Had a patient come in with back pain and obtained an interesting x-ray of the lumbar spine showing what osteoporosis can do to one’s bones.
The more dense the bones, the “whiter” they appear on x-ray. These bones are fairly thin. The lower two vertebrae in the x-ray are a fairly normal height.
At the red arrow is a vertebrae that has been “crushed” – a compression fracture. Imagine taking your fist and just pushing down on the edge of a cereal box until it collapses. That’s what happened to the bone.
At the green arrow is the result of a kyphoplasty – which involves injecting a bone filler material into the bone to expand it. Kyphoplasties have mixed results as can be seen in this x-ray – the height of the vertebrae hasn’t increased a whole lot.
The two best ways to keep this from happening to you are to make sure that your diet includes calcium and to perform resistance exercises (lift weights). In more severe cases, your doctor can prescribe a class of drugs called “bisphosphonates” that will make it more difficult for your body to reabsorb the calcium in your bones.
Here’s a thought … why not view bone health as a biological retirement program. When you’re young, dietary calcium should be sufficient to deposit into bone’s 401K enough to build a bone bank to fund those so-called golden years. We seem to target the wrong population.
Okay, WhiteCoated One, how did you get hold of my x-rays, hmmmm? HIPAA violation! HIPAA violation! Oops. Oh, okay… I only have four distinguishable vertebrae, so that can’t be me.
On a serious note, think of this x-ray whenever youse medicos consider writing a prescription for corticosteroids just to make someone feel better. I do believe that most doctors today are familiar with the possibility of resultant avascular necrosis (osteonecrosis) and osteoporosis, whether they are willing to voice the connection or not. There are folks who end up with AVN/ON after relatively short courses of prednisone; I have been on a daily dose since 1996 — so I have every pissy side effect there is. Just call me “moonface” and if I come over, hide the food.
Anyway, urge countermeasures and prevention to anyone for whom you put on steroids (biphosphonates, calcium, vitamin D, weight-bearing exercise/PT) — and really *stress* the dangers. Honestly, I think it wouldn’t be a bad idea for there to have to be informed consent paperwork when corticosteroid Rx are written so casually for every instance of asthma, allergy, inflammation. Yes, it is cheap, fast, effective –it also can be pure anathema with problems that don’t end with the end of the medication. An emergency department doctor might never see that patient with a mild rash [that probably would go away on its own] two years down the line when they show up again, this time with back pain and vertebral compression fractures.
I do realize that I sound like Chicken Little — but one tends to, when the sky has actually fallen in one’s world! Research probably says that a tapered short course of prednisone is exempt from danger — but I have met many people with joint replacements and glaucoma who can testify otherwise. And then, too, there is a weird standard set with some patients –”steroids helped me so much…” — so they ask for them with every rash or “flare-up” of connective tissue — because it helps, because it helps quickly.
It is a hard sell to tell someone that maybe it would be better to suck up the pain (itch, swelling, whatever) than to take this drug that they can actually *afford* and will “fix” the problem straight away.
I remember reading the bazillion potential side effects on the drugstore printout and just shrugging my shoulders.
That’s why I don’t have any shoulders to shrug today.
Bianca,
I totally agree with you. Prednisone may be effective & cheap, but it’s pure evil!
Prednisone has kept my mom alive for the last 20 years. Taking Fosamax and walking is worth staying alive, I think.
Highly doubt an ER doc’s prescription for 5 days worth of prednisone for an asthma flare up is going to cause osteoporosis. That’s borderline delusional right there.
Nurse K,
I have no problem with short term steroid therapy, it has been beneficial to me in the past. But long term is not for everyone. If your mom is dealing well with the side effects & has quality of life then more power to her. I, on the other hand didn’t have quality of life with long-term use, not to mention a tremendous amount of weight gain which has been difficult to take back off. I no longer depend on corticosteroids to keep my auto-immune disease in check, & unless it’s the only option left, it’ll be a cold day in hell before I take it again.
Gee, if kyphoplasty has mixed results, WHY DO IT? Oh wait – because you can. Meanwhile, missing information: How old was this patient? Medical/health history? And recommending only calcium is like trying to fix a crumbling brick wall by throwing bricks at it and hoping a few stick in the right spots. It’s the whole diet, plus vitamin D sufficiency. Unfortunately this patient was likely given 5 or 6 more Rx drugs and maybe more kyphoplasties.
My understanding is that kyphoplasty is really only indicated for pain, not deformity. – it only restores enough height that pain is usually reduced.
How can you determine that Kyphoplasty had mixed results?
What was the original height of the vertebra prior to tx? If It is like the one with the red arrow or worse – the patient had a 50% to 100% height improvement. Did it improve the angular deformity (posterior or anterior spinal weight loading).
Most importantly did it relieve the patients of their pain symptoms?
If it corrected either one or both of the above it was VERY successful.
IMHO
Is this an example of spondylosis?
Cool! This really helped with my science report. Quite fascinating.