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Thoracic Osteoporosis

What does Osteoporosis mean?

The word “Osteoporosis” comes from the Greek words “ostoun” meaning “bone”, and “poros”, meaning “pore”. Altogether, the words mean “porous” or weak “bone”.

What are the different types of Osteoporosis?

Osteoporosis is divided into primary and secondary types:

  1. Primary osteoporosis is due to bone thinning seen primarily in women after menopause.
  2. Secondary osteoporosis is related to medical diseases or chronic medication exposure (e.g. steroids), which affect the density of bone.

What is the primary mechanism of how Osteoporosis occurs?

The primary mechanism of osteoporosis is an imbalance between how much bone is formed (osteogenesis) versus broken down (osteoresorption). In Osteoporosis more bone is broken down than is formed.

How do you know if you have Osteoporosis?

The World Health Organization (WHO) defines the presence of Osteoporosis by the bone mineral density which is measured through a test called a Bone Density Scan or DEXA scan (Dual Energy X-Ray Absorption). This test should not be confused with a Nuclear Bone Scan which is done to look for infection, fracture, etc. of bone. This test can diagnose Osteoporosis if the test shows that the bone density is at least 2.5 standard deviations (variation from the average) below that of patients with healthy bone.

What are the risk factors for Osteoporosis?

Here are some risk factors of osteoporosis:

  1. Female gender
  2. Advanced age
  3. Family history of osteoporosis
  4. Estrogen deficiency
  5. European or Asian ancestors
  6. Alcoholism
  7. Vitamin D deficiency
  8. Tabaco smoking
  9. Malnutrition

What medications can cause Osteoporosis?

Here are some medications which can contribute to osteoporosis if taken for longer periods of time:

  1. Steroids
  2. Overuse of thyroid hormone replacing medications (L-Thyroxine, Synthroid)
  3.  Blood thinners (Coumadin, Heparin)
  4. Proton Pump Inhibitors (Prilosec, Prevacid, Nexium)
  5. Lithium

What symptoms does Osteoporosis cause?

Osteoporosis is a silent disease. Usually the symptoms are not noticed until a bone breaks.

In the elderly patients, the posture tends to worsen until a “hunchback” is noticed. This “hunchback” is the end-result of many small compression fractures in the mid-back (thoracic spine).

How is Osteoporosis diagnosed?

The diagnosis is established with a Bone Mineral Density Scan (DEXA scan).

This test should not be confused with a Nuclear Bone Scan. This test can diagnose Osteoporosis if the test shows that the bone density is at least 2.5 standard deviations (variation from the average) below that of patients with healthy bone. Typically DEXA scans measure bone mineral density in the femur (thigh bone), forearm (ulnar, radius), and spine (L4). It provides a number in the form of a standard deviation for each of these parts.

Findings on a DEXA scan can be categorized as follows:

  1. Standard Deviation: -1 or greater (i.e. 0.5) is normal
  2. Standard Deviation: -1 to -2.5 (i.e. -1.5) is called Osteopenia
  3. Standard Deviation: less than -2.5 (i.e. -3.0) is Osteoporosis

How is Osteoporosis treated?

Here are some of the common treatments of Osteoporosis:

  1. Medications:

a. Vitamin-D and Calcium supplements

This can decrease the risk of a fracture by 18%. At least 1,200mg of Calcium and 800-1,000 International Units (IU) of Vitamin-D3 must be taken to get the maximum benefit.

      2. Biphosphonates

This is the most common class of medications used to treat and prevent Osteoporosis. Some are taken by mouth, while others are available in intravenous form. They include:

  1. Alendronate (Fosamax)
    1. Ibandronate (Boniva)
    2. Risedronate (Actonel)
  2. Calcitonin

This medicine comes as a nasal spray. It is less effective than the bisphosphonate medications.

      3. Hormone Replacement Therapy

This form of therapy is not commonly used anymore due to increased risks of certain cancers and heart disease.

      4. Parathyroid Hormone (Forteo)

This medication is prescribed for women with severe osteoporosis who are at a high risk for fracture. It is given as daily injections.

      5. Raloxifen (Evista)

This medicine is used for the prevention and treatment of osteoporosis. It can reduce the risk of spinal fractures by as much as 50%. It does have a risk of forming blood clots.

      6. Exercise:

Weight bearing exercises, such as walking, jogging or stair climbing are recommended. They can have an impact on bone mineral density, especially when combined with Calcium and Vitamin-D supplements.

      7. Food

Foods high in Vitamin-D, Calcium and protein are recommended. Here are some foods high in Calcium:

  1. Cheese
  2. Ice Cream
  3. Yogurt
  4. Low Fat Milk
  5. Vegetable such as spinach
  6. Salmon

 

      8. Minimally Invasive Surgical Treatments

If a of the spine occurs, specific minimally invasive treatments can be used:

  1. Vertebroplasty
  2. Kyphoplasty