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Fell down and started pain in the chest and thoracic back. What should be done to cure the problem?

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Spine Surgeon
Practicing since : 1998
Answered : 116 Questions
Dear Doctor,
My Husband, 31, had a fall due to getting unconscious because of neurocystecircosis about three years back.On gaining consciousness back, he felt a lot of pain in the chest and thoracic back.
He was under treatment for about 2 years from then for the neurocystecircosis and the chest & back pain was ignored by doctors saying that its muscular.
However, the back pain did not cure even after 2 years.
Then he was suggested to carry out a Bone Mineral Density Test for which the values were found to be -2.4 for both T and Z scores(osteopenia).
After this test, he was told by the ortho surgeon that he had a compression fracture at that time of his fall which has caused a small change in the shape of a vertibra in the thoracic back which is the cause of the persisting pain. He was also told to take a injection called Bonesta(which he has not started yet).
His current problems are.
1.) Pain in the upper back and tired XXXXXXX all the time.
2.) pain in the bones in general.( more in the feet and fingers of hands)
He is taking following medicines
1.) Shelcal 500 (once in night daily)
2.) Cod liver oil (for vitamin D)
I wish to know from you that
1.) Is injection Bonesta a must? Is there any substitute for this?
2.) Would the Compression fracture have healed by now(abt 3 years)in a wrong shape? If yes, what are the treatments that should be taken by him to get relief from the pain?
3.) what measures should we take to cure the osteopenia.
Regards,I want to report that his Vitamin D3 Level is also insufficient(21.2 ng/mL). however the calcium level is normal(8.9 mg/L)
Posted Tue, 13 Nov 2012 in Osteoporosis
Answered by Dr. S K Mishra 4 hours later
Thanks for writing to us.
I would like to comment on two things.

1. About calcium and Vitamin D level
a. First calcium level is lower side of normal(9-10.5 mg/dl).

b. Also the amount of total calcium varies with the level of serum albumin, a protein to which calcium is bound. The biologic effect of calcium is determined by the amount of ionized calcium, rather than the total calcium. Each 1 g/dL decrease of albumin will decrease 0.8 mg/dL in measured serum Ca and thus 0.8 must be added to the measured Calcium to get a corrected Calcium value.

c. Also note that if he is taking antiepileptics they interfere with vitamin D absorption making vit D low , but as he is taking calcium supplement Ca may be normal.

2. About injection (vertebroplasty)
a. Can be considered if there is tenderness at fracture site and may help in pain improvement

b. However it is a risky procedure and if spillage occurs in dorsal spine weakness may ensue

c. If you opt for vertebroplasty consult an intervention radiologist expert to have best results eg Prof (Dr) A K XXXXXXX NIHMANS Banglore .

Hope that helps
Above answer was peer-reviewed by
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