Osteoporosis Spine Fractures: Risks, Symptoms and Treatments

As people age, their bone strength decreases and bones get thinner. Osteoporosis exacerbates this problem, weaking bones further and increasing the risk of fracture. It is a condition that develops gradually over time, affects millions of people, primarily over age 50, and is more common in women than men. When osteoporosis has weakened the bones, spinal fractures known as vertebral compression fractures can occur, causing severe back pain and physical complications. Other common conditions (fragility fractures) linked to osteoporosis include broken hips and wrists. Osteoporosis is not the only cause of spinal fractures, but a vertebral fracture is often the first sign of osteoporosis.

Causes and Risk Factors

As stated above, osteoporosis occurs as people age. Losing bone density and strength is part of the ageing process, because our bodies are continuously breaking down old bone and making new bone throughout our lives. When we are young, bone mass increases as the body makes new bone more quickly than it breaks down old bone. After about age 20, the rebuilding process is slowed, and if you have not built optimal bone mass by age 30, you are at higher risk for osteoporosis, because you do not have as much bone mass to draw from as you age. Older people tend to become shorter, as the vertebrae in the spine weaken, become narrow, and flatten. Age is not, however, the only risk factor for osteoporosis.

• Gender also plays a role. Women, particularly after menopause, are more prone to osteoporosis. This is because oestrogen, vital for bone density, drops. Men can also develop osteoporosis, particularly if they experience a decline in testosterone levels as they age. Early menopause is a risk factor.
• Family history contributes to a person’s osteoporosis risk. Those who have a parent or sibling with osteoporosis are more likely to develop the condition.
• Race raises the risk. White women and those of Asian descent are at higher risk of developing osteoporosis.
• Body type is also a factor. People with a small body frame have less bone mass to begin with, so there is less to draw from as they age. This increases their risk of osteoporosis and spinal fractures.
• Glandular issues contribute to the risk. Those with an overactive thyroid, parathyroid, or adrenal glands are at a higher risk of developing osteoporosis.
• Your diet can raise your risk of osteoporosis. Low calcium intake throughout your life can lead to osteoporosis in later years. Eating disorders can increase the risk because severely restricting food intake and being underweight lead to weakened bones. People who undergo gastrointestinal surgery lose some of the surface area in their digestive system that absorbs nutrients. This limits absorption of calcium, increasing the risk of osteoporosis.
• Certain medications interfere with the bone rebuilding process. These include steroids, as well as medications that treat seizures, gastric reflux, transplant rejection, and cancer.
• People with some medical conditions are at a higher risk. Medical conditions that increase the risk include celiac disease, inflammatory bowel disease, kidney or liver disease, and rheumatoid arthritis.
• A person’s lifestyle choices make a big difference in bone health. A sedentary lifestyle, excessive alcohol consumption, and tobacco use have all been linked to an increased risk of osteoporosis. Weight bearing activity and sport in teenage and younger life is protective by building skeletal mass.

Symptoms of Spinal Fractures

Osteoporosis is often called a silent disease because, in the early stages, there are no symptoms. Some people learn they have osteoporosis because of a spinal fracture. Spinal fractures, however, do present with symptoms. One symptom is severe, sudden back pain. When a person has osteoporosis, vertebral compression fractures can occur with no significant trauma. Simple movements like bending over, sneezing or lifting something light can cause a spinal fracture. If you have known osteoporosis – the onset of sudden back pain, particularly in the middle (thoracic) or lower back, which is severe and persistent, should trigger a consultation with a medical professional to rule out a fresh fracture. However, less commonly, spinal fractures can also occur without causing severe pain. Sometimes, stooped posture or a loss of height are the first indication a person has of a spinal fracture. This condition can cause people to have difficulty standing upright and eventually, spinal fractures can cause a humped, stooped posture. This can negatively affect mobility and quality of life. Another key indicator of a spinal fracture is the loss of height. When vertebrae fracture and flatten, the spine gets shorter, and height is noticeably reduced. In 10% of people with osteoporotic fractures, the fracture doesn’t heal and becomes chronically painful for weeks or months. It is crucial that this group of people seek specialist help because long term outcome studies for this group show a severe deterioration in activity, quality and longevity of life.

Diagnosis of Osteoporosis and Spinal Fractures

To determine a  diagnosis of osteoporosis and/or spinal fractures, a combination of physical examination, imaging tests, and bone density assessments are used. During a physical exam, a doctor will assess the spine’s alignment and check for areas of tenderness. If osteoporosis or a fracture is suspected, further tests will be required to confirm the diagnosis. The most common imaging test used is an X-ray, which can reveal vertebral compression fractures and any changes in bone structure. While X-rays are useful, they cannot determine the age of the fracture or assess bone density. For a more detailed look at the spine and surrounding tissues, a magnetic resonance imaging (MRI) scan or a computed tomography (CT) scan may be ordered. These scans can help detect whether the fracture is new or old and identify any potential complications, such as nerve compression. Catching spinal fractures is important, because research indicates that people with vertebral compression fractures are at an increased risk of sustaining additional fractures. Unhealed fractures causing pain lead to a loss of activity and general health and wellbeing.

A crucial part of diagnosing osteoporosis is measuring bone density. This is done using a dual-energy X-ray absorptiometry (DEXA) scan, which measures the mineral content in the bones and determines whether an individual has osteopenia (low bone mass) or osteoporosis. The DEXA scan results will help guide treatment decisions and estimate the risk of future fractures. This is an important tool in osteoporosis management. This is normally ordered and interpreted by GP’s and rheumatologists who will deliver treatment for the underlying metabolic problem.

Spinal Fracture and Osteoporosis Treatment Options

Your healthcare provider will work with you to develop a treatment plan that is right for your unique situation and your overall health. The goal of treatment is to relieve pain, stabilise the fracture, and prevent further bone loss. There are different types of treatments available to treat both osteoporosis and spinal fractures.

Non-surgical Treatments:

Often, non-surgical treatment is sufficient to address vertebral compression fractures. Resting and avoiding strenuous activities is typically advised, and pain relief can be achieved through medications like non-steroidal anti-inflammatory drugs or prescription pain relievers. It is important to avoid long-term use of strong painkillers because of the risk of dependency. A back brace can help support the spine in rare cases of spinal instability and allow the fracture to heal naturally, but prolonged use of a brace is discouraged because it can lead to core muscle weakening. Bone strengthening medications are effective for those with osteoporosis. Bisphosphonates are commonly prescribed by GP’s to slow bone loss. Additionally, lifestyle changes like an improved diet, regular exercise, limited alcohol, and cessation of smoking can all help reduce bone loss and improve bone density and strength.

Surgical Treatment:

If non-surgical treatments fail to alleviate pain or if the fracture is severe, surgical intervention may be required. Two minimally invasive procedures, vertebroplasty and kyphoplasty, are commonly used to treat spinal fractures caused by osteoporosis. Both procedures have shown positive outcomes in terms of pain relief and improved mobility, though kyphoplasty has been shown to give better results with less complications such as cement leakage. Long term survival is also better following balloon kyphoplasty according to landmark US research.

• Kyphoplasty involves inserting a small balloon into the fractured vertebra to create space and restore the bone’s height. Once the balloon is removed, the space is filled with bone cement, stabilising the fracture and relieving pain. This procedure is typically done under general or local anaesthesia, and patients can often return to their normal activities within a few days.
• Vertebroplasty is similar to kyphoplasty but does not involve the use of a balloon. Instead, bone cement is injected directly into the compressed vertebra to stabilise the fracture. This procedure is also minimally invasive, with a quick recovery time. However, the cement is injected at high pressure which yields a greater chance of cement leakage and complications. It is cheaper and often offered in the NHS.

Prevention of Spinal Fractures

Preventing spinal fractures starts with addressing osteoporosis early, by taking a number of proactive steps. By taking these steps, many people can reduce their risk of osteoporosis-related spinal fractures, improving their overall quality of life and mobility in later years.

• Regular bone density testing: This is especially important for women over 50 and men with risk factors, because it can help identify osteoporosis before a fracture occurs.
• A healthy diet: This is the key to maintaining strong bones. Ensuring adequate calcium and vitamin D intake, either through diet or supplements, supports bone health. Foods like dairy products, leafy greens, and fortified cereals are good sources of calcium, while sunlight and certain foods like oily fish provide vitamin D.
• Exercise: Weight-bearing and resistance exercises help build bone density and strengthen muscles, which can prevent falls. Balance exercises such as tai chi or yoga are also beneficial in reducing the risk of falls, which can lead to fractures.
• Medications: For those already diagnosed with osteoporosis, medications that strengthen bones and reduce fracture risk should be taken as prescribed.
• Additional lifestyle changes: Smoking cessation and limiting alcohol consumption are vital in preventing further bone loss.

Trust the Experts at Spine Art to Treat Your Osteoporosis and Spinal Fractures

If you are seeking minimally invasive treatments for osteoporosis and spinal fractures, you will find it at Spine Art. A clinical network formed by consultant spinal surgeon, Dan Fagan, Spine Art aims to provide the best care possible for patients, offering minimally invasive solutions to alleviate pain. Committed to offering comprehensive, patient-centred care, we will work to help you regain your well-being and begin your journey to a pain-free life. Using the most modern techniques and providing a comfortable environment for our patients, we help facilitate a rapid return to normal life. To learn more about how the team at Spine Art can help you, book a consultation or contact us through our website.