Osteoporosis and the Spine

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--Dr Gaurav Raj Dhakal
 
Osteoporosis is a condition in which the bone mass decreases. This leads to weakness in the bones of the body and consequently increases the risk to fracture. The spine, hip, wrist and shoulder bones are prone to fractures. Unlike in adults, where a large amount of force is required to break the bones; in osteoporosis minor trauma is responsible for the break. This minor force may be due to slipping in the bathroom, getting up from a lying down position, lifting small weights or minor falls.
 
Osteoporosis may arise after attaining menopause or old age. Risk factors associated with osteoporosis are female sex, post-menopause, smoking, alcohol, lack of exercise, steroid usage, hormonal disorders, psychiatric drugs and low calcium intake.
 
Almost half of the fractures occur in the spine. One-third women above 65 years suffer from vertebral fractures and they lead a low quality of life. Women with at least one new vertebral fracture have a 32% increased risk of mortality. The patient may complain of back pain, pain going down the legs, numbness, and weakness of the legs. Progressive fractures result in shortening of height, stooped posture and decreased quality of life.
 
Plain X rays reveal the fracture vertebrae while MRI scan show the amount of spinal cord compression responsible for the weakness of the legs. It is also imperative to do a Bone Mineral Density (BMD) test to determine the amount of osteoporosis that is present. Follow up BMD also serves as an indicator to improvement after treatment. Other tests that may be done are blood calcium, phosphate and alkaline phosphatase. It is also necessary to rule out tumours and other cancers in elderly with osteoporotic compression fractures.
 
The treatment of osteoporosis is three fold. It is essential to stop smoking, avoid alcohol and maintain a balanced diet. Regular physical activity and weight bearing exercises have beneficial effects on the bone mineral density. Elderly individuals are encouraged to use a walking stick to avoid falls. Calcium and vitamin D supplementation are the cornerstone of all treatment modalities. Other pharmacological medications should be taken in consultation with a specialist. Surgery is indicated in patients with unrelieved back pain despite treatment, weakness of the legs or pain going down the legs, problem with urine and stools after the fracture or paralysis. 
 
Women above 45 years of age and post-menopausal women are advised to consult spine surgeon to learn about the strategies to prevent and treat osteoporosis. The Spine Clinic at Norvic International Hospital provides a comprehensive osteoporosis screening and treatment program. Act now, prevent osteoporosis!
 
The author is a Spine Surgeon practicing at Norvic International Hospital and can be reached at spinegaurav@gmail.com
 

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