Getting “pumped up” for osteoporosis
We’ve all heard of osteoporosis, where bone loses its calcium and density, and spontaneous fractures can often occur, causing significant pain and disability – particularly in seniors and the elderly.
While we may not hear much about osteoporosis, it’s a bigger problem than most of us realize.
Did you know?
• Currently, approximately 10 million people suffer from osteoporosis, and an additional 34 million have been diagnosed with the lesser-form – Low Bone Mass.
• Twenty percent of those affected are men.
• That 85 percent of your bone mass is already acquired in your body by age 18 (girls) and age 20 (boys).
• Osteoporosis causes 1.5 million fractures, according to the National Osteoporosis Foundation.
While many bones can be affected by osteoporotic changes, one area of the body that these changes and the resultant fractures that occur can cause significant pain and loss of function is the spine.
The most common bone(s) affected are the vertebrae – those marshmallow-shaped bones that are separated by the “vertebral discs.” As these bones lose their strength from a lack of density and calcium, they become weaker and weaker, becoming increasingly susceptible to a condition known as “compression fractures.” Simply put, the vertebral bones literally collapse, much the same way as a marshmallow does when you squeeze it, only the bones don’t “bounce back.”
The symptoms a person can exhibit can be proportionate to the severity of the collapse. Keep in mind that even the milder forms of collapse are still quite painful – after all, it is still a fracture. Severe compression injuries can ultimately be deforming to a person’s posture (known as “gibbous”) or can actually cause pressure on the spinal sac and/or spinal nerves if the fracture fragments for any reason.
For decades, the main treatment options consisted of bed rest, pain medications, and wearing an external brace, intended to reduce the chance of further collapse while healing.
Two somewhat little-known procedures now exist that have substantially improved patients’ lives and restored significant function and activity – the Vertebroplasty and the Kyphoplasty.
Vertebroplasty is a procedure typically performed in a Radiology department or operating room under local anesthetic. It’s typically performed by an interventional radiologist, neurosurgeon or orthopedic spine surgeon. The procedure involves the injection of a special form of “bone cement” into the collapsed vertebral bone(s), which then hardens, thus reducing pain and preventing further collapse. The procedure is performed under “live fluoroscopy” so the doctor knows exactly where the needle is at all times.
Because of the very minimally invasive nature of the procedure, most patients experience pain reduction within hours. Best of all, patients are usually able to resume their daily activities within 48 hours.
Kyphoplasty is a similar procedure used to treat the painful and debilitating effects of spinal compression fractures, only it’s done just a little differently.
During kyphoplasty procedures, a small incision is made in the patient’s back through which the doctor places a narrow tube. Using fluoroscopy (live x-ray) to guide it to the correct position, the tube creates a path through the back into the fractured area of the involved vertebrae.
Continuing the use of live fluoroscopy, the doctor inserts a special balloon through the tube and into the vertebrae (the cardiology version of this procedure would be the “balloon angioplasty”) then gently and carefully inflates it. As the balloon inflates, it literally elevates the fracture, returning the pieces to a more normal position. It also compacts the soft inner bone to create a cavity (hollow area) inside the vertebral bone itself.
Once the collapsed vertebra is restored to an acceptable height, the balloon is removed and the doctor uses specially designed instruments under low pressure to fill the cavity with a cement-like material called polymethylmethacrylate (PMMA), in much the same fashion as with a Vertebroplasty. After being injected, the pasty material hardens quickly, stabilizing the bone.
Recovery from either procedure is relatively easy and quick. Pain relief, for the most part, can be immediate for some patients. In others, elimination or reduction of pain is reported within a couple days.
At home, most individuals can return to their normal daily activities, typically with restrictions from strenuous exertion, such as heavy lifting, for at least six weeks.