Osteoporosis is often called the "silent disease," because bone loss occurs without symptoms.
"This disease causes a person's bones to become fragile and more likely to break," explained neurosurgeon Joel Siegal, M.D. "Many people may not know that they have osteoporosis until their bones become so weak that a sudden bump or fall causes a fracture or a vertebra to collapse. One in two women and one in four men over the age of 50, will have an osteoporosis-related fracture in their lifetime.
"The spine is made up of strong bones called vertebrae. A vertebra can break just like any other bone in the body. When the vertebral body collapses, it is called a vertebral compression fracture. These fractures happen most commonly in the lower thoracic or upper lumbar spine. Vertebral fractures are usually caused by a condition such as osteoporosis, a very hard fall, or another type of injury.
"After a vertebra has fractured, there is typically a loss of 20 to 30 percent of the height of the bone," Dr. Siegal continued. "Over several weeks, further compression or collapse of bone may increase, and the vertebra can flatten out, until there's a 70 to 90 percent loss of height in the bone. Gradually, the back hunches over and the person loses height, especially if several vertebrae are involved.
"One fracture can lead to subsequent fractures. Collapsed vertebra may be seen or felt in the form of severe back pain, loss of height and spinal deformities, called kyphosis or stooped posture. For many people, severe back pain persists because the crushed bone continues to move and break."
There are steps to help prevent osteoporosis:
1. Choose a balanced diet rich in calcium (1200 mg daily for men and women over 50) and vitamin D (between 400 and 800 IU daily)
2. Do weight-bearing exercises regularly (exercises where your bones and muscles work against gravity)
3. Follow a healthy lifestyle with no smoking and no excessive alcohol intake
4. Check into bone density testing and the use of physician recommended medications, when appropriate.
"Until the last decade, there was little or no satisfactory treatment for the collapse of bones in the spine resulting from osteoporosis, or the pain associated with these fractures," Dr. Siegal said. "However, procedures such as vertebroplasty and kyphoplasty, can help to strengthen the vertebrae and give very dramatic relief from pain.
"Vertebroplasty and kyphoplasty are considered to be minimally invasive, meaning that open surgery is not required. A needle, about the size of a small straw, is inserted through the skin and into the crushed vertebra. The needle is guided into position using special x-ray equipment.
"Once the needle has been inserted into the crushed bone, a special surgical bone cement is then injected into the vertebra to stabilize it. Often, more than one crushed vertebra can be treated in a single procedure, which is usually performed on an outpatient basis.
"Kyphoplasty is similar to vertebroplasty; however, a small balloon is inserted into the vertebra and inflated, sometimes restoring height to the vertebral body," Dr. Siegal added. "After the balloon is used, the surgical bone cement can be injected to stabilize the vertebra.
"The results of these procedures show that there is about a 95 percent improvement in pain relief, and most people are happy with the outcome in less than 24 hours. There is also often significant improvement in a person's function following treatment. This is due to the stabilization of the bone, which prevents further collapse and relieves the pain. The injection not only expands the compressed vertebra to a degree, but helps to stop the pain caused by bone rubbing against bone.
"With these advanced techniques, the best results are obtained in the first three months after the onset of pain from a bone fracture," Dr. Siegal concluded. "People treated soon after a fracture seem to have better results, compared to patients whose treatment is delayed for more than three months.
"These procedures have also become safer and much more effective, not only for the control of pain, but also for preventing further collapse of the softened bones of the spine. If performed early enough, they can help prevent kyphosis or a permanent disability resulting from the inability to straighten the spine. In addition, the procedure can be performed in some cases for cancer patients, who are suffering from spinal collapse."
For more information about vertebroplasty and kyphoplasty, contact Dr. Siegal at 877.98.SPINE (877-987-7463). Dr. Siegal is a member of Salem Community Hospital's medical staff, where he conducts a monthly neurosurgery clinic. He is also affiliated with the Spine and Orthopedic Institute at St. Vincent Charity Medical Center.