Treatment For Osteoporosis

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. 

This blog entry will address some of the treatment options for vertebral compression fractures as a result of osteoporosis.  Treatment recommendations are based upon the patient’s symptoms and specific medical needs. 

Treatment options may include:

Medical Management  for Vertebral Compression Fractures
This is where the patient is prescribed bed rest with gradual weight-bearing activity, analgesics, bracing, and anti-osteoporotic medications.

Minimally Invasive Treatment Options for Vertebral Compression Fractures

Vertebroplasty is one treatment option.  With this procedure, a hollow-needle is used, which injects a specially formulated bone cement directly into the fractured vertebra. This cement forms an internal cast and stabilizes the bone. 

Another minimally invasive treatment option is kyphoplasty.  Kyphoplasty is a procedure where an orthopaedic balloon is used to life the fractured bone and return it to the correct position.

This blog entry will answer some common questions asked about vertebral compression fractures.

What exactly is a vertebral compression fracture? 
A vertebral compression fracture is where a bone or bones in the spine fracture/break. 

What causes a vertebral compression fracture? 
A vertebral compression fracture can be caused by severe trauma.  For example an automobile accident or a fall from extreme height.  In older individuals the most common cause is if from osteoporosis.  Additionally, cancer can also precipitate a vertebral compression fracture.  Generally, a vertebral compression fracture is of the lower, back (lumbar spine).

Are vertebral compression fractures common?
It is estimated that osteoporosis will result in approximately 1.5 fractures annually.  Although you hear more about hip fractures, the most common fracture as a result of osteoporosis is a vertebral fracture.  It is estimated that more than half of the fractures as a result of osteoporosis are vertebral compression fractures, over 700k annually.

What are the symptoms of a vertebral compression fracture? 
The most common symptom is sudden onset back pain that becomes persistent. If the vertebral compression fracture is the result of osteoporosis, this fracture and accompanying pain can be caused by normal activities and not the result of trauma; i.e. a fall. Other symptoms include back pain that is more severe when  standing or walking, limited spinal mobility and height loss or a forward stooped posture (Dowager’s hump). 

How are vertebral compression fractures diagnosed? 
Vertebral compression fractures are diagnosed with an X-ray.  If there is a spinal fracture on the X-ray, the physician may order a CT-scan to determine the extent of the fracture or an MRI – depending upon the patient’s symptoms. 

Another special interest symposium for this continuing medical education program is entitled, “The Osteoporotic Spine”.  Co-presenters for this session are Kevin Macadaeg, MD, and Michael Stack, MD.  Dr. Macadaeg is a minimally invasive spine specialist with Indiana Spine Group, and Dr. Stack is a rheumatologist with Diagnostic Rheumatology & Research, PC.

Osteoporosis has been identified as a major health concern, and the National Institutes of Health predicts that one in two women and one in four men over the age of 50 will suffer from a vertebral compression fracture.  Many times, not diagnosed until there is a fracture – this session will highlight the latest screening and diagnostic guidelines and recommendations.  Additionally, there will be a review of the recommended treatments including anti-osteoporotic medications and vertebral augmentation (vertebroplasty and kyphoplasty). 

On June 4, Indiana Spine Group will host a continuing medical education dinner on treatment options of the osteoporotic spine.  Objectives of this session entitled, “A Current Review of Pharmacologic and Interventional Treatments of the Osteoporotic Spine”, includes: 

• A review of the latest pharmacologic clinical guidelines for the prevention and treatment of osteoporosis. 
• A discussion of treatment algorithms for the osteoporotic spine; including indications and outcomes of vertebral augmentation. 

 

For more information about this program, please call 317.228.7000.

When osteoporosis results in a fractured vertebra, called vertebral compression fractures (VCF), a patient can have persistent pain.  This pain may interfere with normal activities.  Fortunately, there are treatment options.  The goals of treatment are to reduce the back pain, and to stabilize and strengthen the vertebral body reducing the risk for additional fractures.

In the treatment of patients, there are a few minimally invasive spine treatment options available.  Treatment recommendations are made based upon the patient’s specific medical needs.

One treatment option is vertebroplasty.  During this procedure, specially formulated bone cement is injected through a hollow-needle (that is guided by X-ray imaging) directly into the fractured vertebra.  This creates an internal cast that stabilizes the bone. 

Another treatment option is called balloon kyphoplasty.  With this procedure, orthopaedic balloons are used to lift the fractured bone and return it to the correct position.   

Both of these procedures can be done on an outpatient basis.  Patient’s are either awake with conscious sedation or are given a general anesthesia.  The procedures take approximately an hour to 90-minutes. 

Individuals with osteoporosis are at risk of a spinal fracture – referred to as vertebral compression fractures (VCF).  Depending on the severity of osteoporosis – these fractures can occur with even a mild strain to the spine – such as twisting while lifting or a simple fall.  For individuals with advanced cases of osteoporosis a fracture can even result from normal activities such as bending forward.   

Generally a person with a fractured vertebra will have persistent back pain, although they usually do not realize that this is the cause. Since one fractured vertebra can easily lead to another, it is important for early diagnosis and treatment.

Here are some of the main symptoms of a vertebral fracture – that may occur alone or in combination:   

• Sudden onset of back pain
• Back pain that worsens while standing or walking
• Limited spinal mobility
• Height loss
• Deformity and disability

If you have noticed any of the above symptom(s), talk to your doctor. 

According to the National Osteoporosis Foundation (NOF) – osteoporosis is a major health threat for 55 percent of the Americans over the age of 50.  Additionally, the NOF estimates that 10 million Americans already have osteoporosis and 34 million are at risk. Commonly a disease that affects women – approximately 20% of those with osteoporosis are men.

Because it is usually not diagnosed until an individual fractures a bone, it is referred to as the “silent disease”.   Typically, the fracture is a result of a fall – generally a fractured hip, wrist, arm or leg, and unfortunately these can be painful. But spinal fractures can occur – even doing simple household chores.