Osteoporosis means decreased calcium deposition in the bones in elderly people i.e. those above 60 years of age, and can result in weakening of the bones in the body. The thirty -three bones in the spine called vertebrae are particularly affected by osteoporosis and this can lead to persistent back pain.When the osteoporosis is severe it can lead to compression fractures in the bones of the lower and upper back and even a small fall in the bathroom or a jerk encountered in the rear seat of a moving car or bus can be the cause of these spine fractures. This can cause severe pain in the back and inability to stand or walk. If the nerves behind the spine or spinal cord come under pressure due to the fracture it may lead to weakness in the legs and loss of sensation in the legs.
Steps to prevent osteoporotic spine fracture are
1. Healthy diet with adequate calcium i.e. milk, paneer, cheese, yoghurt and green leafy vegetables
2. Even though the diet may have adequate calcium,osteoporosis might still occur in elderly postmenopausal ladies because of inadequate retention of calcium in the bones. Medications such as calcium and vitamin D3 supplements and other medications such as bisphosphonate tablets and nasal calcitonin spray may be required. One must always consult a spine specialist before starting these medicines. The spine specialist might need to get a DEXA scan to check the level of osteoporosis if clinical examination suggest that the bones are weak.
3. Light exercise particularly in the elderly and exposure to sunlight are also useful in preventing calcium loss from the bones of the spine and they also keep the back muscles healthy
How to recognize osteoporotic spine fractures
If there is severe back pain after a minor injury in elderly patients and it persists, then it may be a sign of osteoporotic spine fracture. The spine specialist may ask for an X-ray or MRI of the spine to confirm the presence of spine fracture. Most osteoporotic spine fractures heal without surgery and can be treated by a course of analgesics, calcium supplements and a brace for the back.
However, when the fracture makes of the spine unstable endangering the spinal cord behind the vertebrae or when the fracture refuses to heal beyond 4to 6 weeks of nonsurgical treatment, surgery may be required. Most of the times a minimal invasive surgery injection of bone cement in the fractured vertebra under local anesthesia can produce dramatic relief by a procedure known as vertebroplasty/kyphoplasty.
In cases where the spine is unstable screws and rods may be applied to the vertebrae above and below the fracture to stabilize the spine in addition to application of bone cement at the fracture site. Most of these patients are able to walk comfortably on the first day after spine surgery.However, prevention is always better than cure and timely recognition and treatment of these spine fractures is very important in preventing severe pain and permanent disability.