Osteoporosis

Literally meaning 'porous bones', osteoporosis is a medical condition that is characterized by fragile skeletal structure. Osteoporosis threatens nearly 34 million women in the US alone and many more worldwide. Osteoporosis is commonly noticed in post-menopausal women. But actual loss of bone mass happens in the 30s. This occurs due to loss of lose an excessive amount of their protein and mineral content, particularly calcium from the bones. Over time it leads to reduced bone mass and decreased bone strength. Normal bone marrow has small holes within it, but a bone with osteoporosis will have much larger holes. Osteoporosis can be classified into two categories - primary and secondary. Primary osteoporosis is associated with bone loss, which is prevalent in older persons and post menopause women. Secondary osteoporosis results from chronic conditions that contribute significantly to accelerated bone loss.

Most often osteoporosis is caused by a combination of lifestyle, genetic and hormonal factors. Slender, small-framed women are particularly at risk. Typical symptoms of osteoporosis are severe back pain, curvature of the spine and loss of height. A woman suffering from osteoporosis suffers from joint aches and muscle aches. There is an increased tendency to fractures on account of brittle and thin bones. Osteoporosis can be hereditary. Women with very thin body frames can be at increased risk of osteoporosis on account of lesser bone mass. Prolonged use of corticosteroids can put a woman at increased risk of osteoporosis since drugs such as prednisone, cortisone, prednisolone and dexamethasone damage bone mass. Other medications that can lead to bone loss are diuretics, anti-seizure drugs and anticoagulants. Hyperthyroidism is another contributory factor to developing osteoporosis. Chronic conditions such as renal failure, malnutrition and connective tissue diseases contribute towards development of osteoporosis.

Diagnosis of osteoporosis may include a series of tests such as bone densitometry (a bone density scan) performed by your physician. There are three types of bone density scans: dual-energy x-ray absorptiometry (DEXA), single photon absorptiometry (SPA), and quantitative computed tomography (QCT). The most common bone density scan is the DEXA - a test that measures bone density based on how bone absorbs two sets of photons (atomic particles with no electrical charge) generated by an x-ray tube. A bone density test is recommended by physicians to post menopausal women, especially those with a higher risk factor.

It is essential to build on your bone mass during the ages of 25 - 35 so as to keep osteoporosis at bay. This can be done by maintaining a balanced diet, with plenty of calcium and following a regular exercise regimen. Weight-bearing exercises are of special importance in strengthening the bones. Running, skipping, aerobics, tennis and weight training are ideal osteoporosis exercises that can be undertaken thrice a week for at least 30 minutes. Apart from bone density, these exercises also increase the strength, co-ordination and balance, thereby reducing the risk of falls. A sedentary lifestyle can put you at increased risk of developing osteoporosis in latter years.

• Consuming a balanced diet, rich in calcium
  
• Eating green leafy vegetables, citrus fruits, dairy products, nuts and shellfish
  
• Calcium supplements
  
• Avoid smoking and excess alcohol intake
  

Vertebral Compression Fracture

Vertebral compression fracture occurs when a part in the vertebra collapses due to the compression of the bone in the spine. With age, vertebrae is weakened and loses its strength and leads to a condition called osteoporosis. Osteoporosis is a kind of bone loss that causes bones to break easily. Osteoporosis is the leading cause of vertebral compression fractures especially in the age group of 40 to 50 and above. Post menopausal women and men above the age of 65 years are at highest risk of suffering from vertebral compression fractures.

Apart from osteoporosis, there could be other reasons that lead to vertebral compression fractures. Young adults suffer from vertebral fractures due to spinal injuries during rigorous exercises, sports activities or accidents. These compression fractures normally heal within 8 to 10 weeks with good rest and pain medication. Vertebral compression fractures may also be attributed to cancer tumors associated with multiple myeloma and metastatic bone disease. In very rare cases, infection or Osteomyelitis of the vertebra also results in compression fractures.

Wedge fractures are the most common type of compression fractures wherein the front part of the vertebral body collapses and becomes wedge shaped. Other types of vertebral compression fractures include biconcave (collapse of central portion of vertebral body) crush fractures (collapse of entire vertebral body). These fractures happen most commonly in the thoracic spine (the middle portion of the spine), and lumbar spine (low back).

Symptoms of Vertebral compression fracture

Compression fractures caused by injuries produce sudden onset of sharp and throbbing pain. Fractures caused by osteoporosis may cause very mild to severe pain in the back. Normally the pain is intense in standing posture and there is respite when lying down.

Vertebral compression fractures also lead to kyphosis and loss of height especially with the fractures associated with osteoporosis.

Sometimes a severely fractured bone can impinge on the spinal cord. Thus, numbness or tingling in limbs or other areas of the body may occur if the spinal cord is affected. This can impair sensation in the areas supplied by the damaged nerve tissue.

Diagnosis

Doctor's evaluation of symptoms plays a major role in diagnosing compression fractures. Noting of complete history of the patient and clinical examination are necessary to determine the presence of vertebral compression fracture. When doctor suspects vertebral compression fracture, an x ray is ordered to confirm the diagnosis. If the X-Ray reveals a fracture, further imaging tests like CT scan and MRI are performed to rule out the involvement of spinal cord and also to understand the age of the fracture. A neurological exam may also be done to test for reflexes, muscle strength and sensory perception.

Treating Vertebral Compression Fracture

The conventional methods of treating vertebral compression fractures include pain medication, rest and bracing. While pain medication helps in alleviating the pain to some extent, back braces reduce the chance of further collapse of the bone, prevent deformity, and allow injuries to heal by taking the pressure off the fractured vertebral bone. Giving rest to the back by decreasing activities as much as possible helps in healing the fractures naturally and quickly.

There are also some minimally invasive methods used to treat vertebral fractures which are gaining popularity. Vertebroplasty and Kyphoplasty are two medical procedures that are increasingly being used to treat compression fractures. Here the fracture is treated by injecting a bone cement onto the collapsed bone through hollow needle. These are image-guided surgical procedures with minimum invasion that promise faster pain relief.

Further treatment also depends upon the underlying cause that is leading to vertebral fracture. If the osteoporosis is causing the bones to collapse, doctor may prescribe calcium and other bone strengthening supplements to avoid future compression fractures. If a tumor has caused compression fracture, more invasive surgery will be required remove sections of bone or tissue.

Dexa scan

A DEXA scan or Dual Energy X-ray Absortiometry scan is a diagnostic tool that measures bone mineral density. This type of scan is usually prescribed for those at increased risk of osteoporosis. p DEXA or peripheral DEXA is used to measure bones on the periphery of a person such as wrist, fingers and heels. Central DEXA is used to measure bones in the spine and hip. This type of DEXA scan can accurately measure low bone density and is the preferred test for diagnosing osteoporosis. An imager passes over your body, emits radiation from two different sources in alternation. The DEXA scan differs from the regular bone scan in that the use of 2 different x-ray energy sources provides precision and accuracy. Besides it is able to detect loss of bone density much earlier than when it can surface on a regular x-ray. A detector measures the amount of radiation that comes through the bone being examined. This throws light on its density. A Dexa scan usually takes about 20 minutes and involves small amount of radiation.