the thing.  In other words I must listen to what my body tells me to do! Just as well the French Open tennis is on and I have plenty to keep me busy as I am going slightly stir-crazy!

 

Will keep posting. :emoticon-dont-know:



#7 Amanda Thorpe

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Posted 26 June 2013 - 12:11 PM

Hello Suze

 

My goodness, isn't it amazing the damage we can do to ourselves? A work colleague ruptured discs by twisting round for the hair dryer. A former doctor told me it's the small unguarded movements that cause the damage and how true that is!

 

Take care.


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#8 suze932

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Posted 01 July 2013 - 02:44 AM

After I saw my local Rheumatologist and asked about the continued use of steroids and other medication being linked to my osteoporosis (diagnosis now confirmed).  He is of the opinion that as I am currently feeling so rough after the injury, that I should stay on all my meds for the time being as tapering me off the steroids would probably be counter-productive at this time as they are helping to keep me going!  Swings and roundabouts I s'pose!

 

He has also put me on Alendronate for the osteoporosis - a once weekly pill which must be taken standing up and with no food or other medication as otherwise it causes burning to the oesophagus - lovely!

 

Otherwise I am taking slow exercise and managing to frighten the passers-by with my wheelie-zimmer-frame!  At last I feel as though some progress is being made to recover from these fractures and that alone is a lot to be grateful for!  Thanks for everyone's support over the last couple of months.

:emoticons-clap:  :you-rock:



#9 Joelf

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Posted 01 July 2013 - 04:00 AM

Hi Suze,

 

I've been taking the Alendronic acid tablet once a week for the last four years; it is a bit of a pain to have to wait 30 minutes before I can have a cup of tea or anything else, but providing I drink a large glass of water with it, I've never suffered any burning of the oesophagus with it. Actually, I used to do my ironing during the 30 minute interval, but I considered that it made me rather a sad case, so now I go straight onto the forums and do some work there....much better!! ;)

 

Kind regards,


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#10 dorothymay

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Posted 17 August 2013 - 10:12 AM

I had pain in my wrist and xray found a fracture. A scan showed osteoporosis so I was put on Alendronic acid but couldn't swallow it due to the effects of the sclerodrma so am now having yearly infusions thanks to my rheumatologist.

#11 judyt

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Posted 17 August 2013 - 01:05 PM

Hi All,

 

I have been thinking about Alendronic Acid a bit this week so am interested to read this thread again.

 

I mentioned a while ago that I had crushed my T7, and that was in 2004.   Had a bone density scan after that and have been on Fosamax plus since 2006.   I had read somewhere, or been told, that after 5 years there is no more benefit from Fosamax.  So when I saw my Rheumy for my annual visit about 10 days ago I asked what he thought.

 

His response was that one doesn't just stop taking it without first checking on how things are going bone wise.   So I had another scan last week which showed that my bones are back to the middle of the normal range :terrific:  and then on Friday I had a special blood test, the name of which escapes me.   That is supposed to show something about my bone health and after that the decision can be made as to whether I discontinue Fosamax or not.

 

I, personally don't find the therapy hard to cope with, as long as I can remember which day is Sunday :emoticon-dont-know: .   I sit up in bed with my laptop on my knee just as I am doing now while Ian reads the paper and we don't get up and going till quite late sometimes.   Bliss.

 

I have to say that all in all I have been very pleased to find that all this "effort" has had the desired effect.  I am just wondering now that if I stop the medication, what will happen to our lazy Sunday mornings??

 

Best wishes to the rest of you in dealing with these things.

Judyt



#12 suze932

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Posted 18 August 2013 - 02:51 AM

Hi Judy

 

Thanks for the posting.  My update on the thread is that 2013 has so far been a Kamikaze year as I seem to be in self-destruct mode, having suffered a heavy fall on my right shoulder, jarring my neck and spine, when getting out of the bath.  Careless or what but apart from feeling really stupid, the knock on joint inflammation effects have been really excruciating.  I am not normally a wimp about pain but don't seem to be able to get it under control, in spite of patches and painkillers.

 

I have not so far been back to see my orthopod and no appointment to be  re-DEXA-scanned to see how the Alendronic Acid is affecting my bone density score so am going back to my GP this coming week to see what she suggests, although it is usually a straight re-referral to wherever is thought fit!  Can you remember what kind of recuperation time your spinal fracture took to heal.  Obviously in view of the above'dive-bomb episode'  I will have to add on some considerable time for my recovery but it would be nice to have an idea as prospects seem to be gloomy at the moment.

 

Thanks for everyone's support.

 

Sue :emoticons-clap:  :emoticon-hug:

 

 



#13 Joelf

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Posted 18 August 2013 - 07:46 AM

Hi Sue,

 

I am sorry to hear that you've had another fall and that you're suffering such a lot of pain.

 

I do sympathise; a month or so ago I came off a very exuberant horse and hit the deck rather hard!! Although at the time I got back up again and carried on riding him, afterwards I felt terrible and ached everywhere particularly my head, neck and back, so much so that I went to the local A&E where they did xrays, a CT scan and an MRI scan of my neck, but thankfully nothing was broken.  I put that down, in part, to my taking Alendronic Acid and also a calcium and vitamin D supplement. I had the most fantastic set of bruises though and everything that moved hurt!! I really am getting too old to hit the ground at speed; I just don't bounce anymore!! ;)  :blink:

 

A DEXA scan I had last year showed slight osteopenia in my hips, but other than that my bone density is fairly good for my age, despite my taking steroids for the past four years. You might find though, that you might need to take the Alendronic Acid for a longer period, in order to get the most benefit from it. I'm not sure how long your spinal fracture will take to heal, but my husband, who's managed to break a various assortment of bones over the years, usually takes 6-10 weeks for them to mend.

 

I do hope you will soon feel much better and that you don't have anymore Kamikaze episodes!! :emoticon-hug:

 

Kind regards, 


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#14 judyt

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Posted 18 August 2013 - 01:35 PM

Hi Sue,

 

Reading back over this thread I see that you talk about a spinal fracture and a fall in the bathroom.   You certainly are in the wars this year.   You asked me how long the healing process took and I am almost too afraid to tell you :crying:.   In 2004 when I first fell and crushed my T7 I was in agony for weeks.   Not only did I have an undiagnosed fracture/crush injury but I had also hit my hip and I was sore all over it seemed.   I didn't have any time in hospital but Ian hired a wheelchair for a couple of weeks to get me around and I don't think I got out of my dressing gown for all of that time either.

 

In general, as Jo has said, it takes about 6 weeks for a fracture to heal.   Ian has Multiple Myeloma, a bone marrow cancer which causes bones to become brittle, and he has had one spinal fracture which took about 6 weeks.   He is very careful now but even so as you know it is easy to damage yourself when things are going wrong anyway.

 

At first I was advised to get some Physiotherapy as soon as I felt able, but because of the crush I think that was probably the wrong advice.  

 

At last after 6 months I asked my GP for advice and by then she said the only thing was Physio so I started that again.  

 

I went to a sports Physio, because they are experts in all sorts of fall injuries, and he started me on Pilates type exercises which strengthen your core muscles.   After a few sessions with him I tried joining a Pilates group near home but I found that was too much for me.  

 

Remember with Sclero we have reduced exercise capacity anyway.   The best thing I did was to join a Women's Fitness centre based on a circuit where you spend only 30seconds on each machine.   At first I couldn't believe that such a short time could do any good but I found that after a good number of circuits the therapy did do a lot of good.   I went there for a couple of years twice a week until I found even that was too much for me.   I spent so much time sleeping after I got home that I decided it was easier to stop.

 

I have noticed the difference now in my stamina, and in my muscle tone but I am really not able to start that lark again so I am back to having to rest often and lie down for 30mins or so when my back gets too tired and sore.

 

It is hard to tell what is causing the most grief for us, the injury or the effects of Sclero and our meds.   In my case, because I am quite a lot older than most of you others I just accept my limitations and get on with enjoying what I can do and try not to even think too much about what I can't do.   Fortunately, unlike lots of ladies my age, I don't have a weight problem unless you call being too skinny a problem, so I like to think that must help.

 

You have my sympathy and very best wishes that you will improve.

Judyt



#15 Amanda Thorpe

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Posted 19 August 2013 - 02:19 PM

Hello Sue

 

I am sorry pain is getting you down, it most certainly can. I guess the positive is that your pain will diminish with time as your fracture heals. I don't know if any sort of physiotherapy would help you?

 

Take care and I hope you feel better soon.


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#16 suze932

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Posted 25 August 2013 - 12:30 AM

Hi ladies

 

Thanks so much for your positive input to my falls and recuperation whingefest!

 

My general practitioner (GP) has now referred me back to my local Sclero specialist- hopefully prior to my September Royal Free Rheumatology appointment - to see what he suggests re. onward treatment and osteoporosis recuperation.  

 

GP has also referred to a physio as it is my great belief that unless we keep moving we stop altogether!  The first three sessions have given me some tips on how to manage movement and so far it seems to be working, unless I do too much in which case pain is not easy to get a handle on, but amytriptyline short term at least allows me to sleep.  Will come off this as soon as I can though.

 

Your kind support and advice is great. Thanks.

 

Sue



#17 Amanda Thorpe

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Posted 27 August 2013 - 03:11 PM

Hello Sue

 

I was on 75mg of amitriptyline for a few years and found it easy to come off, slowly does it though, glad it and the physiotherapy are helping. Amitriptyline is very good for neuropathy when prescribed at a higher does, like 75mg and that's what I had it for.

 

Take care.


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