Osteoporosis in the spine: what are the causes and treatments? Is there a cure?

The osteoporosis is a very common disease that affects millions of people, especially those with older age (from 65 years). It is characterized mainly by the loss of bone mass, which commonly leads to spontaneous fractures.

This consequence is what makes many diagnoses possible, since before the first fracture, the person will hardly know that he suffers from this pathology.

Better understand what are the causes, possible treatments and other important information:

What is osteoporosis in the spine?

Osteoporosis is a disease characterized by a gradual decrease in bone density and its main consequence is the fact that it increases the risk of fractures. This condition can manifest itself in any bone in the body, including the spine.

Its cause is linked to the imbalance between bone formation and resorption . To understand this process, it is necessary to know that the bones are constantly renewing.

This is because they are formed by osteoclasts (cells responsible for reabsorbing aged areas) and osteoblasts (responsible for the production of “new bones”).

It is a permanent and constant process, which allows bone reconstruction in both healthy and fractured bones, explaining why every 10 years (on average) the human skeleton is renewed.

However, over time, the resorption of old cells increases and the formation of new bone cells decreases. Consequently, the bones become more porous and lose resistance – which leads to osteoporosis .

The main characteristic of this disease is bone fragility, which can lead to spontaneous fractures caused by small impacts.

It is worth noting that, when this condition affects the spine , it may be that the person takes a long time to receive a diagnosis. Considering the fact that the pain or discomfort will only appear from the occurrence of a fracture.

Therefore, it is necessary to pay attention to the other most common symptoms of when osteoporosis affects the spine: loss of height and development of a curved upper back. The diagnosis always needs exams like the x-ray .

What is the difference between osteopenia and osteoporosis?

The difference between osteopenia and osteoporosis is based on the degree of bone involvement due to wear. Thus, osteopenia is characterized by cases in which there has been a milder loss of bone mass. Osteoporosis, on the other hand, is characterized by more severe losses that can lead to spontaneous fractures.

According to the WHO (World Health Organization), a person who has osteoporosis has bone mineral density equal to or less than 2.5 standard deviations. While those who have osteopenia have values ​​between 1 and 2.5 standard deviations.

This change is measured through special X-ray examinations. In them, the result shows bone densitometry in gram of mineral per square centimeter analyzed (g / cm2). Thus, the values ​​obtained are compared with those of healthy adults of the same sex, in order to analyze whether there is any deviation or not.

In general, in the initial stage (osteopenia) when there is less bone fragility, there are no symptoms. However, when this condition progresses (leading to osteoporosis), the most common signs are the occurrence of fractures in the vertebrae.

In these cases, the person tends to feel pain and bone sensitivity, as well as to have height reduction and kyphosis (spine with abnormal curvature). It is worth noting that the discomfort is directly associated with the site of the fracture or bone wear.

What regions of the spine can osteoporosis affect?

As mentioned, osteoporosis can affect any bone in the human body. In general, the most recurrent are: vertebrae, femur, radius and humerus.

Therefore, when this disease affects the spine region, it can reach literally any of its parts – lumbar, cervical (neck region) or dorsal (middle of the back).

Understand better how the problem can manifest itself in our column:

In the vertebrae

It is very common that, when reaching the spine, osteoporosis causes fractures in the vertebrae due to greater bone fragility. In general, these small fractures result from minimal trauma – such as when coughing very hard, bending down to pick up an object, closing a window, etc.

When this occurs, compression of the vertebrae is caused. Initially, it may be that the person feels only “common” back pain, but as time goes by and injuries increase, permanent deformities may occur.

Among these, the most common are kyphosis (spine with abnormal curvature) and reduced height. In addition, as the disease progresses, the pain may become more severe.

Low back

Complications in the lower back are usually noticeable in patients with persistent pain. This tends to be located in the lower dorsal (or lumbar) region and can often cause pain in the buttocks and thighs.

Generally, in this stage of the disease evolution, the person already suffers from permanent deformities such as a decrease in height. Due to the compressions of the vertebrae and their flattening in the lower back.

Cervical

There is no indication that cervical spine injuries are frequent due to osteoporosis. This does not mean that the disease cannot reach this region.

As we have seen, it is quite common that this condition affects the vertebrae causing pain in the central part of the back and also in the lumbar region. However, in cases of greater advances in osteoporosis, the person may also experience complications in the cervical (neck region).

What causes osteoporosis?

In general, osteoporosis is related to the aging process, which affects bone regeneration and causes this disorder. However, according to the ITC Vertebral Institute, there are other risk factors that can be highlighted:

  • Family history of the disease;
  • Deficiency in the production of hormones;
  • Use of medications based on cortisone, heparin and epilepsy treatment;
  • Diet deficient in calcium and vitamin D;
  • Low exposure to sunlight;
  • Prolonged immobilization and rest;
  • Sedentary lifestyle;
  • Smoking;
  • Excessive alcohol consumption;
  • Some rheumatological, endocrine and liver diseases.

However, it is worth mentioning that all of these are risk factors – that is, they only increase the chances of developing the problem. This does not necessarily mean that the person who has one (or more) will have the disease.

What are the symptoms of osteoporosis in the spine?

The main consequence of osteoporosis is bone fragility. When it affects the spine, it can cause pain especially in the dorsal (middle of the back) and lumbar (lower). Discomfort that occurs only due to spontaneous fractures caused by minimal trauma

However, it is worth noting that at first osteoporosis is very silent and symptoms usually appear only when the disease is already at a more advanced stage, which is when fractures usually occur.

As a result, it is common for patients to be asymptomatic and discover the problem accidentally, for example, when performing radiography of a nearby region.

Another sign is the deformities caused by osteoporosis: such as kyphosis or even causing the person to have a “hump”. Here also falls the stature decrease – remembering that these are processes that occur gradually.

Does spinal osteoporosis hurt?

No . The back pain is one of the symptoms of osteoporosis, however, manifests itself only when the disease is already in an advanced stage and there are already fractures. Considering that, at first, this is an asymptomatic pathology and does not cause any pain.

Thus, bone fragility itself is not what causes the pain. This symptom appears as a result of small fractures that affect the spine, so this is the most common cause of prolonged pain due to osteoporosis.

It is worth noting that fractures do not always cause permanent pain, sometimes they can cause only a momentary discomfort – which makes diagnosis difficult, considering that many patients do not seek medical assistance in these cases.

Osteoporosis in the spine is serious?

Initially, osteoporosis is not a serious problem as it does not cause other damage to the health of the carrier. However, its complications are considered serious, since they can cause permanent limitations.

Such limitations are associated with spontaneous fractures that can occur due to osteoporosis – which occurs through small traumas (coughing excessively, bending down to pick up an object, excessive use of force, etc.).

Especially when osteoporosis affects the spine, these complications become more serious taking into account the difficulty in treating spinal injuries.

In this sense, some specialists consider this disease to be a public health problem, which is one of the main pathologies associated with the aging process.

Osteoporosis in the spine retires?

In some cases, yes . There is no law that guarantees immediate retirement in cases of pathologies such as osteoporosis.

However, Law 8,213 / 91 deals with the conditions and benefits of Social Security – among them is disability retirement. What can happen when there is a large bone compromise due to osteoporosis.

But it is important to know that, in such cases, it is necessary to undergo an expertise. So, it is necessary to present exams and medical reports that can prove the disability situation.

Therefore, it is worth emphasizing that disability retirement is approved when a disease compromises the person’s ability to continue exercising their activities.

Is there a cure?

No . As mentioned, osteoporosis is a disease that is associated with difficulty in bone regeneration, which causes loss of bone mass and leads to fragility. Therefore, considering that there is still no way to reverse the process, the disease has no cure.

Despite this, there are already surgical treatments that aim to minimize complications resulting from the disease and help to reduce bone fragility. There is also medication care in case of permanent pain and other measures – such as exercise and physical therapy.

In this sense, it can be highlighted that the correct performance of the treatments indicated by a professional has the purpose of reducing the progression of the disease and, consequently, preventing fractures. With this, providing greater quality of life to the carrier person.

How to treat osteoporosis in the spine?

Osteoporosis in the spine has no cure. However, there are several treatments necessary for those who suffer from this disease – which aim to delay bone mineral loss, decrease the risk of fractures, relieve pain and, consequently, improve the quality of life.

In general, the treatment for this disease is not unique, but guided by a multidisciplinary team. Thus, it may involve the use of medication, food, exercise practices, changes in lifestyle, etc.

Following, you can better understand how some of the therapies work:

Medicines

It is common that in the treatment of osteoporosis, medications are used in order to supply calcium or vitamin D deficiency – considering that they are involved in the formation and maintenance of bone mass, thus preventing fractures.

In this sense, it is important to know that what is advised is that the daily calcium intake is equivalent to 1,200mg to 1,500mg. As for vitamin D, especially for people aged 50 or over, it is recommended to ingest 800UI to 1000UI.

So, when this does not occur or there is a deficiency of absorption, supplements of these nutrients can be prescribed, such as:

  • Sany D;
  • Ossotrat-D;
  • Prosso ;
  • AltaD ;
  • Calcitran B12.

However, medicines with other drugs (active ingredient) can also be indicated to treat the disease. Those that are part of the so-called “first-line treatment”, according to a document from the Ministry of Health, are those of the bisphosphonate class:

  • Sodium ibandronate – are drugs that prevent the decrease in bone mineral density, such as Bonviva or Osteotec ;
  • Sodium alendronate – specific inhibitor of bone resorption, which helps prevent fractures. Present in remedies like Alendil or Bonagran ;
  • Risedronate sodium – this compound inhibits the loss of bone material and preserves bone mineralization, is indicated for treatment and prevention of osteoarthritis in women in the post-menopausal period and men at high risk of fractures. It is present in remedies like Actonel or Osteotrat .

These are just a few examples of remedies that can be indicated in the treatment of osteoporosis. In addition to these, anti-inflammatory and analgesic remedies that help relieve pain may also be prescribed.

Exercises

The practice of physical exercises is always beneficial to health, considering that it is fundamental for a good functioning of the body and can avoid many problems.

However, anyone who suffers from osteoporosis needs to have a medical consultation beforehand, in order to assess their general systemic conditions and the degree of the disease. Thus, based on this information, it will be possible to create an appropriate exercise routine.

It is worth mentioning that this routine is individualized, varying according to the physical capacity of each person, the existence of other pathologies and the degree of bone loss.

Among the exercises that can be prescribed by a professional are walking , cycling, swimming and others with low impact. Outdoor activities may be recommended in order to increase levels of vitamin D (absorbed through the sun’s rays).

Physiotherapy

In the treatment of osteoporosis, physiotherapy can be indicated in order to prevent recurrent complications such as deformities and bone fractures. At the same time, it also strengthens the muscles and joints, which can help the patient’s pain.

Exercises can also improve a person’s balance and can help prevent falls – one of the main causes of fractures resulting from osteoporosis.

All treatment needs professional guidance and should be done at the frequency prescribed by the doctor. It is common for the exercises to focus on stretching and muscle strengthening, but they can vary according to each patient (always being of low impact).

Surgery

As mentioned, osteoporosis has no cure. Therefore, even invasive procedures such as surgery do not aim to end the disease once and for all.

Therefore, surgery is commonly indicated only for cases in which the person suffers from significant or disabling pain, without improvement from other therapies. In general, these patients may find it difficult to move and are even restricted in bed.

In these cases, the surgery consists of a “fracture cementation” process. The procedure can be done through vertebroplasty (injection of bone cement directly into the body of the spine’s vertebra) or kyphoplasty .

The difference between both is that kyphoplasty is more modern and accurate, in this surgery a balloon is inflated inside the bone of the spine, causing the vertebra to expand. Then, the cement is placed in the cavity created by the balloon, which generally allows for a better result.

Regardless of the method, in general, the improvement is almost immediate. Thus, significantly easing the pain of the fracture and allowing the patient to move again.

How to prevent osteoporosis?

Osteoporosis is a disease that is commonly associated with the aging process, to which we are all subject. However, throughout life we ​​can have some health care that helps in the prevention of this pathology:

  • Adopt a healthy and balanced diet;
  • Practice physical exercises;
  • Ingest the appropriate amount of calcium;
  • Maintain the recommended levels of vitamin D – which can be done mainly through exposure to the sun (at appropriate times).

The combination of these factors can be an excellent preventive measure, not only for osteoporosis, but for other health complications.


Diseases like osteoporosis can be silent or have their symptoms ignored (and even mistaken for other problems). Therefore, it is necessary to pay attention and not ignore persistent pain, always seeking medical help to obtain the diagnosis.

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