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A Broken Back Without the Fall

A Broken Back Without the Fall

Friday, 23 August, 2019 - 10:15
Photo: Tonpor Kasa/Getty Images
Cambridge- Asharq Al-Awsat
You didn't fall, and you didn't do anything strenuous. So it may come as a surprise when the bad back pain you've been experiencing turns out to be one or more broken bones in your back. "A common story is that someone bends down to put something in the dishwasher or steps off a curb a little hard and puts additional load on their spine. The weakened bone is not adequate to take that load, and it collapses," says Dr. Julia Charles, a rheumatologist and bone cell researcher at Harvard-affiliated Brigham and Women's Hospital.

What weakens the spine?
Your spine contains about 30 bones called vertebrae, stacked on top of each other like a roll of quarters. Each vertebra consists of an external bone surface (like plaster), and an inside filled with a honeycomb of support rods called trabeculae.

The body constantly renews these structures, using two groups of specialized cells: osteoclasts, which break down old bone, and osteoblasts, which build new bone.

Over time, the osteoblasts can't keep pace, and the trabeculae become narrower and weaker. For some people, the bones become especially thin and brittle — a condition called osteoporosis.

In women, menopause is partly to blame. "We know that around menopause, osteoclasts are more active, and osteoblasts slow down," says Dr. Charles.

Compression fractures
When a vertebra isn't strong enough to support the load you place on it, it may collapse. That's called a compression fracture.

Sometimes the fracture is sudden and comes with sharp, excruciating pain that can sideline you for months.

"But the majority of the fractures don't have symptoms," Dr. Charles explains. "It's not uncommon for a chest x-ray or CT scan to show an old compression fracture you didn't know you had."

Long-term risks
When one vertebra fractures, there's a high risk that another will. Each fracture brings a slight loss of height and a reduced ability to bend.

Multiple fractures contribute to a rounding of the back known as dowager's hump (dorsal kyphosis). The condition significantly increases the risk for disability, as well as difficulty digesting food or breathing.

Treatment
If an x-ray shows you've suffered a compression fracture, your doctor may recommend taking over-the-counter painkillers such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin).

For more severe pain, your doctor may recommend a short course (up to four weeks) of a nasal spray called calcitonin (Miacalcin), which inhibits bone breakdown; or possibly opioids, such as oxycodone (OxyContin).

Lingering pain
Pain often lasts up to six weeks. For people whose pain lasts more than six months, a treatment called vertebral augmentation (such as kyphoplasty) may be considered. It's a little like pouring cement into a broken vertebra to make it stronger.

But Dr. Charles says its effectiveness is debated. "There are good studies showing it's not helpful in controlling pain from the average sudden-onset compression fracture. Still, it's possible some people may benefit," she says.

Long-term outlook
Think of a compression fracture as a wake-up call to seek treatment for osteoporosis. Treatment for osteoporosis could include any of the following:

Taking prescription medications. Examples include oral alendronate (Fosamax) or intravenous zoledronic acid (Reclast) to increase bone density. These may lower the risk for another compression fracture by up to 70%.

Getting enough calcium. Calcium is important for maintaining bone health. If your diet contains 1,200 milligrams of calcium per day, that's sufficient. If your diet contains less than this, add calcium pills at each meal to make up the difference, Dr. Charles says.

Taking vitamin D. We need vitamin D to absorb calcium. Dr. Charles recommends 800 international units per day. You may get some of that through milk fortified with vitamin D. Vitamin D3 capsules can provide the rest.

Exercising. Weight-bearing exercise, like walking, helps build bone. "But we don't have good data on what's safe when you have osteoporosis," Dr. Charles warns. "Resistance bands and light weights are fine, but try not to load the spine."

What if you put off treatment? "Your risk for another compression fracture increases fivefold, and having a compression fracture increases your risk for hip fracture as well," Dr. Charles says. "The choice not to treat osteoporosis comes with risks."


(Harvard Health Letter)

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