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Conditions
Osteoporosis |
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The term osteoporosis literally refers to a condition
where the bones become porous; that is, holes begin to appear inside the bones. As
a result of this, they become lighter, weaker, and more susceptible to fracture (the
condition is also referred to as brittle bone disease).
Why does this happen?
Like all the other structures in our body, bones are formed from living tissue. Certain
cells (called osteoblasts) are responsible for bone formation, whereas others
(called osteoclasts) are responsible for bone depletion. Depending on the rates of
formation and depletion, bone mass either goes up or comes down.
Bone formation is very obvious during childhood – as you get older you become taller.
However, our bones continue to grow until the age of about 30 (increasing in mass, if not
in length). Following on from this, net depletion tends to occur and, when it gets to a
certain level, osteoporosis may be diagnosed.
However, individuals suffer from different rates of depletion, depending on several
factors (including age, race, sex, and lifestyle). In general terms, though, osteoporosis
is far more likely to affect post-menopausal women from the age of about 50 onwards. |
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How is it diagnosed?
As depletion occurs, the overall mass of the affected bones
is reduced; if this can be detected, osteoporosis may be diagnosed. Most patients,
however, probably aren’t aware of their osteoporosis until a fracture occurs
(resulting in pain). Fractures can often be detected by normal X-ray techniques, but
general bone thinning is far more difficult to detect – for example, you may need to
lose between 30% and 50% of bone mass before it becomes apparent using normal X-ray
methods.
Fortunately, a more sophisticated method exists, referred to as DEXA (or Dual Energy X-ray
Absorption), which allows for early detection of osteoporosis. DEXA is very safe, easy to
administer, and very accurate – changes in bone mass as small as 1% can be seen. |
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What are the consequences for back pain?
In theory, all bones in the human skeleton can display osteoporosis. However, the physical
composition of the bones does vary and, as a result, some bones are more likely to exhibit
osteoporosis than others. Unfortunately, the risk of fracture to the bones in the spine
(as well as the wrist and hip) is far greater than for others; for example, 1.5 million
osteoporotic fractures occur annually in America (approximately) and, of these, the
following break-down is given:
- 700,000 vertebral fractures (spine)
- 300,000 hip fractures
- 250,000 wrist fractures
- 300,000 fractures at other sites
Source: The Osteoporosis and Related Bone Disease National Resource Center.
Within the spine itself, the area most at risk from osteoporotic fracture is the lumbar
spine – this is because the vertebrae in this section carry the most weight
(resulting in the most stress). A fractured vertebra will often lose between 15% and 20%
of its overall height, causing many people with osteoporosis to literally shrink (the
fracture itself is essentially a compression fracture, where the forces cause the holes
inside the vertebrae to collapse).
In itself, an osteoporotic fracture is very painful, but the resulting collapse will often
lead to secondary problems, most of which are very severe; for example, spinal nerves may
become trapped, and the pressure on the inter-vertebral discs will increase (possibly
leading to a slipped disc). |
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What are the risk factors?
Osteoporosis is caused by a number of factors – some of these, like age, sex and
race, are beyond our control; other factors, however, such as diet and lifestyle, can
be changed to lower the risk of onset.
The primary risk factors are:
- Sex
- Age
- Race
- Poor diet
- Lack of physical exercise
- Smoking
- Hereditary disposition
The vast majority of all sufferers are women (80%). In general, this is because women
are smaller and lighter than men – they have a lower bone mass. Estrogen (a female
sex hormone) also lowers the rate of bone depletion – during and after menopause
levels of estrogen fall dramatically and, as a result, the rate of bone depletion
increases. Estimates predict that up to 40% of all women over the age of 50 will suffer an
osteoporotic fracture (source: Bone and Joint Decade).
Our diets are also extremely important in determining whether we’re likely to develop
osteoporosis. For example, the primary constituent of bone is calcium (something we
consume via milk, cheese and other food-stuffs); hence, if our intake of calcium is too
low, the risk of osteoporosis goes up – our bodies are literally unable to produce
enough bone to keep up with the rate of depletion. Vitamin D, which promotes the
absorption of calcium in the body, is also extremely important.
Our diets are also important in determining the risk of osteoporotic fracture – if we
consume too much fat and sugar, we put on weight – too much weight increases the
level of stress on the entire skeleton (particularly the vertebrae in the spine) and this
increases the risk of fracture.
Weight bearing exercise is very important in the prevention of osteoporosis – most
people know that exercise leads to an increase in muscle tone, strength and mass, but the
same is true of our bones – the body actually responds by producing more bone (or
increasing the rate of formation), so that we adapt to new levels of activity. A lack
of physical exercise leads to a reduction in bone mass, increasing the chances of
osteoporosis. |
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Can it be treated?
Most treatments for osteoporosis concentrate on prevention.
For example, by increasing the amount of calcium and vitamin D we consume, we can help to
increase the rate of bone formation (provided we do so within safe, acceptable levels
– high levels of calcium can lead to kidney stones, for example). Post-menopausal
women are often given ERT (estrogen replacement therapy), or HRT (hormone replacement
therapy – a combination of estrogen and progesterone), although alternative therapies
exist. Increasing our levels of exercise, and cutting down on fat and sugar intake is also
generally advisable, although exercise should not be attempted in the presence of a
fracture.
Vertebral compression fractures can also be prevented (or at least delayed) by keeping the
spine in a healthy, decompressed state – this can be achieved by using the backrack, or by visiting a spinal
specialist, trained in orthopaedic medicine.
The important point to note here, is that the back should be decompressed in a safe,
non-violent manner (for this reason, we recommend that osteopathy and chiropractic
are avoided in cases of osteoporosis). Please note: in the event that a fracture already
exists, the backrack™ should not be used.
A number of experimental, surgical treatments do exist for the treatment of osteoporosis,
but these aren’t widely available yet (regulatory approval is currently being
sought). The techniques that are used on the spine – namely vertebroplasty and
kyphoplasty – involve the injection of a special cement into the porous bone, where
it rapidly solidifies, strengthening the overall structure. Unfortunately, we don’t
have access to clinical data that might indicate whether the treatment is successful or
not. |
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