Osteoporosis and Back Pain
Osteoporosis is a condition where the bones become thin and weak due to loss of bone minerals. It is estimated in the UK that 2% of women aged 50 years have the condition and this rises to 25% by the age of 80. It can be detected with a simple scan, known as a DEXA*. Women are more susceptible, due to the hormone changes after the menopause. Normal bones rely on sunlight, acting on cells in the skin to produce Vitamin D, together with dietary intake. Either lack of sunlight or a diet poor in Vitamin D may lead to this condition. Dairy products, including milk, eggs, cheese and yoghurt are good sources. Sunlight does not need to be direct and burning to allow Vitamin D production.
If bones are weak they are prone to fracture. It is estimated that 9 million osteoporotic fractures occur around the world each year, most commonly affecting the hip. Back pain is not itself caused by osteoporosis, but can be due to fracture of a vertebra, which may then collapse, causing a forward bend on the spine (a Kyphosis). This in turn puts more pressure on the vertebrae and others may fracture, worsening the situation. The “Dowager’s hump”, a severe forwards curve in the upper thoracic spine is an extreme example of this.
The other area of the spine vulnerable to trauma in osteoporosis, is the sacrum, the old tail bone. This may be damaged by sitting down too hard on a hard chair, by falling onto the backside, or by banging the hip region. A fracture of the sacrum can cause extreme pain.
Management of these fractures due to osteoporosis involves correcting the bone mineral density. This can be done with oral Vitamin D and Calcium supplements, with other medication, some given by injection, to increase bone stock, or with surgical techniques.
Deciding which treatment option is right for an individual depends upon many factors and is, therefore, best undertaken in a multi-disciplinary team environment, where all the various areas of expertise are represented. At the London Spine Clinic this takes place regularly and many patients, with osteoporotic fractures have been successfully managed.
Kyphoplasty is a technique used to both improve alignment after osteoporotic vertebral fracture and to abolish pain. By placing a needle into the affected bone, a balloon catheter can be inserted, typically just below or in the fractured area. Expanding the balloon, by injecting it with radio-opaque fluid which can be seen on an x-ray, realigns the bone fragments, improving the overall spinal alignment. The balloon can then be deflated and removed and the cavity created filled with cement. This hardens quickly, giving internal support to the fractured bone, which reduces pain and prevents further collapse.
Balloon inserted into fractured bone and inflated. Balloon removed, cement injected as a liquid and then hardens in place. Note the improvement of the alignment of the spine.
If you suffer from osteoporosis, make sure you are treated and make sure this is monitored. Specialists in rheumatology and endocrinology can advise on the best treatment for you. If you develop a fracture, contact the London Spine Clinic for a rapid diagnosis and treatment.
Written By Mr John Sutcliffe
*DEXA stands for "dual energy X-ray absorptiometry