Osteoporosis and the Spine

Osteoporosis is a condition in which the bones become weak due to a lack of quantity, thus becoming thinner, and more likely to break. In 2017 to 2018, the CDC published that the prevalence of osteoporosis and generally low bone mass in adults 50 and older was around 55%. Unfortunately, people with osteoporosis are more vulnerable to fractures due to the reduced bone mineral density.

Why does osteoporosis occur? After age 30 to 40, the body’s normal remodeling process for bone becomes unbalanced and older bone is removed more quickly than new bone is brought in to replace it. This can lead to a net loss of density overtime which decreases the strength. It is also more common in women than men due to lower levels of estrogen in women after menopause. Another thing that can weaken the bone is poor nutrition or a sedentary lifestyle.

The first sign that someone has osteoporosis might be from suffering a broken bone from a minor injury or low level fall that normally would not have caused a fracture in a healthy person. This is called an insufficiency fracture and can happen in the wrist, upper femur or thighbone, or spine most commonly. In addition to aging, hormonal changes, and genetic pre-disposition, there are a variety of medication such as steroids that can also contribute to osteoporosis if taken over a long period of time. Make sure you discuss your medication list with your doctor regarding this if you have questions.

If your doctor suspects that osteoporosis may be affecting you, a thorough history and physical examination should be performed, usually followed by some tests that may include blood and urine tests as well as a specialized x-ray called bone densitometry testing, or DEXA. A DEXA scan gives your doctor a result called a T score which compares your bone density to that of a healthy 30 year old.

Prevention and treatment includes a wide spectrum of modalities from dietary changes and taking supplements such as calcium and vitamin D to taking more advanced prescribed medication to increase bone density. The underlying goal is to build stronger bone and prevent insufficiency fractures from occurring, which can severely debilitating quality of life.

There are a variety of effective prescription medication’s to treat osteoporosis including bisphosphonates, Prolia, anabolic agents such as Teriparatide, and estrogen replacement therapy. Each patient requires an individualized approach to determine which is best.

In summary, osteoporosis is a common diagnosis and can occur due to a variety of reasons. Taking steps to prevent bone loss in the first place through adequate nutrition and exercise is crucial. When insufficiency fractures do occur, specific osteoporosis medication can help prevent further breaks.


Illustrations of normal vertebrae and vertebrae with osteoporosis