Osteoporosis
Osteoporosis is a disorder that results in bone becoming less dense. This results in an increased risk of fracture and compression and may lead to pain.
Osteoporosis caused half a million wrist fractures and 250 thousand hip fractures in the United States in 1987. Compression fractures of the spine occur so often that statistics cannot even be kept. Complications arising from osteoporosis are now the twelfth leading cause of death in the United States. These are primarily related to complications resulting from hip fractures, which result in immobility of elderly patients.
Causes Of Vertebral Compression
Normally, the vertebrae are able to withstand the normal stresses of daily activities, such as changing positions, reaching and bending, lifting and carrying, coughing and sneezing.. In people whose bone has become osteoporotic, simple activities like those mentioned above can cause sudden collapse or "compression" of the vertebral body. Often this collapse occurs in the front portion of the vertebral body. This results in loss of height of the bone with consequent "anterior wedging".
The symptoms of Osteoporotic Compression Fracture
The patient experiences acute onset of pain which is often severe. Unlike disc disease, lumbar stenosis or facet pain, there is no particular posture, which is especially bad. The patient feels most comfortable in bed and immobile. Even simple motions such as rolling from side to side in bed or sitting up can be excruciating.
The Natural History of Osteoporosis
Although bed rest is important initially, if the patient remains at bed rest for a prolonged period of time, further weakening of the bone occurs. In addition, the patient becomes deconditioned, stiff, and is at risk for complications related to immobility (e.g. phlebitis). As far as the acute pain related to the compression itself, this generally resolves over the course of several weeks to months. There is now ample evidence that the patient's activity level, posture and exercises, as well as intake of calcium, estrogen and other medications, all affect the course of the patient's condition.
How does activity level, posture, and exercise affect osteoporosis?
People who are more active, specifically up on their feet for at least several hours per day, have a lower rate of progression of osteoporosis. People who perform a greater percent of their activities with their spine in extension (with the natural arch maintained) probably have a lower rate of progression of vertebral fractures. People who perform regular exercises involving weight bearing have a lower fracture rate as well. Thus, walking is a much better exercise for osteoporosis than swimming. Recent studies have clearly demonstrated that just as the spine responds to activity level and weight bearing exercise, so does the wrist. People who do "loading exercises" for their arms are found to have significantly increased bone density when compared with those who do not. This would be expected to result in decreased risk of fractures, improved function, and decreased disability.
Treatment of Osteoporosis
Evaluation of calcium intake is very important. Activity level and postural advice are important as well. Physical therapy can be very helpful in reducing acute symptoms and teaching the patient exercises to maintain or regain extension (natural arch) of the spine. Often people who have had multiple compressions have gradually developed a "dowager's hum," or increased thoracic kyphosis. This rounded-back posture results in increased pain in the neck and upper back and predisposes to further vertebral compression in the spine. In early to middle stages, at least some of this posture may be reversible. Exercises which encourage extension can reduce progression of compression fractures whereas those which encourage flexion (bending) of the spine have actually been shown to increase the rate of fracture. As mentioned above exercises which "load" the arms are important as well. An example is shown below. In addition, corsets can be very useful in supporting and maintaining the patient's posture.
In Summary
Osteoporosis is a common process in the aging population. This can result in vertebral compression, postural abnormalities, as well as fractures of the wrist and hip. These conditions are associated with pain and disability, as well as increased mortality. Aggressive conservative management can reduce pain and disability in many cases and return the individual to a better quality of life.