Osteoporosis
What is Osteoporosis?
Osteoporosis is a diagnosis of very low bone density. Patients with osteoporosis are at risk for broken bones, with potentially serious consequences.
"Osteopenia" represents low bone density. Patients with osteopenia are also at risk for broken bones, and are at risk for developing osteoporosis.
Diagnosis
Bone density (also known as "bone mineral density" or "BMD") is measured by a DEXA (or DXA) Scan. This test involves x-rays of the hips, wrists, and spine. The density measured is then compared to a person with normal bone density.
Dr. Bjerke discusses Osteoporosis on KTVN's "Ask the Doctor"
Symptoms
Osteoporosis is a silent disease without symptoms for most people. However, people with Osteoporosis are at risk for broken bones. Some bones are at much higher risk of fracture than others, including spinal vertebrae. Someone with Osteoporosis and back pain may have a "Compression Fracture" of the spine. Most patients won't need an operation, and pain can be controlled with oral medication. If the pain is severe and not improving, it may be treated with a minimally-invasive operation called a Kyphoplasty.
Compression Fractures of the Spine
What is a Compression Fracture of the Spine?
A normal spinal vertebral body (the body is the front half of the vertebra) is rectangular. A compression fracture of the spine occurs when the front (or anterior) wall of the vertebra fractures. The front wall of the vertebra will then lose height, and the overall shape of the vertebra will appear "wedged" or rectangular. They most commonly occur in the thoracic or lumbar spine. Compression fractures in the cervical spine are extremely rare.
Causes
Compression fractures occur because of weakened bone, trauma, or both.
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Low bone density: Most compression fractures occur in people with low bone density. Patients with osteopenia or osteoporosis are at increased risk of compression fractures of the spine. Any patient with a compression fracture that happens with little or no trauma should have a bone density checked. In rare cases, a compression fracture may occur in patients with a tumor or because of other medical problems.
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Trauma: The normal vertebral body is very strong. A lot of trauma is necessary to cause a fracture (such as a car accident, fall from a height).
Symptoms
The first symptom of a compression fracture is back pain. Leg pain, weakness, or problems with bowel and bladder function are rare, and may represent a more serious problem. In severe cases or where many vertebrae have compression fractures, patients may have "kyphosis," a condition where a "hunchback" deformity or leaning forward may occur.
Diagnosis
Vertebral compression fractures are diagnosed after a careful history is taken, and appropriate imaging demonstrates the broken bone.
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History: Your medical provider should appreciate that your medical history may contribute to your symptoms, which may or may not be related to your symptoms. It is also important to understand the timeframe for your symptoms, and what makes the symptoms worse or better. Your provider will also learn all previous treatments you have had, and if they have provided any relief.
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Physical Examination: A physical examination is important to diagnose a vertebral compression fracture. The only with a compression fracture is usually back pain, but it is important to make sure that there is no nerve damage or a more serious problem.
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X-rays: X-rays are the first step for imaging. Even if other images have been taken, x-rays provide unique information that is not available from other studies. They will also be taken at future visits to see if the fracture is becoming worse.
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MRI: An MRI scanner uses a magnetic field and radio waves that are not harmful to visualize the body in 3D. In most circumstances, it is the best way to see the soft tissues of the body, including nerves, intervertebral discs, and other parts of the spine other than the bones. It is also helpful to detect when a fracture may have occurred.
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CT: A CT scan uses many x-rays to produce a 3D image of the body. It is often the best way to visualize the spinal bones or bone spurs.
Compression fracture of the spine
Treatment
It is important to first recognize and address the underlying cause of a compression fracture. This usually means obtaining a bone density scan (DEXA) to assess bone strength. If the bone density is low, you should ask your primary doctor about the best way to treat this.
For most patients, the best treatment is time. Most compression fractures will heal on their own without treatment. Some patients find that a brace such as an "extension brace" or a Thoracolumbosacral Orthotic (TLSO) will provide some pain relief. For patients who have severe pain despite this, or whose fracture is severe enough, a "kyphoplasty" may be offered to stabilize the fracture with an operation. See Kyphoplasty for more information on this procedure.