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Osteoporosis: Introduction, Diagnosis and Treatment

Osteoporosis is a disease that affects bone density and quality, causing bones to become fragile and increase the risk of fracture. It is a common disease that can affect every bone in the body, but some bones are more prone to fractures.

Introduction: Understanding Osteoporosis and its Effects on the Spine

Definition and Characteristics of Osteoporosis

Osteoporosis is a disease which reduces the density and quality of bone. Density means the bone mass (bone mineral density) and quality means the bone fibers. With osteoporosis, bones lose their strength, become more porous and fragile and there is an increased risk of fracture. Osteoporosis occurs silently and progressively, very often without any symptoms or pain until the first fracture happens.

Areas of the Body Most Prone to Fractures

It is a general disease, so it may affect every bone in the body. Some bones, such as the wrist bones, the upper leg bones and the spine bones, however, are more prone to develop symptoms or to fracture due to their anatomical structure and mechanical exposure to more heavy loads.

The loss of mechanical strength may cause fractures in the spine to simply happen without any injury. It is estimated that up to half of women and one third of men, experience at least one osteoporotic spine bone (vertebral) fracture during their life.

Vertebral Fractures

The loss of mechanical strength may cause fractures in the spine to simply happen without any injury. It is estimated that up to half of women and one third of men, experience at least one osteoporotic spine bone (vertebral) fracture during their life.

Vertebral fractures due to osteoporosis can give rise to a sudden onset of pain. The patient feels a sudden sharp pain (often associated with a “crack” in the back). It is usually worse during activities and reduced at rest. An X-ray or magnetic resonance scan (MRI) can confirm if there is a fractured vertebra. Vertebral fractures can result in serious consequences, including loss of height, intense back pain and deformity (sometimes called Dowager's Hump). Often this gets better within 3-12 weeks as the fracture heals, and there are no ill effects. Sometimes the fracture is slow to heal and persistent pain and reduced physical activity occurs with secondary effects such as negative self-esteem.

Complications from Multiple Vertebral Fractures

Sometimes, particularly when there are many fractures, this may result in deformities and loss of balance of the spine.

Diagnosis: Understanding DEXA Scans

Introduction to Osteoporosis Diagnosis

Not all vertebral fractures in older people are due to osteoporosis. Osteoporosis therefore has to be proven prior to starting treatment.

Indicators of Osteoporosis

A history of fractures of the spine, wrist or hip would suggest osteoporosis

The Most Reliable Test for Osteoporosis

The most reliable test for osteoporosis is the DEXA (Dual-Energy X-ray Absorptiometry). With this examination, it is not only possible to confirm osteoporosis but also to determine the degree of osteoporosis.

Treatment: Non-Operative and Surgical Options

Non-Operative Treatment

Healthy Diet and Lifestyle

Non-operative treatment aims at slowing and preventing the progression of osteoporosis by changing the metabolism of bone. A healthy diet and healthy lifestyle with exercise are important steps in treatment.

Prevention of Falls

Prevention of falls, “protective” devices such as walking sticks or crutches may be helpful for older people.

Medications for Bone Mass Loss

There are specific medications that inhibit or slow the further loss of bone mass (bisphosphonates, hormones, and others) and encourage new formation of bone. In general, taking calcium for the improvement of the bone quality can take months and years. This treatment should therefore be continued for a long period and patients should be followed on a regular basis.

Calcium and Vitamin D

Calcium and Vitamin D are important in the medical treatment of osteoporosis.

Surgical Treatment

It is estimated that only about 10% of all osteoporotic spinal fractures need surgery.

Goals of Surgery

The main goals of surgical treatment can be summarized in the following points:

  1. Pain relief
  2. Stabilisation of the fractured vertebra
  3. Reduction of any deformity
  4. Removing any pressure on the spinal cord
  5. Straightening of the spine

Kyphoplasty and Vertebroplasty

Stabilisation and pain relief can be treated with Kyphoplasty or Vertebroplasty which means placing a type of bone ‘’cement’’ inside the bone.

Surgical Procedures Using Spinal Instrumentation

If there is deformity of the spine, sometimes this can be repaired by larger surgical procedures using spinal instrumentation.

EUROSPINE is a society of spine specialists of various disciplines with a large knowledge of spine pathologies. All well-known and accepted treatment modalities for spine pathologies are represented by the members of the society. However, the Society cannot accept any responsibility for the use of the information provided; the user and their health care professionals must retain responsibility for their health care management.

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