Osteoporosis and spinal collapse
Osteoporosis is a common bone disease characterised by reduced bone mass and thinning of internal bone structure. This leads to an increased risk of fractures especially neck of femur, wrist and collapse of vertebrae. Osteoporosis itself has no symptoms.
The precise mechanism causing this disease is not clear. It is found most commonly in post-menopausal women, particularly the older woman, and in people of all ages receiving long-term steroid treatment. Certain diseases (e.g. Cushing’s disease, thyrotoxicosis, rheumatoid arthritis and chronic renal failure) are associated with the development of osteoporosis. Increased rate of bone loss occurs with increasing age, (particularly in the over 70’s in both sexes) and with excess alcohol consumption.
Fractures related to osteoporosis are a major problem in all developed countries causing considerable economic impact. Up to thirty (30%) percent of women and twelve (12%) percent of men will experience an osteo-porotic fracture at some time in their life. Twenty (20%) percent of all osteo-porotic fractures result in death.
Fractures due to osteoporosis often occur following minor injury or no injury at all. Spinal (or vertebral) collapse may develop painlessly, or cause acute agonising localised pain, which radiates around the ribs and abdomen. These spinal fractures tend to become multiple, and as the vertebrae collapse, a shortened curved back known as a kyphosis often develops. This may cause chronic back pain and walking problems. Healing of the fractures is not impaired, and with healing, the pain usually subsides.
Disabling Effects
Low bone density alone does not cause symptoms or disability. People with advanced osteoporosis may be completely symptom free with no care or mobility needs until a fracture occurs. Even if very considerable loss of bone density has occurred, it will be pain and functional limitations associated with fractures and vertebral collapse that will give rise to care needs and mobility problems.
Such a person with this level of disease and complications may have difficulty getting into and out of bed and the bath, rising from a normal height chair, dressing and undressing, preparing a main meal and attending to toilet needs. Such a person may be helped by an Occupational Therapy assessment and through prescribed assistive equipment such as mobility and dressing aids, etc. Environmental adaptations and the use of a wheelchair may be necessary. However, even with the use of such equipment, under these circumstances there may be care needs both day and night.
Severe disability is most common in the elderly, particularly elderly women, but can occur in younger at risk age groups.
The healing of osteo-porotic fractures is not impaired, so any resultant disability may not last more than a few weeks or months. This is often the case in the younger person. However in the elderly, who have sustained repeated fractures and progressive collapse of the spine, no significant improvement in disability is likely.
Treatment
This depends upon consideration of a combination of clinical factors, specialist bone density scans where available and individual risk factors.
If bone density is very low and fractures have occurred, then drug treatment is strongly indicated. This is effective in reversing bony loss, and with long-term treatment bone density typically increases by 5-10%.
Lifestyle advice is the mainstay of management, particularly in the younger person. This includes stopping smoking, limiting alcohol consumption to 20 units maximum per week, appropriate calcium intake (1500mg daily) and regular exercise.
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