By Daniel E. Choi, M.D.

An ounce of prevention is worth a pound of cure. One of the most common conditions I see at Long Island Spine Specialists are compression fractures of the spine. Compression fractures affect many of my elderly patients and are extremely debilitating.  They are usually the result of osteoporosis, a bone fragility condition estimated to affect 200 million women worldwide.

Osteoporosis is a disease of progressive bone loss that increases a patient’s risk of hip, spine, wrist, arm, and leg fractures. According to the American Academy of Orthopaedic Surgeons (AAOS), one in two women over the age of 50 will experience an osteoporosis-related fracture in her lifetime.

Prevention

According to the International Osteoporosis Foundation, adults should do the following to prevent osteoporosis:

-Ensure adequate calcium intake (dairy products, kale, almonds are good sources of calcium)
-Maintain an adequate supply of Vitamin D.
-Participate in regular weight-bearing activity.
-Avoid severe weight-loss diets, smoking, and second-hand smoke.

One way your body produces Vitamin D to maintain bone health is through exposure to sunlight. When I was a resident physician in training and eternally stuck indoors, my primary care doctor drew my Vitamin D level, which was abysmally low, and suggested Vitamin D supplements. So, I keep them handy next to my Keurig in the morning, an easy way to remember to keep up with my Vitamin D intake.

It’s important to note that too much Vitamin D can be harmful! Supplementation should always be done under the oversight of your doctor and results of blood tests.

Screening

Unfortunately, most times that I end up diagnosing osteoporosis it is after a patient presents to me with a compression fracture with debilitating back pain at our Long Island practice. I end up sending the patient for a study called a DEXA scan, short for dual-energy x-ray absorptiometry, which confirms our suspicions of osteoporosis as the cause of the fracture.

A DEXA scan is a painless study that quantifies my patient’s bone density or how much bone loss my patient has currently. For women, DEXA is recommended to be done as a screening exam at the time of menopause. If osteoporosis is diagnosed early on, medications can be given to reverse the bone weakening effects of osteoporosis.

Treatment

If a screening DEXA scan shows evidence of osteoporosis, one medication I recommend for my patient to start is a bisphosphonate medication. This medication works to markedly increase bone mass and helps to prevent future spine and hip fragility fractures. Prevention of future fractures is much more preferable than waiting to treat a fragility fracture caused by osteoporosis.

Spine compression fractures caused by osteoporosis are typically treated non-operatively. A brace is given to the patient for pain relief and support. There is also a role for surgical treatment with a procedure called a kyphoplasty if bracing and modifying the patient’s activity do not help improve the patient’s pain.  A kyphoplasty is usually done as a same-day procedure that does not typically require overnight stay in the hospital. A small balloon is expanded in the space of the fractured bone and cement is injected into the new space created. Many scientific studies have validated and shown that kyphoplasty is effective in relieving pain and improving function after a compression fracture if nonsurgical treatments fail.

This post and account is for educational purposes only and not intended for use in diagnosing or treating medical conditions.

Dr. Daniel E. Choi completed a prestigious orthopaedic spine surgery fellowship at Harvard Medical School and has extensive experience in treating cervical, thoracic, and lumbar spine disorders. He training includes a special focus on minimally invasive spine surgery.

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