The aging process causes bone density to decrease due to reduced bone formation and collagen production, hormonal changes, and lack of weight-bearing activities. The loss of bone density or hardness is called osteopenia or osteoporosis depending on the severity. Certain people are even more prone to this condition depending on their sex, race, height, weight, social factors, personal medical and family history, which can be identified by the FRAX tool. The DeXA scan is the test that measures bone density and the T score indicates the risk of a bone fracture.
The most serious consequence of having more fragile bones is a fracture, which can be due to a fall or other trauma or can even occur with a minor stress of the bone. A fracture of the vertebrae, or bone of the spine, is one of the most painful conditions that I see on a regular basis. A spine fracture is particularly dangerous because the pain is so severe that it immediately affects one’s ability to do minor activities such as taking deep breaths, coughing and sitting up or standing easily. Even opioids are minimally effective at controlling the pain. Depending on a variety of factors it may take 6-12 months for the fracture to heal on its own. Understandably, people who sustain spine fractures spend most of their time lying down and moving as little as possible in order to control the pain.
For over 20 years, a non-invasive procedure called a Percutaneous Balloon Kyphoplasty, or PBK has been available that can immediately fix the fracture, alleviate acute pain and prevent chronic pain related to the fracture. PBK involves injecting bone cement into the fracture to create an internal cast. It immediately relieves the fracture pain and also prevents the bone from becoming deformed which can cause the “humpback” appearance that prevents people from being able to stand up straight. The most important effect of the PBK is that people are able to resume their pre-fracture activities within one or two. Recent studies have shown that people who undergo PBK have lower death rates and improved function at one year and five years, compared to people who are treated with only medication and back braces. Quite frankly, this is the most successful treatment that I perform in my office, but it is also the treatment option that patients are least informed about.
Once a person has had one vertebral fracture, the risk of having another one is five times greater. This is why it is extremely important to start a regimen to reduce the ongoing risk with a balanced multimodal plan. The plan should include aggressive medication management to increase bone density, careful weight-bearing exercise including balance and core strength reeducation, and appropriate lifestyle changes such as dietary improvement, smoking cessation, and alcohol moderation.
If you have been suffering from back pain that has become more severe and uncontrolled despite the usual treatments, you may have an undiagnosed fracture that can be treated. Call my office for an evaluation!