What is Osteoporosis? Who is likely to get Osteoporosis?
Osteoporosis is a disease where the bones in the body become weak and break (fracture) easily. Osteoporosis is fairly common in India and usually affects post-menopausal women > 65 years old and men more than 70 years. It can occur at a younger age in Rheumatoid Arthritis; long-term use of steroids; paralysis patients; bed-ridden patients; and with long term use of medicines like warfarin, phenytoin, etc. Osteoporosis can be a silent disease unless it manifests itself in the form of a fracture of the hip, spine or wrist. Therefore, WHO recommends that Osteoporosis should be screened for in females > 65 years and men > 70 years.
How to diagnose osteoporosis?
The screening tests for Osteoporosis are the Fracture Risk Assessment Tool (FRAX Tool) and a Bone Densitometry (DEXA) scan. The FRAX tool is an online questionnaire that calculates the risk of suffering a major osteoporotic fracture over the next 10 years based on the patient’s age, sex and other risk factors. We use a 2 site DEXA scan to evaluate for osteoporosis.
What are the symptoms of osteoporosis?
Patients with spinal osteoporosis can present with back pain, decrease in their height, roundedness of their back or fractures in their spine from minor trauma. They can suffer fractures from a simple fall at home; a slip in the bathroom; coughing, sneezing and bending; and some patients can get fractures even without any trauma.
Is Calcium and Vitamin D not enough to halt osteoporosis?
No, Calcium and Vitamin D supplementation is not the treatment of osteoporosis. Depending upon the severity of osteoporosis and other factors your Spine Specialist may prescribe oral (weekly or monthly) Bisphosphonate tablets, injectable (once a year) Zoledronic Acid, 6 monthly subcutaneous Denusomab injection or a daily subcutaneous (like Insulin injection) Teriparatide hormone injection.
What is the treatment of spinal osteoporotic fractures?
Most patients that suffer an osteoporotic spinal fracture get better in 2-4 weeks. We do not recommend bed rest for these patients, but get them to walk as soon as they can tolerate it within the limits of pain. We may use a lightweight brace to get these patients to walk as soon as possible. We also use Calcitonin nasal spray in acute osteoporotic fractures as they give quick pain relief to these patients. The most important aspect in the treatment of an osteoporotic fracture is in recognizing it so that proper medical treatment can be initiated so that further osteoporotic fractures can be prevented.
What is Balloon Kyphoplasty?
Patients that continue to suffer from pain even at 3-6 weeks from a fracture may benefit from a cement injection procedure (Kyphoplasty / Vertebroplasty). Kyphoplasty / Vertebroplasty is a highly effective procedure for relieving pain in these painful Osteoportic Spinal Fractures.
This percutaneous procedure is particularly suitable for the elderly with multiple medical comorbidities as general anesthesia; open surgery and blood loss can be avoided. In this procedure, a needle is inserted in the fractured spinal bone under Xray guidance. Thereafter, a balloon is inserted in the bone and inflated to regain the height of the compressed vertebra. Then, bone cement is injected in the fractured spinal bone under the guidance of an X-ray. The injected cement gives immediate structural support to the fractured spinal bone, thereby relieving pain.
How soon can the patient walk after Balloon Kyphoplasty?
As balloon kyphoplasty is a day care procedure done without general anaesthesia, most patients are able to walk immediately after the procedure and are discharged on the same evening after the procedure. Patients report upto 90% relief in pain within 1 week of balloon kyphoplasty.
Can all osteoporotic spinal fractures be treated with balloon kyphoplasty?
Some Osteoporotic Spinal fractures are not suitable for cement injection and they may need fixation with Titanium screws and rods. In these cases we typically use Cemented screws to increase the hold of screws in the osteoporotic bone. It is utmost important to start medical treatment for osteoporosis in parallel to cement injection / fixation surgery to prevent further fractures.
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