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Osteoporosis

What is Osteoporosis

Osteoporosis is a condition in which the bones gradually become porous, brittle, and fragile. The bones become susceptible to fracturing and fractures that do occur heal slowly. The spine is the area of the body most severely affected by osteoporosis, followed by the hips and wrists.

*Osteoporosis is not to be confused with osteoarthritis, which involves deterioration of the cartilage coating the bones in a joint.

The Effects of Osteoporosis on the Spine

The vertebrae are the bones most often affected by osteoporosis. In advanced osteoporosis, weakened vertebrae may actually collapse under the weight of the body alone or from simply coughing. Multiple compression fractures of the vertebrae (collapsed vertebrae) result in a gradual loss of height and a hunched back (dowager's hump)

Symptoms of Osteoporosis

*There are usually no symptoms in the early stages of osteoporosis.

*Postural changes, loss of height, & back pain develop as osteoporosis progresses.

Postural Changes: As osteoporosis advances there is a gradual change in posture that can lead to back pain. Back pain is a common symptom of osteoporosis but because back pain is also a symptom of muscle strain or osteoarthritis, osteoporosis is not always suspected until it is advanced.

Too often, osteoporosis is not recognized until the person has a noticeably hunched back or a painful fracture of a vertebra has occurred. Sometimes osteoporosis is diagnosed after a fall results in a broken hip or wrist.

Loss of Height: A small loss of height (up to an inch) is a normal part of aging, as the shock-absorbing disks that separate the vertebrae gradually lose height. An excessive loss of height may be a sign osteoporosis. A loss of height from osteoporosis develops as a result of multiple compression fractures of weakened vertebrae.

Back Pain: Back pain becomes more common as osteoporosis progresses.

Back pain from postural changes of osteoporosis is often due to muscle strain. The stooped posture of osteoporosis puts more stress on the back muscles, and back pain in a person with osteoporosis may actually be the result of back muscle strain. The head being forward from stooping also places extra stress on the neck muscles can cause neck pain.

If the stooped posture is very severe, the nerves of the spine can become compressed, which can cause severe back pain.

Back pain from a vertebral compression fracture is usually caused by muscle spasms around the vertebra. When a vertebra fractures, there may be acute, severe back pain. However, a vertebral fracture often goes unnoticed or only causes minimal pain. When back pain does occur from a vertebral fracture, the pain mainly comes from the muscles around the vertebra going into spasms.

Risk Factors for Osteoporosis

The risk of osteoporosis increases with age. Osteoporosis is most common in women over the age of 50. However, men can also develop osteoporosis. Small-framed people are at an increased risk, as are Caucasians and Asians. A family history of osteoporosis is a major risk factor.

People who are sedentary are at an increased risk of osteoporosis. A chronic lack of calcium and vitamin D, smoking, excessive alcohol consumption, eating disorders such as anorexia nervosa, an overactive thyroid, and long-term use of corticosteroids also increases the risk of developing osteoporosis.

Weight-bearing exercises and calcium and Vitamin D supplements can help prevent osteoporosis from developing or at least slow down its progression.

Testing for Osteoporosis

Bone density testing is recommended for those considered to be at high risk, e.g. family history. Many women wait until they are post-menopausal to get tested for osteoporosis, but it is best to get tested before menopause so if there is lower than normal bone density, treatment can begin early. Many people are frightened to get tested for osteoporosis because they are afraid they will find out bad news. But osteoporosis is treatable. Early detection means earlier treatment to slow down or stop the progression of osteoporosis.

All people lose bone mass as they age, it is only when it is excessive that problems arise.

When bone density is less than the average but not thin enough for a diagnosis of osteoporosis it is called osteopenia.

Preventing Osteoporosis

Preventing osteoporosis should ideally begin during childhood. Getting sufficient calcium, vitamin D and weight-bearing exercise is vital to build strong, dense bones. Bone density increases rapidly until the age of 20. Maximizing bone density during childhood and adolescence is important - the denser the bones are to start with the more bone density one can afford to lose with age.

Bone density continues to increase, though at a slower rate, between the ages of 20 and 30. Bones gradually decrease in density after age 30 - 35 in both men and women. Continuing to get adequate calcium, vitamin D and weight-bearing exercises can slow down the process of bone loss considerably. At any age, lifestyle changes can help maintain bone mass.

Calcium and Osteoporosis

Calcium is a major component of bones. Adequate calcium intake is essential in preventing osteoporosis. Vitamin D is required for the utilization of calcium. Every cell in your body needs calcium. If you don't consume enough calcium, your body will withdraw it from your bones to keep the amount in your blood stream constant. See Calcium page.

Excessive alcohol consumption (over 2 drinks per day) and smoking interfere with the body's absorption of calcium and increase the risk of osteoporosis. Carbonated beverages and large amounts of caffeine also interfere with calcium absorption.

In women, bone loses mass at a more rapid rate in the 5-7 years after menopause. Estrogen replacement therapy is effective in slowing down bone loss and preventing osteoporosis but increases the risks of heart disease and certain cancers. There are many medications to effectively treat and prevent osteoporosis, with various side effects. Medications are usually used in postmenopausal women who have lower than normal bone density.

Weight Bearing and Strengthening Exercises Increase Bone Density

*If you have osteoporosis, check with your doctor as to the safety of any exercise.

Many people don't think of bones as living tissue, but they are. Like muscles, bones get stronger (denser) from doing strengthening exercises and weight bearing exercises.

Weight bearing exercises such as walking, stair climbing, etc. mainly strengthen bones in the legs, hips and lower spine. Strengthening exercises such as weight lifting or exercises that use the body as resistance (like push-ups) are effective in strengthening bones in the arms and upper spine.

For people who already have osteoporosis, weight bearing and strengthening exercises can help prevent further bone loss. These exercises also keep the back and abdominal and hip muscles that support the spine strong. Strong back and abs muscles reduce compression forces on the vertebrae and prevent back pain.

However, some exercises are risky for those with osteoporosis - the amount of risk depends on the severity of the bone loss. Those with osteoporosis should avoid exercises that twist the spine or excessively bend the spine to avoid a compression fracture of a vertebra. A doctor or physical therapist can recommend appropriate exercises.

Balancing exercises (which strengthen muscles that support the spine in addition to improving balance) also reduce the risk of falls; a major concern for those with osteoporosis is breaking a hip or other bone in a fall.

Treating Osteoporosis

There are a variety of medications (bisphosphonates, calcitonin, hormones, etc) used to treat osteoporosis. For details on FDA-Approved Medications for Osteoporosis Prevention and/or Treatment see National Osteoporosis Foundation - Medications to Prevent & Treat Osteoporosis

Getting adequate calcium and vitamin D on a daily basis are essential. Besides helping to prevent further bone loss, calcium helps relax tense back muscles and helps prevent muscle spasms.

It is important to treat back pain. Left untreated, back pain may cause a person to become sedentary, which can accelerate bone loss as well as muscle loss.

For relieving back pain there are pain medications, cold and heat Therapy, topical rubs, etc.
See details on Back Pain Treatment page (massage therapy is contradicted for advanced osteoporosis)

Weight bearing exercises and strengthening exercises to prevent further bone loss and strengthen the muscles that support the back.

Treating Vertebral Compression Fractures caused by Osteoporosis

A back brace can relieve the acute back pain of a vertebral fracture by supporting the spine and distributing the weight of the body. A back brace will also prevent the spine from bending or twisting too far. A back brace should not be worn for too long or the muscles of the back will atrophy from lack of use and strong muscles are essential for supporting the spine. Bone loss also is accelerated during inactivity.

Bed rest is needed for a few days after a vertebral fracture. Resuming normal activity as soon as possible, as recommended by your doctor, helps maintain strength in the muscles that support the back and helps maintain bone mass.

When your doctor thinks you are ready, do exercises to strengthen the muscles that support the spine. Strengthening back and abdominal muscles improve posture, reduce compression forces on the vertebrae and prevents back pain.

Vertebroplasty & Kyphoplasty - Minimally Invasive Procedures

Vertebral Compression Fractures do not usually require surgery. The back pain from a compression fracture usually subsides within a couple months without surgery.

If conservative treatment falis to relieve the pain from a recent vertebral compression fracture, a minimally invasive procedure called vertebroplasty or a similar procedure called kyphoplasty may be performed in an attempt to relieve the pain. In either procedure, cement is injected into the collapsed vertebra to stabilize and strengthen the vertebra. Kyphoplasty also can partially or fully restore the height of the treated vertebra. Studies on the effectiveness of these procedures for relieving back pain have had mixed results.

Reducing Risk of additional Vertebral Fractures

Once a vertebra has fractured, the risk for other vertebral fractures increases. If not already taking medication for osteoporosis, medication to increase bone density and reduce the risk of recurring vertebral fractures most likely will be prescribed. Adequate calcium and vitamin D intake are still essential.

Balancing exercises improve balance and strengthen muscles supporting the back. Good balance decreases the risk of falls - especially important to those with osteoporosis. A doctor or physical therapist can advise on what exercises are most appropriate.

Prevent falls by wearing shoes that have non-slip soles. Be especially cautious when using stairs and hang on to the railing.

Osteoporosis is Treatable and Preventable

A bone density test is the only way to diagnose osteoporosis in its early stages. Treating osteoporosis early can prevent deformity, back pain, fractures and broken bones.

Lifestyle changes can reduce the risk of developing osteoporosis or halt or slow down its progression.