What about bone density and Spinal Osteoporosis?

Bone is a living tissue that is in a constant state of remodeling.  The body normally resorbs and then rebuilds bone throughout the skeleton in response to physical stress on the bone.  The more the bone is stressed, the more the body naturally reacts to build up that bone to become stronger.  Stress fractures are an example of the body’s inability to build up bone fast enough, leading to a low stress chronic fracture in the bone, that is only healed after the source of the stress is removed to allow the bone healing to catch up with the need for stronger bone. 

Osteoporosis is a condition affecting normal bone metabolism characterized by decreased bone strength over time.  More bone is resorbed through normal body physiology than is remodeled and strengthened.  The main impact is noticed in cancellous bone, the main weight bearing bone in the spine and next to joints.  Clinically, it is primarily noticeable due to an increase in vulnerability to bone fracture.  It is most commonly a predisposing factor in fractures in the hips (proximal femur), wrists (distal radius), shoulders (proximal humerus), knees (tibial plateau) and spine (vertebral bodies).  Osteoporosis occurs when the body no longer replaces the tissue. 

Adult women typically achieve most of their lifetime of bone strength in their 20’s, and reach their pinnacle of bone density around age 30.  From there, bone density slowly declines until menopause around age 50, and declines more rapidly after that.  The more rapid decline is related to loss of estrogen, which promotes bone strength.  This can occur earlier than 50 in cases of surgical removal of the ovaries in younger women. Age is the primary risk factor, along with genetics, lifestyle activity levels, and chronic diseases such as thyroid conditions, chronic steroid use (prednisone), certain types of lung disease, cancer, kidney failure, smoking, alcoholism, eating disorders, and vitamin D deficiency.  Adult men can also experience loss of bone strength, though it is less common.  Family history and genetics seem to play a large part.

“Osteoporosis” comes from the Latin for porous bone. “Osteopenia” means less bone, a milder degree of bone loss than osteoporosis.  These conditions are characterized by an increased vulnerability to fracture from minor trauma such as a trip and fall.  Osteoporosis has sometimes been referred to as the "silent disease" because a person with the condition may experience no symptoms until a fracture occurs.

How is Spinal Osteoporosis Diagnosed?

An essential tool in the diagnosis of osteoporosis is a dual-energy x-ray absorptiometry (DEXA) scan. This scan is very accurate and used to determine bone mass density. Age and gender adjusted results are provided in ranges for normal bone density, osteopenic bone, and osteoporotic bone.  You can compare your bone density to what would be expected as normal for people just like you.  While regular x-rays can be useful at diagnosing extreme cases of bone loss, x-rays will not show bone mass loss until there has been a 30-50% loss. This is why a DEXA scan is so important.

The US Preventative Services Task Force recommends all women 65 years and over have a DEXA scan to evaluate bone density. In addition, women who have had early or surgically induced (hysterectomy with oophorectomy) menopause should also be tested. After the initial scan, a repeat DEXA scan is recommended (and covered by Medicare) every two years.

How is Spinal Osteoporosis Treated?

Once osteoporosis is diagnosed, effective prescription medications are available to help increase or maintain bone density and decrease fracture risk. Medications that slow down bone loss are Fosamax, Actonel, or Miacalcin. Fosamax or Actonel are taken once weekly and can decrease the risk of hip and spine fractures. Although not quite as effective, your doctor may prescribe Miacalcin if you cannot tolerate Fosamax or Actonel or if an individual has certain gastrointestinal disorders.

A newer medication that builds new bone is called Forteo. Forteo is self-administered through a daily injection underneath the skin of the abdomen or thigh for one year. It is the most effective drug available to fight against osteoporosis, although it is not used as a first choice because of its cost. 

Dr. Datta took the time to thoroughly explain his findings from my MRI and explained in a way I could understand. He did not rush through my appointment and made sure he answered all my questions. He and his staff were kind, caring, and professional.

Linda R.

What Can I Expect After Treatment?

Aside from the continued use of medicines and treatments to slow down bone loss, exercise can have benefits following the initial treatment. Physical therapists and trainers will likely recommend a combination of weight-bearing and balance exercises. Weight training can help strengthen muscles and bones, and balance training will help prevent falls that could have potentially severe consequences in individuals with brittle bones.

Osteoporosis Providers

Michael ChangMichael Chang, MD
Spine Surgeon
Dennis CrandallDennis Crandall, MD
Spine Surgeon
Jason DattaJason Datta, MD
Spine Surgeon
Alec SundetAlec Sundet, MD
Spine Surgeon
Lyle YoungLyle Young, MD
Spine Surgeon