By Amanda N. Sacino, MD-PhD . Neurosurgeon and Managing Partner
May is Osteoporosis and Awareness Month. Osteoporosis, often called the “silent disease,” is a condition in which bones become weak and brittle due to the loss of bone density and mass. This weakening can progress without symptoms until a bone breaks—often from a fall or, in severe cases, from something as minor as a sneeze. One of the most common and serious consequences of osteoporosis is spine compression fractures, which can lead to chronic pain, loss of height, and reduced quality of life.
What is Osteoporosis?
Osteoporosis is a skeletal disorder characterized by low bone mineral density and deterioration of bone tissue. It primarily affects older adults, especially postmenopausal women, but can also affect men and younger individuals under certain conditions. Bone is living tissue that constantly breaks down and regenerates. When bone loss outpaces the formation of new bone, the skeleton becomes porous and fragile.
Risk factors include aging, hormonal changes (particularly the drop in estrogen in women after menopause), family history, poor nutrition (especially low calcium and vitamin D), sedentary lifestyle, smoking, and excessive alcohol use. Certain medications and medical conditions—like corticosteroids, rheumatoid arthritis, or thyroid disorders—can also increase the risk.
What Are Spine Compression Fractures?
Spine compression fractures occur when one or more vertebrae (the bones in the spine) collapse or are compressed. These fractures can happen suddenly or develop over time and are most often caused by osteoporosis. In people with weakened bones, even minimal stress—like lifting a light object, coughing, or twisting—can cause a vertebra to crack or collapse.
These fractures are most common in the thoracic spine (the middle portion of the back), but they can occur anywhere along the spine. Often, patients are unaware they have suffered a fracture, attributing the pain to general back issues or aging.
Symptoms and Diagnosis
The most telling symptom of a spine compression fracture is sudden back pain, particularly in the middle or lower back. The pain can be sharp and debilitating or present as a persistent, dull ache. Other signs include:
• Loss of height over time
• Stooped posture or kyphosis (a curved, hunched back)
• Limited spinal mobility
• Pain that worsens with standing or walking and improves with rest
In severe cases, multiple fractures can compress nerves, leading to numbness, tingling, or weakness in the limbs.
Diagnosis typically involves a physical exam followed by imaging tests. An X-ray can often reveal the collapsed vertebrae, while a DEXA (dual-energy X-ray absorptiometry) scan is used to measure bone density and confirm osteoporosis. In some cases, an MRI or CT scan may be used to evaluate the severity of the fracture and rule out other causes of back pain, such as cancer or infection.
Treatment Options
The treatment for spine compression fractures depends on the severity of the fracture and the degree of osteoporosis. It usually includes a combination of pain management, activity modification, and bone-strengthening interventions.
1. Conservative Treatment
Most compression fractures can be managed conservatively:
• Pain Relief: Over-the-counter pain medications like acetaminophen or NSAIDs can help. In some cases, stronger prescription pain relievers may be necessary.
• Bracing: A spinal brace or orthotic may be used to limit motion and provide support during healing.
• Activity Modification: Bed rest may be recommended initially, followed by gradual reintroduction of movement and physical therapy to restore mobility and strength.
2. Medical Treatment for Osteoporosis
Treating the underlying osteoporosis is critical to prevent future fractures. This may involve:
• Calcium and Vitamin D Supplements: Essential for bone health.
• Bisphosphonates: Medications that slow bone loss and help rebuild bone density.
• Other Medications: Such as denosumab, teriparatide, or romosozumab, depending on the patient’s profile and response to initial therapies.
• Lifestyle Changes: Incorporating weight-bearing exercises, quitting smoking, reducing alcohol intake, and improving diet.
3. Surgical Treatment
In cases where conservative treatment is ineffective or the pain is severe and persistent, minimally invasive surgical procedures may be considered:
• Kyphoplasty: A procedure which involves inserting a balloon to create space which can help restore vertebral height before bone cement is injected into the fractured vertebra to stabilize it.
Prevention
Preventing osteoporosis and spine compression fractures starts early. Building strong bones through adequate calcium and vitamin D intake, regular physical activity (especially weight-bearing and resistance exercises), and avoiding smoking and excessive alcohol can go a long way. For those at risk, regular bone density screenings and early medical intervention are key.
Living with Osteoporosis
Though osteoporosis and spine compression fractures can be life-altering, many people live well with proper management. A multidisciplinary approach involving primary care physicians, endocrinologists, orthopedists, and physical therapists can help optimize outcomes. Education and support—through patient groups or community resources—also play a vital role in maintaining both physical and emotional well-being.
239-422-APEX (2739)
3530 Kraft Road, Suite 203 • Naples, FL 34105
www.apexbrainandspine.com