Osteoporosis & Osteopenia
A Cause of Vertebral Compression Fractures
Osteoporosis is a condition in which the bones of the body become weak and it is generally considered a part of the aging process. It begins when the body takes away more calcium from the bones than it deposits into the bones. With osteoporosis, the bones can become brittle as the bone mass and density is lost.
Weakening of the bones of the body is a gradual process. As the disease advances, the bones can easily fracture. This fracture can lead not only to pain but also deformity of the body.
Kyphosis refers to the abnormal curvature of the rib-bearing thoracic spine. An increase in kyphosis may develop as a result of poor posture early in life, or as a result of compression fractures of the spine, often seen with osteoporosis.
Related to Osteoporosis, Osteopenia refers to a weakening of the bone in which the bone is not as strong as a normal bone nor is it as weak as an osteoporotic bone. When bones become weak, they transition in strength from normal bone to osteopenic bone to osteoporotic. In the United States alone, over 700,000 osteoporotic vertebral compression fractures occur yearly.
Symptoms of Osteoporosis
Osteoporosis is considered to be a silent disease because it is often not noticeable until one develops pain or a deformity of the body. It often reveals itself as a fracture of the spine, hip or ribs.
When a fracture of the spine occurs, the patient experiences pain, and if the fracture is severe enough, the patient may notice bent over posture known as kyphosis. The patient may also notice that they are shorter. With severe cases of kyphosis, patients may experience gastrointestinal symptoms, as well as difficulty breathing.
Osteoporosis occurs with aging. Women are more prone to develop osteoporosis after menopause, due to changes in estrogen levels. Calcium is essential for the strength of the bones in the body. When osteoporosis occurs, more calcium is taken out of the bone than is replaced into the bone. This imbalance of calcium in the bones leads to weakening of the bones and eventual fracture. Bones gradually change from normal in strength to osteopenic to osteoporotic.
Diagnosis of osteoporosis and osteopenia is made using a bone mineral density test. A scan known as a DEXA scan enables a measurement of bone mineral density to be made. A result known as a T score is generated. T scores refer to a comparison between the bone density of a patient and that of a young Caucasian woman. A T score of +1 to -1 is considered normal bone density. A score of -1 to -2.5 is considered osteopenia or low bone density. A score of lower than -2.5 is considered osteoporosis. In addition, x-rays of the bones of a patient with osteoporosis may show fractures or a type of “washed out appearance” in which the bones are poorly seen due to loss of calcium.
Women are more likely to develop osteoporosis than men. As one’s age increases, the likelihood of developing osteoporosis increases as well. Individuals with low body weight are more likely to develop osteoporosis than are those who are heavier. Estrogen deficiency is a risk factor. Caucasians are more likely to develop osteoporosis than are those of other ethnic backgrounds. Cigarette smoking is a risk factor for osteoporosis. Those with a family history of osteoporosis are also more likely to develop osteoporosis. Osteoporosis is also known to affect those with a sedentary lifestyle more so than those with an active lifestyle.
Osteoporosis is also associated with certain endocrine disorders (hyperthyroidism, hyperparathyroidism, Cushing's disease and others). Certain medications including steroids, excessive thyroid hormone replacement, anticonvulsants and others are known to cause osteoporosis.
Causes of nutritional deficiency such as malabsorption, liver disease and alcoholism are associated with osteoporosis. Malignancy such as multiple myeloma is also associated.
Prevention of osteoporosis is aimed mainly at decreasing or eliminating those risk factors which can be avoided or diminished. Exercise which includes weight bearing exercise that place stress and strain on the bones is important to prevent osteoporosis. Adequate nutritional intake including vitamin D and calcium is important.
At times, nonsurgical options may be useful in the treatment of compression fractures of the spine due to osteoporosis. Braces can be used to provide support to this area of the body. It is important that the brace be tall enough to adequately protect the portion of the body involved. Pain medications including nonsteroidal anti-inflammatory medications (NSAIDS) may be effective.
All patients who meet the bone mineral density criteria for osteoporosis, whether or not they have fractures, should be treated with medications to improve their bone density. Adequate intake of calcium and vitamin D is essential. For women in post-menopause, estrogen intake may be needed. Medications such as the antiresorptive biphosphonates alendronate and risedronate are important. Human parathyroid hormone is effective as well.
Percutaneous augmentation of the vertebral body using a medical grade type of cement (Methylmethacrylate) provides pain relief in up to 90% of patients. There are two techniques which are generally used, vertebroplasty and kyphoplasty. With vertebroplasty, the bone cement is injected into a hole created within the vertebral body. This helps to strengthen the vertebral body but does not change the shape of the body. With kyphoplasty, the height of the vertebral body compressed is partially restored by a balloon expanded in the compressed body. After the balloon has been expanded, cement is placed within the vertebral body. Kyphoplasty not only solidifies the strength of the vertebral body but also helps to correct some of the kyphotic deformity of the spine.
With proper medical treatment and exercise, osteoporosis and osteopenia can certainly be improved. As far as osteoporotic compression fractures of the spine, surgical treatment with kyphoplasty and vertebroplasty have excellent results. It is important to remember however, that although the levels treated with medical cement have been stabilized and hardened, decreasing the risk of future additional fracture, other levels of the spine are still osteoporotic and at risk for fracture. Therefore, after the successful surgical treatment of an osteoporotic compression spinal fracture, nonsurgical management must be implemented to attempt to correct osteoporosis in the body.
For more information on Osteoporosis or for a consultation at the Kraus Back and Neck Institute please call: