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The Aging Spine

Osteoporosis and Compression Fractures

Osteoporosis is a decrease in bone mass, more commonly seen in women in the post-menopausal period. It is a decrease not only in the mineral (such as calcium and phosphorus) component, but also in what is called the organic (such as protein) component of bone. About 15-20 million people have osteoporosis, and over one half million suffer spinal fractures due to osteoporosis each year. These fractures can occur with minimal trauma or no trauma at all.

Symptoms and Diagnosis
Back pain is the most common symptom of this condition, and x-rays may show wedge or compression fractures of the vertebrae. MRI or CT scans may be necessary to further evaluate these fractures. It is very important to confirm a diagnosis of osteoporosis because similar symptoms occur with other conditions such as infections, other metabolic bone diseases, and benign or malignant bone tumors. The extent of the osteoporosis can only be estimated on plain X-rays and must be confirmed by specific bone density tests or, in some cases, by bone biopsy to confirm its presence.

Fortunately, most spinal fractures due to osteoporosis are successfully treated with just medication to control the pain, but the underlying osteoporosis should also be addressed once it is recognized. The treatment of osteoporosis itself is rapidly evolving. Combinations of calcium, vitamin D, and estrogen are controversial. Calcitonin is used in some cases to inhibit the breakdown of the minerals in bone, and fluoride has also been tried in an attempt to increase bone mass. More recently, drugs in the bisphosphonate family have been used to help maintain and possibly increase bone mass.

In addition to medications, other devices such as back braces help control pain and keep the deformity from getting worse. Although braces usually do not correct the wedging of the bone, they do support the spine and may decrease secondary muscle spasm.

In rare cases, surgery may be necessary to control the pain, improve the deformity, or decompress the nerve roots or spinal cord. New techniques to treat the problem of compressed vertebrae include vertebroplasty and kyphoplasty. In vertebroplasty, the vertebrae are injected with a bone cement to improve the strength of the bone. In kyphoplasty, cement is injected after improving the wedging by inflating a balloon inside the vertebra body and filling the space with cement. Both procedures require at least sedation and local anesthesia but sometimes require general anesthesia. The procedures are done using only very tiny incisions under x-ray control. As with any other surgical procedure, there are certain risks.