Osteoporosis
A condition of weakened, porous bone that raises the risk of fractures, including painful spinal compression fractures that can cause height loss and a stooped posture.
Quick Answer
Osteoporosis is a condition in which bones lose density and become fragile, increasing the risk of fractures. In the spine it can cause vertebral compression fractures that lead to sudden back pain, loss of height, and a forward-curved posture. It is often silent until a fracture occurs. Treatment focuses on strengthening bone and preventing fractures, and painful vertebral fractures can sometimes be treated with vertebral augmentation.
Key Takeaways
- Osteoporosis weakens bone and increases fracture risk, often without warning.
- Spinal compression fractures can cause sudden back pain, height loss, and stooped posture.
- It is more common in older adults and postmenopausal women.
- Bone density testing (DEXA) is used to diagnose it before a fracture occurs.
- Painful vertebral fractures may be treated with vertebroplasty or kyphoplasty.
At a Glance
| What it is | Loss of bone density leading to fragile bones |
|---|---|
| Spinal effect | Vertebral compression fractures |
| Common symptoms | Sudden back pain, height loss, forward-curved posture |
| Who it affects | Older adults, especially postmenopausal women |
| Diagnosis | Bone density scan (DEXA), spine imaging when fracture suspected |
| Treatment | Bone-strengthening therapy; vertebral augmentation for painful fractures |
Symptoms
Osteoporosis itself is usually painless and silent until a fracture occurs. In the spine, a vertebral compression fracture can cause sudden, sharp back pain, often after a minor strain or even without obvious injury. Over time, multiple compression fractures can lead to gradual loss of height and a forward-curved posture.
Some compression fractures cause little pain and are found incidentally on imaging. When pain is present, it is typically localized to the level of the fracture and may worsen with standing or walking and ease with lying down.
Common Warning Signs
- Sudden back pain after minor strain or lifting
- Gradual loss of height
- A stooped or forward-curved posture
- Back pain worse with standing and relieved by lying down
- A prior low-impact fracture
When to Seek Care Promptly
- Severe back pain after a fall
- Back pain with leg weakness or numbness
- Loss of bladder or bowel control
- Rapidly worsening posture change
- Pain that does not improve with rest
Diagnosis
Osteoporosis is diagnosed with a bone density scan, called a DEXA scan, which measures bone mineral density and estimates fracture risk. Blood tests may be used to look for contributing causes. When a compression fracture is suspected, X-rays, and sometimes MRI or CT, confirm the fracture and its age.
MRI is particularly useful for distinguishing a recent, painful fracture from an older, healed one, which helps guide whether a procedure to treat the fracture is appropriate.
Treatment
The foundation of osteoporosis treatment is improving bone strength and preventing future fractures. This includes adequate calcium and vitamin D, weight-bearing exercise, fall-prevention strategies, and prescription medications that slow bone loss or build new bone. These are usually managed by a primary care physician or endocrinologist.
When a vertebral compression fracture causes significant, persistent pain, vertebral augmentation may be offered. In vertebroplasty or kyphoplasty, bone cement is injected into the fractured vertebra to stabilize it and relieve pain, sometimes restoring some vertebral height. At Atlantic Brain and Spine, these cases are reviewed to confirm the fracture is the pain source and that the procedure is appropriate.
The Diagnosis-to-Treatment Pathway
1. Risk assessment
Age, history, and risk factors prompt bone density testing.
2. Bone density scan
A DEXA scan confirms osteoporosis and estimates fracture risk.
3. Fracture evaluation
X-ray and MRI identify and date any vertebral compression fracture.
4. Medical therapy
Bone-strengthening medication, calcium, vitamin D, and exercise are started.
5. Pain assessment
Persistent fracture pain is evaluated for vertebral augmentation.
6. Vertebral augmentation
Vertebroplasty or kyphoplasty stabilizes a painful fracture.
7. Ongoing prevention
Fall prevention and continued therapy reduce future fracture risk.
Frequently Asked Questions
Osteoporosis itself is usually painless. Pain occurs when a fracture happens, most often a vertebral compression fracture in the spine, which can cause sudden back pain. This is why bone density testing is important to detect osteoporosis before a fracture occurs.
It is a fracture in which a weakened vertebra collapses, often from osteoporosis. It can cause sudden back pain, loss of height, and a stooped posture. Many are managed with rest and bracing, while painful ones may be treated with vertebral augmentation.
Kyphoplasty is a minimally invasive procedure in which a balloon is used to create space in a fractured vertebra and bone cement is injected to stabilize it and relieve pain. Vertebroplasty is similar but injects cement without the balloon. Both are used for painful osteoporotic fractures.
Osteoporosis can be managed and bone density can improve with treatment, though the goal is primarily to strengthen bone and prevent fractures. Medications, nutrition, and exercise all contribute. Your physician will tailor a plan to your bone density and risk.
Most compression fractures heal with conservative care such as rest, pain control, and bracing. Vertebral augmentation is considered when pain is severe and persistent and the fracture is confirmed as the source. Open surgery is reserved for fractures causing nerve compression or instability.
It is diagnosed with a DEXA bone density scan, which measures bone mineral density. Testing is recommended based on age and risk factors, and can identify osteoporosis before a fracture happens so treatment can begin.
Specialists Who Treat Osteoporosis
Your care is provided by Atlantic Brain and Spine's spine team, including fellowship-trained neurosurgeons and orthopedic spine surgeons.
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