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Vertebral Fractures: You May Have a Broken Back and Not Know It

Published
December 1, 2011
Publication
Bottom Line Personal
Source
David Borenstein, MD
Print
418

Don’t assume that an aching back means just a pulled muscle. It’s among the most common symptoms of vertebral fractures, small cracks in the vertebrae of the spine.

About 25% of postmenopausal women in the US eventually will develop a vertebral fracture. Men over age 60 are prone to them, too. Up to two-thirds of these fractures never are diagnosed because the pain is so minor that patients don’t bother to tell their doctors—or, as is often the case, because there’s no pain at all.

The risk: Hairline cracks in the vertebrae eventually can cause the bone to crumble and collapse, a condition known as a vertebral compression fracture. When you see someone with a hunched-over posture, the so-called dowager’s hump, you’ll know that he/she has a compression fracture. These fractures also can cause patients to lose inches in height over the years.

Studies have shown that patients with compression fractures face a 23% higher risk for death than those with stronger bones. Difficulty breathing and pneumonia also can occur in severe cases because the stooped-over posture often interferes with normal lung function.

Article Continues Below

BONE LOSS

Unless you’ve had a severe injury (from a car accident, for example), vertebral factures usually are due to osteoporosis, the leading cause of bone loss. They also can be caused by osteopenia, less severe bone weakening that can start decades before the development of full-fledged osteoporosis. People who have one fracture are at greater risk of developing another.

For women, the main cause of bone loss is the postmenopausal decline of estrogen. In the first five years after menopause, women can lose up to 25% of their bone density.

Men have thicker bones to begin with, and they lose bone more slowly, but they’re not immune to fractures. About 25% of men develop osteoporosis by age 70. By the time they reach 75 to 80, they’re just as likely as women to have severe bone weakening.

The only way to know that you have osteoporosis is to get a bone-density test. The most accurate test is a dual-energy X-ray absorptiometry (DXA). The test is painless, takes about 10 minutes and exposes patients to less radiation than a chest X-ray. Cost: $150 to $200. The test usually is covered by insurance. Newer DXA machines also are able to scan the spine to detect spinal fractures. This test is referred to as a vertebral fracture assessment (VFA).

You might see kiosks at pharmacies and malls that offer a heel sonogram. It’s a fast, inexpensive test that measures bone density in the heel. It can indicate which patients might have low bone density. However, the test is not as accurate as DXA. I don’t recommend it.

Every woman should get a DXA test around the time of menopause. Men should have the test if they have a family history of osteoporosis…if they’re taking steroids (which can cause bone loss) for another condition…or if they have low testosterone, which also leads to bone weakness.

PREVENTING FRACTURES

Early diagnosis of osteoporosis and then adopting bone-building strategies can protect the spine. Patients with low bone density who don’t improve with lifestyle measures may need to take bisphosphonates (such as Fosamax) or other medications. Drug therapy can improve bone density by at least 4% a year and reduce the risk for future fractures by 30% to 40%. The general recommendation for bisphosphonates is to take them for five years because long-term bisphosphonate therapy has been linked to a rare type of thigh fracture.

Here, important lifestyle steps…

Get more calcium. It improves the body’s ability to develop new bone. Women need 1,200 milligrams (mg) daily until menopause and 1,500 mg afterward. Men should get 1,000 mg until age 65 and 1,500 mg thereafter.

Dairy foods and fortified juices and cereals are the best dietary sources of calcium. (One cup of milk or fortified juice has about 300 mg of calcium.)

Supplements can help if you don’t eat a lot of high-calcium foods. Both forms of supplements—calcium citrate and calcium carbonate—are effective.

Helpful: Take calcium supplements with meals. The stomach’s acidic environment during digestion improves calcium absorption.

Supplement with vitamin D. A majority of Americans are low in this nutrient, which is needed for calcium absorption. The recommended daily amount is 600 international units (IU) for those ages 51 to 70 and 800 IU after that. However, higher amounts—usually between 1,000 IU and 2,000 IU daily—often are recommended, particularly for those who have dark skin and/or those who don’t get a lot of sun exposure.

Eat leafy green vegetables, such as spinach and kale. These are high in vitamin K, which helps calcium in the blood enter the bones. The Harvard Nurses’ Health Study found that women who ate at least one daily serving of leafy green vegetables were 50% less likely to suffer a hip fracture than those who ate less. It’s not known whether these foods protect the vertebrae, but increasing vitamin K intake as part of a healthy diet is probably helpful.

Walk for 30 minutes four times a week. Walking and other types of weight-bearing exercise (in which the muscles and joints work against gravity) significantly increase bone density. People who exercise regularly throughout their lives put more bone “in the bank” to protect against future fractures.

Riding a bicycle (including a stationary bike) has similar effects. The spine benefits from any exercise that requires you to be upright. This includes jogging, aerobics, yoga and jumping.

Swim for pain relief. Swimming isn’t a weight-bearing exercise, so it won’t increase spinal strength—but it’s very useful for strengthening the muscles that surround the spine and helping to prevent pain and stiffness.

Strengthen abdominal muscles. Strengthening the muscles that surround the spine and abdomen (the so-called “core muscles”) can help reduce back pain if you have a fracture. Also by improving muscular support around the spine, strong core muscles may help protect the back from future injuries.

Try this: Lie on your back with your knees bent and your feet flat on the floor. Tighten the abdominal muscles while gently pressing your lower back toward the floor. Hold the tension for five to 10 seconds, relax, then repeat the movement 10 times. Do this daily.

You also can do crunches to strengthen the core muscles in the abdomen and lower back. Crunches are safe for most patients, but they do put pressure on the spine—talk to your doctor before doing them if you have significant bone loss and/or fractures.

To do them: Lie on your back with your knees slightly bent…cross your arms over your chest…and gently raise your shoulders a few inches off the floor. Hold the stretch for a second, then relax. Repeat 10 times. Do this daily.

Use heat and/or cold for pain. To relieve pain initially, apply an ice pack to your lower back. Keep it there for about 10 minutes. Do this several times during the first 48 hours.

After that, heat reduces muscle spasms and can minimize back pain. It also increases circulation, which flushes pain-causing chemicals from the injured area. Apply a hot water bottle or heating pad to your lower back for 10 to 20 minutes several times daily.