Literally meaning “porous bones,” osteoporosis involves a decrease in bone density and mass that results in increasingly weak and fragile bones. It is a disorder that is associated with advancing age, and women are four times more likely than men to be affected, although men are very much at risk.
Primarily because of osteoporosis, 25 percent of postmenopausal American women have suffered a fracture of one or more vertebrae. Whereas a hip or wrist fracture is more likely to happen as a result of a fall, fractures in the spine often occur with minimally stressful movements, such as bending over or getting out of a chair. Rather than snapping like a twig, the weakened bone simply collapses, like a paper cup that you step on. That is what is known as a compression fracture.
In addition to advancing age and the start of menopause, risk factors include a family or personal history of broken bones; a small frame; low levels of sex hormones such as estrogen and testosterone; smoking; alcohol abuse; an inactive lifestyle; and a diet that is low in calcium and vitamin D.
Doctors sometimes notice osteoporosis because of a patient’s loss of height or rounded, stooped shoulders. Detectable loss of height usually occurs fairly late–usually after one or two vertebrae have already collapsed. It is better to be aware of the risk and on the lookout for early signs so that bone loss can be slowed.
Strategies for building and maintaining bone density are the same at any age: regular weight bearing exercise, a good diet and avoidance of smoking, excessive alcohol use and too much dieting.
Most Americans know the benefits of getting plenty of calcium but are unaware of the important role vitamin D plays in helping the body take in calcium. What is usually given as the recommended daily allowance for vitamin D (400 to 600 IU a day) is now believed to be one half to one third the amount that is really needed. You can get the vitamin D you need by exposing your hands, arms and face to direct sunlight 10 to 15 minutes three times a week. Otherwise, extra vitamin D must be obtained through food (salmon, eggs, fortified milk) or supplements.
If you have risk factors for osteoporosis, your doctor is likely to schedule you for a bone mineral density-screening test. Most medical groups believe in testing all women over age 65, younger women with risk factors and both men and women over 65 who have had a fracture.
Osteoporosis usually starts years earlier, and the onset of back pain can occur after several vertebrae had already collapsed. At this stage, the spinal structure eventually begins to worsen, resulting in loss of height and the stooped, rounded shoulders known as dorsal kyphosis or dowager’s hump. Eventually, the body becomes pitched forward and rounded with less space for internal organs, causing difficulty with breathing and digestion. Back muscles are forced to work harder to maintain stability and balance. Blaming their problems simply on age, some people react by spending more and more time in a chair or bed...leading to even greater bone loss, weakness and disability.
For a compression fracture, early treatment includes drugs to treat the loss of bone density plus use of a back brace to hold the spine straight and relieve excess pressure while the damaged vertebrae can heal. In addition, gentle exercise such as swimming in a heated pool along with routines can strengthen the muscles along the spine.
For more advanced cases, minimally invasive procedures, introduced in the 1990s, are available. Vertebroplasty and kyphoplasty both involve injection of surgical cement into the compressed part of the vertebra. When performed by a skilled, experienced team, these procedures are generally safe. And although long-term effects are unknown, a 2007 review of 21 studies involving 1,309 patients found that both vertebroplasty and kyphoplasty resulted in more than a 50 percent reduction of pain.
Prevention is key. The recommended amounts of calcium and vitamin D as well as weight bearing exercise go a long way. Knowing the early warning signs and risk factors can help make you aware of symptoms you or someone you know may be experiencing. Do not attribute this to age, contact you doctor to talk with them about screening, your risk for developing osteoporosis and the options available to you for treatment.
Kerri Musselman, PharmD—Rev. 5/12/10 TNK
