According to the National Osteoporosis Foundation one in two women and one in four men will sustain an osteoporotic fracture sometime in their lives.  One of the most common fractures as a result of osteoporosis is a spinal fracture. 

In this spine wellness educational video, Dr. Kevin Macadaeg discusses osteoporosis and vertebral compression fractures.  Dr. Macadaeg is a minimally invasive spine specialist with Indiana Spine Group. 

The last few spine wellness blog entries have discussed the effects of smoking and the spine.  For example smoking can increase your risk for lower back pain, increasing healing time following spine surgery and increase your risk for osteoporosis. 

For a spine wellness fact sheet about smoking and your spine's wellness, click here.

In these next series of blog entries – I will answer common questions about scoliosis – including the diagnosis, and provide an overview of the treatment options both medical and surgical treatments.

The Scoliosis Research Society defines scoliosis as a lateral deviation of the normal vertical line of the spine, which is greater than ten degrees when measured by an X-ray.  Scoliosis is often referred to as “curvature of the spine.”

According to the National Scoliosis Foundation (NSF), scoliosis affects 2-3% of the population.  The common age for onset is 10-15 years, old and it affects both genders equally although females are eight times more likely to have a greater degree of curvature that requires treatment the NSF indicates.  Although scoliosis is not heredity, there is an increased likelihood of an individual being diagnosed with scoliosis if a family member has had it. 

The different types of scoliosis include:

§         Idiopathic Scoliosis – This is where scoliosis occurs without a known cause.  This is the most common type of scoliosis.

§         Congenital Scoliosis – This is when an individual is born with scoliosis as a result of the vertebrae not being properly formed during pregnancy.  This malformation occurs within the first six weeks of embryonic formation.

§          Neuromuscular Scoliosis – This is caused as a result of a neurological disorder such as muscular dystrophy that results in a weak trunk and the individual can not support the weight of their body.

§         Adult Scoliosis – This is when scoliosis is diagnosed in an individual as an adult.  It can either be undiagnosed scoliosis when the individual was younger or the result of age-related degeneration.  An example of age-related scoliosis is osteoporosis. 

If you have a question on scoliosis that you would like answered in this series of blog entries, please send your question to info@indianaspinegroup.com. 

A recent blog entry referenced the International Osteoporosis Foundation (IOF).  The IOF is an international non-profit organization headquartered in Switzerland, whose mission is to increase awareness and understanding of osteoporosis.  Their goals are to:

·                     Increase awareness and understanding of osteoporosis.

·                     Motivate people to take action to prevent, diagnose and treat osteoporosis.

·                     Support national osteoporosis societies in order to maximize their effectiveness.

According to the IOF:

• Osteoporosis affects 75 million people in Europe, USA and Japan.
• In 2000, 9 million individuals suffered an osteoporotic fracture.
• I out of 3 women and 1 out 5 men will suffer an osteoporotic fracture. 
• Of these fractures, approximately 58% will be spinal fractures. 

The World Health Organization (WHO) introduced a new diagnostic tool in the fight against fractures resulting from osteoporosis.  This new risk assessment tool – call FRAX (fracture risk assessment tool), was created to provide a way to assess the risk for osteoporotic fractures more accurately.   FRAX provides the 10-year probability that an individual may have a major osteoporotic fracture; including hip, clinical spine, forearm, hip or shoulder.  FRAX takes into consideration the results of the FRAX questionnaire and bone mineral density (BMD) at the femoral neck (part of the thigh bone that connects to the hip joint).

Indiana Spine Group would like to recognize World Osteoporosis Day – today October 20.

• It is estimated that 10 million individuals in the US have osteoporosis.
• Eighty percent of those with osteoporosis are female, and twenty percent are male.
• Approximately one in two women will have an osteoporotic related fracture in their lifetime after the age of 50.
• One out of four men will suffer an osteoporotic related fracture in their lifetime after the age of 50.

Here are a few links to resources about osteoporosis:
National Osteoporosis Foundation
International Osteoporosis Foundation
MedLine Plus
American Academy of Orthopaedic Surgeons

A few concurrent sessions at Back Talk, will address The Aging Spine. One session, entitled The Aging Spine | Osteoporosis and Spinal Arthritis Update, will be presented by Michael Stack, MD, PhD.  Dr. Stack is a board-certified rheumatologist with Diagnostic Rheumatology & Research. 

During this continuing medical education session, Dr. Stack will provide the latest information on osteoporosis and spinal arthritis. This will include:

• The latest screening, diagnostic and treatment algorithms for osteopenia and osteoporosis.
• Indications and contra-indications of medications and hormone replacement therapy to prevent and treat osteoporosis. 
• The symptoms, diagnostic triage and current treatment options for spinal arthritis. 

Recently we have updated the educational resources on our Indiana Spine Group web site.  With this update, we included a few educational videos.  These videos include myself and other physicians with Indiana Spine Group discussing different topics; i.e. artificial cervical disc, spinal pain, spinal stenosis, etc.

Previously, I did a series of blog entries on osteoporosis and spinal fractures. In the next 25 years, the number of adults aged 65 and older are expected to double, according to a study by the Department of Health & Human Services Administration on Aging. With this increased longevity, it is also projected that the incidence of osteoporosis and subsequent spinal fractures will increase.

To help protect your bone health, which should begin as early as childhood, the Surgeon General’s office prepared a helpful resource. This resource entitled Bone Health and Osteoporosis, summarizes a two-year, 400 page report prepared by the country’s top experts on osteoporosis. To review this report, click here. Learn the facts about osteoporosis and how you can help prevent osteoporosis and improve your bone’s health. 

Another sponsor for Back Talk, Indiana Spine Group's continuing medical education symposium is Stryker Interventional Spine.  Stryker Interventional Spine specializes in minimally invasive spine treatment options for the relief of chronic back pain. Stryker Interventional Spine provides physicians with a wide range of minimally invasive spine surgical tools. This includes spine surgical tools for   radiofrequency, vertebroplasty, disc decompression and discography. 

Vertebroplasty is a minimally invasive spine procedure that is used to treat vertebral compression fractures (VCFs) as a result of osteoporosis, trauma or tumors.  

Discography is a procedure that is used to diagnose the the cause of back pain; and to identify which spinal disc(s) are involved.

Radiofrequency is a type of injection which utilizes an injection which involves heat – and the goal of this interventional pain management procedure is to interrupt pain signals therefore eliminating back pain. 

Disc Decompression is a spine surgical procedure that is performed to alleviate pinched nerves. The two common types of decompression spine surgical procedures are microdiscectomy and laminectomy.  

To learn more about Stryker Interventional Spine, and their minimally invasive spine products visit their web site.  

Exercise is not only good for loosing weight or for your cardiovascular health.  Exercise is also important for your spine health! It is important to strengthen and condition your spine. By building a strong spine, it will help you to avoid back pain and back injuries.  Exercise also helps to build bone mass to help prevent osteoporosis later in life. It is never too early to begin. 

For spine wellness tips and a  few bone-building guidelines to exercising to help reduce your risk of osteoporosis, this link provides tips prepared by Spine Universe

Planning continues for the annual spine symposium / continuing medical education conference Back Talk. The overall objective of this conference is to provide primary care physicians and practitioners comprehensive information for the diagnosis and treatment of their patients with spinal disorders, injuries and abnormalities. 

At the conclusion of this program, participants will:

·        Provide a comprehensive diagnostic assessment of patients that present with back and neck pain; including the physical exam, imaging and psychological assessment.

·        Review current evidence-based treatments of spinal disorders from a non-operative to an operative perspective; including medical and physical therapy, chiropractic care and when referrals are indicated. 

·        Identify the diagnostic and treatment algorithms of spinal conditions specific to life stages – from the pediatric patient to the older adult; i.e. pediatric injuries, scoliosis, osteoporosis, and the degenerative spine.

·        Discuss spinal injuries resulting from sports activities and trauma, their non-operative and operative treatments as well as preventative measures. 

·        Identify uncommon and difficult causes of spine disorders; including rheumatologic disorders and cancer.

·        Understand the key principles of spine wellness to maintain a healthy spine; i.e. nutrition, lifestyle and exercise.

·        Discuss emerging technologies and the future of spine care. 

For more information, visit the Back Talk information page on Indiana Spine Group's web site.

Planning on the third annual spine symposium / continuing medical education program continues.  This conference entitled, Back Talk:  Comprehensive Concepts in the Diagnosis and Treatment of Spinal Disorders - will address one of the key reasons people visit their physicians, back pain! 

This symposium will discuss the latest spinal diagnostic and treatment information for back and neck problems.  Overall conference objectives include:  

·        Provide a comprehensive diagnostic assessment of patients that present with back and neck pain; including the physical exam, imaging and psychological assessment.

·        Review current evidence-based treatments of spinal disorders from a non-operative to an operative perspective; including medical and physical therapy, chiropractic care and when referrals are indicated. 

·        Identify the diagnostic and treatment algorithms of spinal conditions specific to life stages – from the pediatric patient to the older adult; i.e. pediatric injuries, scoliosis, osteoporosis, and the degenerative spine.

·        Discuss spinal injuries resulting from sports activities and trauma, their non-operative and operative treatments as well as preventative measures. 

·        Identify uncommon and difficult causes of spine disorders; including rheumatologic disorders and cancer.

·        Understand the key principles of spine wellness to maintain a healthy spine; i.e. nutrition, lifestyle and exercise.

·        Discuss emerging technologies and the future of spine care. 

For more conference infomration, visit Indiana Spine Group's web site, or call (317) 228-7000.

With this blog entry, I will answer a question recently asked by one of my patients.  What is celiac disease and is there a link between celiac disease and osteoporosis?

Celiac disease is a genetic, autoimmune disease affecting the digestive system.  In this disease, the lining of the small intestine is damaged by a protein called gluten.  This damage to the small intestine interferes with the absorption of nutrients.    Gluten is found in wheat, rye, barley – and also some medications/vitamins.  To learn more about celiac disease – visit this link.   

In respect to osteoporosis; one side effect of celiac disease is “brittle bones”.  Often celiac disease goes undiagnosed or is misdiagnosed, in that the symptoms vary in people and mimic other common aliments.  As a result of this, a research study was conducted at the Washington University Bone Clinic to determine if there was a link between celiac disease and osteoporosis.  This study concluded that celiac disease is uncommon, but individuals with osteoporosis were more likely to have celiac disease.  As a result of this study, researchers recommend that individuals diagnosed with osteoporosis to be screened for celiac disease (blood test). 

One common question asked by male patients is if there are any medications that can be used to help stop or treat their osteoporosis.  The answer to this is - yes. Although, there are limited medications that have been approved for the treatment of osteoporosis in males.

There are two types of drugs for osteoporosis – one category is to slow bone loss and these are antiresorptive medications.  The other is to increase the speed of bone formation and these are anabolics.  The FDA has only approved two antiresorptive medications for the treatment of osteoporosis in men -  alendronate and risedronate.  The brand names for these medications are Fosamax and Actonel, respectively.  The only anabolic that has been approved for the treatment of osteoporosis in men is teriparatide, brand name Forteo. 

Additionally, in males - if blood tests have determined that there is a low level of testosterone – which helps to prevent bone health in males – testosterone replacement therapy may be an option.

Diagnosis

In males, osteoporosis is often times is undiagnosed and overlooked.  That is why it is important to let your physician know if you notice a change in posture, loss of height or sudden back pain.  To diagnose osteoporosis, your physician will order a DEXA screening – which is a specialized X-ray that measures your bone mass.  Additionally, your physician will conduct a complete medical exam to identify risk factors; i.e. medial history, physical exam, urine and blood tests.

Prevention

Some risk factors for osteoporosis are unavoidable, but the good news is many can be controlled.  The following identifies a few key recommendations to help prevent and treat osteoporosis:

1. Maintain a healthy lifestyle; no smoking, exercise, a nutritional  diet and minimal alcohol use.

2. Exercise!  Weight-bearing exercise is important.  Weight-bearing  exercises are those activities where bone and muscles work against  gravity.  Popular weight-bearing exercises include walking, jogging and tennis/racquet ball.  Also weight lifting is good.  Be sure to talk to your physician before starting an exercise program.

3. Regular check-ups.  Routine medical examinations help your physician  to identify any underlying medical conditions that can affect bone  health.

4. Adequate levels of calcium and Vitamin D.  The National Osteoporosis Foundation recommends that men under 50 years of age get 1,000 mg of  calcium daily, and for over 50 years old 1,200 mgs.  Additionally, it is   recommended that men under 50 get 800-1,000 IU of vitamin D3 per day  and over 50 years of age, 800 – 1,000 IU.  Note:  Vitamin D3 is an active form of vitamin D. 

When you hear about osteoporosis, generally you think of it as a of older women.  Yes, osteoporosis is more common in females, than males.  But according to the National Osteoporosis Foundation, it is estimated that approximately two million males in the U.S. have osteoporosis.  It is also predicted that about 12 million men are at risk for developing osteoporosis. 

For men, here are some of the risk factors as identified by the National Osteoporosis Foundation:

1. Prolonged use of certain medications. For example, steroids to treat asthma or arthritis, anticonvulsants, aluminum-containing antacids and certain cancer treatments.
2. Chronic diseases that affect hormone levels such as diseases that affect the kidneys, lungs, stomach or intestines.
3. Undiagnosed low levels of testosterone.

Other risk factors for men, that are also risk factors for women include:  lifestyle, age, heredity and race. 

Diagnosing vertebral compression fractures can be difficult – in that X-rays do not always show the fracture.  In this instance, if the patient has back pain and an X-ray does not show a fracture – many times it is assumed that the back pain is caused by muscle strain.

That is why sometimes, it is important to see a spine specialist; i.e. a minimally invasive spine specialist that focuses on spine diagnosis and treatment.  One key component in diagnosing spinal fractures is the patient’s medical history.  Additionally, a clinical exam is important to determine the sensitivity and tenderness around the affected vertebrae. 

If a vertebral compression fracture is suspected, even if an X-ray does not show a fracture – other diagnostic tests may be ordered as a result of the patient’s medical history and clinical exam.  These tests can include a CAT scan, MRI or nuclear bone scan. 

If a vertebral compression fracture is diagnosed – it is important to determine the cause for effective treatment.  The most common cause of a vertebral compression fracture is osteoporosis but other causes are trauma or some types of cancer. 

If the cause of the vertebral compression fracture is determined to be osteoporosis, common treatment options include bracing, analgesics, medications to help sustain or restore bone mass, and vertebral augmentation. In vertebral augmentation, the goals of treatment are to stabilize and eliminate the pain caused by the vertebral compression fracture.  The two types of vertebral augmentation available include vertebroplasty and kyphoplasty. 

One of the most common causes of spine fractures – referred to as vertebral compression fractures, is osteoporosis.  One statistic projects that there are approximately 750,000 spine fractures resulting from osteoporosis per year in the U.S.

Many times, spine fractures resulting from osteoporosis are overlooked and not diagnosed.  Frequently, when older people complain of back pain – it is thought to be related to muscle strains or normal aches and pains due to aging.  It is important for individuals to recognize that if they have sudden acute back pain – following an activity such as golf (or other twisting), lifting or even a small fall – this could be the result of a fractured vertebra.  Following the acute pain resulting from the fracture – the pain may then lead to chronic back pain and therefore many times is thought of as just that – back pain.

When you think about osteoporosis and vertebral compression fractures – this does not just occur in the elderly.  Anyone who is 40 or over is susceptible to this – depending on their risk factors for osteoporosis.

If you suspect that your back pain is a result of a vertebral compression fracture, see your physician or a minimally invasive spine specialist.  For more information, call our office at 317.228.7000.