Case Study: 78-Year-Old Man with Osteoporosis and Vertebral Fracture

Patient Profile

  • Age: 78 years old
  • Gender: Male
  • Medical History: Hip replacement
  • Current Presentation: attended physiotherapy with back pain following 2-month stay in hospital.

Clinical Background

The patient had been admitted to hospital, and had unfortunately spent two months mostly bed-bound. During his time in hospital, he developed back ache and back pain. When he was released from hospital, his posture had become slightly forward bent. His back was very stiff and he was having mild difficulty with mobility and walking. There were no red flags and no serious signs of severe pathology. There was no trauma.

Diagnosis

The gentleman had not been diagnosed with osteoporosis when he presented for physiotherapy. Vertebral fractures are significantly less common in males compared to females.

Contributing Factors

  • Age-related frailty: Reduced muscle mass and balance issues heightened risk of falls and injury. The patient had become less mobile due to being in hospital and had lost weight.
  • Polypharmacy: None
  • Comorbidities: Diabetes and general frailty may have contributed to poor bone quality and slower healing.

    • Management Plan

    We treated him about 3-4 times but with minimal or no improvement. From about the third session, we suggested an MRI would be beneficial although on mutual agreement, the treatment continued.

    The MRI scan showed two wedge compression fractures at T12 and L1. The bone marrow oedema present suggested that the fractures were recent. In T12, there was a greater than 50% collapse.

    Spinal MRI Spinal MRI

    We referred the patient to Michael Kotrba, at Shirley Oaks Hospital in South London. Michael is an expert in vertebral fractures and kyphoplasty. The patient underwent kyphoplasty successfully at two levels.

    Spinal imagery

    The patient was then referred to Riz Rajak at Shirley Oaks Hospital for injectable osteoporosis medications.

    Rehabilitation phase

    1. Physiotherapy

    • Initially gentle mobilisation to the spine.
    • Exercises for leg strength, and posture.
    • Gentle core strengthening to support the spine.
    • Gait re-education, focusing on posture and weight-bearing precautions.
    • Falls prevention education and home safety assessment.
    • Ultrasound to the spine.

    Exercises:



    Repeat 10x, twice per day.



    Repeat 10x, twice per day.



    Repeat 10x, once per day.



    Repeat 10x, twice per day.

    Outcome

    Following the surgery (kyphoplasty) the patient reporting positive improvements with his lower back pain. His mobility had slightly improved.

    Over the course of 6 months, he put on weight, his mobility and strength significantly improved, and he improved his posture. He had to work hard at it, seeing us twice per week for the first three months. He made a reasonably good recovery at the time of writing this case study, with further improvements expected over the next six months. Total rehabilitation time: 12 months.

    Learning points

    • Osteoporotic fractures, including perioperative fractures, are a serious risk in older adults who are bed-bound.
    • Early identification of osteoporosis and proactive management can reduce fracture risk, but surgical teams must remain vigilant during procedures.
    • Fragility fractures can be multisite, especially when a significant event (like surgery) triggers mobilisation stress on weakened bones.
    • Multidisciplinary care—involving surgeons, physiotherapists, occupational therapists, and osteoporosis specialists—is essential for optimising outcomes and reducing future fracture risk.