Osteoporosis is the most common bone disease. It occurs due to a decrease in the bone mass, which results in weakness of the bones. This weakness becomes so severe that you could end up breaking your spine even without major accidents. If you suffer from osteoporosis, activities such as lifting a bag, standing from a sitting position and injuries from falls can result in spine fractures.

The spine, hips, wrist and shoulders are the commonest bones to fracture. Often, a fracture of the spine may be the first sign that you are suffering from osteoporosis. The problem is, once you have a fracture, then you will have already lost a substantial amount of bone. Around 25 percent of patients with osteoporotic spine or hip fracture end up dying within six months.

Risk factors for osteoporosis

Age and sex: Post-menopausal women and women above 45 years of age are at risk for osteoporosis because women lose 3 percent of their bone mass every year in the first seven years after menopause. One in two women and one in eight men will have an osteoporosis-related fracture in their life time.

Genetics: There is a 50-85 percent increased risk of developing osteoporosis if you have a family member who has been affected by osteoporosis.

Others: Inadequate intake of dietary calcium and Vitamin D, poor nutrition, smoking;  use of alcohol, steroids and antiepileptic medication can be contributing factors.

The risk of developing osteoporosis depends on how much bone mass you obtain by 30 years of age and how well you maintain the mass.

Diagnosis

The patient is typically a woman above 45 years of age or post-menopausal women with diffuse back pain, stooped posture, presenting with loss of height or development of a fracture due to minor trauma. The diagnosis is made by a plain X-ray to confirm the fracture and a DEXA scan to detect the amount of bone loss and blood calcium, phosphorus, vitamin D and serum creatinine levels. A DEXA scan takes approximately 30 minutes and is a painless procedure. A DEXA score of -1 to -2.5 is considered to be a decrease in bone mass, while values less than -2.5 is diagnostic of Osteoporosis. The scan is repeated  yearly to monitor the response to treatment.

MRI and CT scans are performed to rule out or confirm spinal cord and nerve root compression.

Prevention of osteoporosis

Make sure that your diet is nutritious and well-balanced, with adequate quantities of calcium and vitamin D.  Dairy products such as cheese, butter, cream, fortified milk, yogurt, broccoli, collards, turnip, fish, oysters and fortified cereals are good sources of Vitamin D and calcium. Avoid smoking, alcohol and caffeine. To build strong bones do some weight-bearing exercises such as walking and strengthening drills. 

Medication

Calcium and vitamin D supplements are the mainstay of treatment. Other anti-osteoporotic medications are to be taken with the prescription of a spine surgeon. Surgery is reserved for those patients with unrelieved pain due to a spine fracture or a spine fracture causing cord or nerve compression resulting in paralysis.

The key to the management of osteoporosis is preventing or slowing bone loss. It is strongly recommended that any woman above 45 years of age or those who are postmenopausal consult a spine surgeon and take timely preventive measures.

Dr Dhakal is a spine surgeon at Norvic International Hospital ([email protected])