Osteoporosis of the Spine

“Osteoporosis” refers to weakness of the bones. It is a disease that causes bones to become brittle. It is a progressive condition that gets worse with age. Usually, it affects all bones of the body with a greater predilection for hips, wrist and spine. In spinal osteoporosis, the spinal bones get affected in such a way that even a simple a fall or mild strain such as bending over or coughing can cause a fracture.

Bone is a “living” tissue – it is continuously broken down and replaced. Osteoporosis is said to occur when new bone formation is not able to keep up with loss of old bone.

Risk Factors:

• • Age – risk increase with advancing age

• Women – especially older women who are past menopause – are at highest risk.
• Family history – osteoporosis among parents or siblings increases risk, especially if one of them had suffered a fractured hip.
• Body habitus – small body frames might have less bone mass to draw from as they age, hence increased risk of developing osteoporosis.behaviours and traits of people with osteoporosis and severe asthma

• Hormones – Osteoporosis is more common in people who have excess or reduced levels of certain hormones – such as:

1. Estrogen – reduced levels in women post menopause
2. Testosterone – reduces in men as they age.
3. Certain hormonal suppressive therapy like that for prostate cancer (reduce testosterone levels in men) and for breast cancer (reduce estrogen levels in women) can accelerate bone loss.
4. Thyroid hormone – excess can cause bone loss – as seen in hyperactive thyroid gland or taking too much thyroxine supplementation.
5. Parathyroid and adrenal glands – Osteoporosis has also been associated with excess hormones from these other glands

• Diet – Osteoporosis may also occur to improper dietary intake

1. Calcium – Prolonged deficiency of calcium in diet leads to decreased bone density, early bone loss and high risk of fractures.
2. Decreased food intake – Disorders of eating such as bullemia nervosa, crash diets that severely restrict food intake lead to undernourishment weakening bones in males and females.
3. Abdominal surgery – Surgeries that remove portions of the digestive system such as bariatric surgery to reduce the stomach size or removal of part of the intestines due to disease limits the ability to calcium.

• Lifestyle – Abnormal habits may elevate risk of developing osteoporosis.

1. Sedentary life – those with desk jobs involving prolonged sitting, indoor office work, reduced outdoor physical activities, “couch potatoes”, have a greater risk of osteoporosis.
2. Alcohol – Excessive consumption (more than two alcoholic drinks per day) found to increase risk of osteoporosis.
3. Smoking – use of tobacco has shown to contribute to weak bones.

• Medical conditions & Medications – Certain conditions and drugs predispose to development of osteoporosis:

1. Lupus
2. Multiple myeloma
3. Rheumatoid arthritis
4. Celiac disease
5. Inflammatory bowel disease
6. Kidney or liver disease
7. Steroids: Prolonged use in cancer, transplants etc., can interfere with the bone-rebuilding process and cause osteoporosis

Prevention

Simple measures early in life with nutrition and regular exercise can help in keeping bones healthy and prevent or at least delay onset of osteoporosis.

• Calcium – 1,000 milligrams of calcium a day is suggested as the normal dietary intake for both males and females between the ages of 18 and 50. This may increase to 1,200 milligrams for women above 50 and men above 70 years of age.
• Dietary Calcium-rich sources:

1. Milk (preferably low-fat) and dairy products such as cheese, curds
2. Green leafy vegetables
3. Soya and soy products, such as tofu, soy milk
4. Calcium-fortified foods including cereals, orange juice

• Calcium supplements – In case of reduced dietary intake

• Vitamin D – it is required for the body to absorb calcium. Vitamin D is derived by the body on direct exposure to sunlight. However, many people lose this ability especially those living in high latitudes, those remaining predominantly indoors (for office-work or housebound), or regular use of sunscreen.

1. Daily dietary recommendation: 600 international units (IU) for adults aged 51 to 70; 800 IU/day after age 70 through food or supplements.

• Exercise – No diet is enough without adequate exercise. This is required for building strong bones and reduce bone loss. Starting a regular exercise routine early in life will have long-term benefits.

1. Any weight-bearing exercise, activities promoting balance and good posture are beneficial for bone strengthening
2. Walking, running, jumping, dancing and weightlifting are found to be more helpful.

Symptoms of osteoporotic spine fractures:

Most patients do not have any symptoms. Any sort of back pain ranging from diffuse dull aching to severe debilitating symptoms.

“Red flags” especially in elderly patients include:

• Sudden, severe back pain – may or may not be related to a pre-existing injury
• Pain worsening on standing or walking
• Difficulty straightening or bending or twisting back
• Change in shape of spine – tendency to remain stooped
• Pain persisting even on lying down
• Pain that shoots down the arms or legs

Treatment:

Medications: As suggested by your doctor

• Calcium and Vitamin D supplements
• Medicines to prevent bone loss and help bone building – Bisphosphonates, Hormonal therapy
• Lifestyle modification & home remedies

1. Stop smoking
2. Avoid excessive alcohol consumption
3. Prevent falls.

When to consult a doctor: The red flags

Presence of persistent symptoms should alert to a more serious underlying cause like fracture and a prompt consultation with your doctor is recommended-

Surgery may be required in severe or unresponsive cases – to relieve pressure on the spinal cord and nerves, and to add stability to the spine. These include:

• Balloon kyphoplasty – percutaneous procedure to inject bone cement into the fractured bone
• Spinal fixation