Often called the silent disease, osteoporosis is a bone condition characterized by decreased bone mass and the subsequent deterioration of bone tissue.
What Is Osteoporosis?
Osteoporosis is a bone condition characterized by decreased bone mass and the subsequent deterioration of bone tissue. Often called "the silent disease", this progressive condition causes bones to become more porous, thin and brittle, thus more susceptible to fracture. The spine can be particularly vulnerable – vertebral compression fractures may occur in those whose osteoporosis has reached the advanced stage.
Men, women and in rare cases even children can develop osteoporosis; however, the condition is most prevalent in older adults. An estimated 44% of Americans over age 50 – some 44 million people – have been diagnosed with the condition or identified at increased risk for osteoporosis due to low bone mass. Of those diagnosed with osteoporosis, 80% are women.
The exact cause of osteoporosis is unknown; however, there are a number of established risk factors. Age, nutrition, lifestyle and genetics, as well as certain medical conditions and medications, can all play a part.
During childhood and early adulthood, the body creates new bone faster than it can absorb existing bone, a process that starts to reverse around age 30. Bone loss in women speeds up when the production of estrogen slows down, usually between the ages of 45-55. Likewise, men begin to experience bone loss as their production of testosterone declines, generally around age 45-50.
One of the reasons women are more likely to develop osteoporosis, and develop it earlier, is that their bones are typically smaller and lighter than men’s, so there is less bone mass to begin with. People who do not achieve ideal bone thickness when they are young also are more likely to develop the condition.
Bone strength is a product of both bone mass and density. Bone density depends, in part, on the amount of calcium, phosphorus and other minerals the bone contains. Bones deficient in these minerals tend to be weaker with less internal supporting structure, which makes them more porous and fragile.
Excessive dieting or eating disorders, such as anorexia nervosa, may contribute to bone loss. Studies have shown that cola drinks, which contain phosphoric acid, also may interfere with bones’ ability to absorb calcium.
People who get little or no exercise are at risk for developing osteoporosis. Weight bearing exercises, such as walking, jogging and weight lifting, work muscles and bones against gravity, which helps maintain their strength and density. Smoking increases the loss of bone density, and heavy alcohol consumption may inhibit bone formation.
People who have a parent or sibling with osteoporosis have a 60% to 80% chance of developing the condition, as well. People of Asian or European descent are those most likely to develop osteoporosis; people of African descent the least likely.
Small-framed, thin people also are at greater risk. Smaller bones mean less bone mass. And thin people have less body fat – fat cells produce estrogen, which can help prevent bone loss in women after menopause.
Medical Conditions and Medications
Several medical conditions, including hyperthyroidism, Cushing’s syndrome and hyperparathyroidism, increase the risk of osteoporosis. Some medications also may contribute to bone thinning. They include
- Corticosteroids (for treating asthma and chronic obstructive pulmonary disease)
- Endometriosis medications
- Aromatase inhibitors (for treating breast cancer)
- Thyroid replacement medications
- Antacids containing aluminum (if overused)
What Are The Symptoms of Osteoporosis?
Unfortunately, the reason osteoporosis is called the "silent disease" is that it has no physical symptoms in its early stages. As the condition progresses, the following symptoms that indicate weakening bones may occur
- Lower back or neck pain
- Bone pain or tenderness
- Curved backbone or stooped posture (“dowager’s hump”)
- Gradual loss of height
- Fractures from minor trauma, especially in the hip, spine or wrists
How Is Osteoporosis Diagnosed?
Early diagnosis is critical. If you believe you are at risk for osteoporosis or have experienced any of the above symptoms, contact your physician. He or she will make a diagnosis based on your medical history, a physical examination and a bone density test – a painless, accurate and non-invasive procedure that measures bone thickness.
How Is Osteoporosis Treated?
Although there is no cure for osteoporosis, there are a variety of treatment options that have the potential to reduce, stop or even reverse bone loss. Even small changes in diet, exercise and medication may help prevent the more serious consequences of the condition, such as broken bones. There also are a number of osteoporosis prevention and/or treatment medications currently approved by the U.S. Food and Drug Administration.
Consult with your physician to determine which treatment plan is best for you, and follow the program he or she recommends to rebuild and maintain bone health.
Vertebral Compression Fractures
Back pain is not just another inevitable aspect of growing older. It could be a sign of stress fractures within your spine called vertebral compression fractures.
What Is A Vertebral Compression Fracture?
Spinal fractures occur when the normal vertebral body is "squashed", or compressed in height. When the load on a vertebra exceeds its stability or inherent strength, the bone can collapse. Pain, limited mobility, height loss and spinal deformity are often the result. In severe cases, part of the vertebral body may protrude into the spinal canal and put pressure on the spinal cord and nerves. Organ function, including that of the bowel or bladder, also may be compromised.
Vertebral compression fractures can happen for a number of reasons: trauma from a fall or a car accident; bone thinning due to osteoporosis or even the spread of a tumor into the spine.
Knowing how to prevent, recognize and treat vertebral compression fractures is critical for maintaining good spinal health. Here is some information to help you learn more about this type of spinal injury.
What Causes Vertebral Compression Fractures?
There is no one single cause; however, the vast majority of vertebral compression fractures are the result of osteoporosis, a condition that causes bones to progressively become more thin and fragile. When bones are brittle, even everyday activities and minor traumas, such as lifting a laundry basket, missing a step, or even coughing or sneezing, can cause these tiny fractures.
Osteoporosis-related compression fractures can occur anywhere in the spine, but are most often found in the lower vertebrae of the upper back. The vertebral bone tends to collapse toward the front of the spine, creating wedge-shaped vertebrae that cause the spine to curve forward (kyphosis), eventually leading to the "dowager’s hump" frequently associated with the advanced stage of the disease. Learn more about osteoporosis.
Tumors growing in or near the spine are another cause of compression fractures. Doctors frequently monitor those diagnosed with certain types of cancer, including multiple myeloma or lymphoma, for spinal breakage. Tumors also may spread to the spine as a result of cancer in other organs and areas of the body, such as the breasts, lungs and intestines.
People with strong, healthy bones also can sustain compression fractures from a hard fall or blow to the back or torso. Vertebrae can withstand a good deal of shock; however, if the force on the spine is too great, they can break.
What Are The Symptoms of Vertebral Compression Fracture?
The primary physical symptoms of vertebral fracture include one or more of the following
- Sudden onset of back pain
- Increase in pain when standing or walking
- Variable pain relief when lying down
- Limited spinal mobility
- Weakness or numbness in the affected areas
- Height loss
- Deformity and disability
- Shortness of breath
These additional symptoms signal the possibility of multiple vertebral fractures
- Hunched back ("dowager’s hump")
- Bulging abdomen
- Gastrointestinal problems – crowding of the internal organs can be a serious side effect of multiple compression fractures
- Shortness of breath – it’s possible for the torso to become so compressed that it’s difficult to breathe
- Hip pain (hip fracture)
How Are Vertebral Compression Fractures Diagnosed?
If you think you may have a compression fracture, see a doctor. (To find one near you, visit our Physician Locator.) Here are some questions your doctor may ask
- How long have you been in pain? Was the onset sudden or gradual?
- Where is the pain located? What is the intensity?
- Does the pain radiate to other parts of the body?
- In what positions is the pain better or worse?
- Is the pain getting worse or better over time?
Your doctor also may recommend one or more of the following diagnostic tests
- A spinal X-ray to determine the presence of a fracture
- An MRI to check for the age of the fracture and other abnormalities in the soft tissues, including nerves and ligaments
- A nuclear bone scan, another test that can determine the presence and/or age of a fracture
- DEXA scan
How Are Vertebral Compression Fractures Treated?
Treatment of compression fractures includes measures to alleviate the pain, stabilize and repair the fracture, and diagnose the underlying cause of the breakage.
Non-surgical treatment options your doctor may recommend include
- Medications to relieve bone, muscle and nerve pain
- A reduction in activity or bed rest
- A spinal brace to limit motion
- Medication to stabilize or improve bone density
- Physical therapy
- Epidural spinal injection
- External soft bracing
If compression fractures fail to heal or if pain persists despite non-surgical measures, your doctor may recommend surgery as the next step toward relief. Surgical procedures for treating vertebral compression fractures are usually minimally invasive.
How Can I Prevent Vertebral Compression Fractures?
The best way to avoid vertebral compression fractures is to begin taking preventive measures toward building a strong back and spine early in life. But, even if you didn’t, it’s never too late to start! Here are a few tips
Exercise – Exercise, especially strength/resistance training and/or lifting weights regularly, can help build strong bones. Engaging in some form of cardiovascular exercise and strength training at least three times a week can help combat bone loss, and the earlier you start exercising and strength training the better. Strong muscles also help you maintain balance to avoid falls and other accidents.
For back-strengthening programs at the beginner, intermediate and advanced levels, check out these exercises for the back and spine.
Eat Right – Eat a nutrient-rich, balanced diet, with sufficient intake of calcium, Vitamin D and phosphorus. Avoid smoking and excessive alcohol use; smoking contributes to bone density loss and too much alcohol inhibits bone formation. If possible, maintain a healthy weight – additional pounds place excess strain on the back.
Stay Hydrated – Drink between six and eight cups or water a day to keep the body well hydrated. Water helps reduce stiffness and contributes to overall spine health. Learn how to maintain bone density for a healthy spine.
Practice Good Posture – Maintaining a "neutral spine" is the foundation of good posture. In a neutral spine, the natural curves of the spine (the concave, or lordotic, curves, and the convex, or kyphotic, curves) are in proper balance. The spine is neither rounded forward nor arched back too much.
Proper posture keeps your bones properly aligned and alleviates excess stress on your musculoskeletal systems, allowing your muscles, joints, and ligaments to work as intended.