August 21, 2012 00:00 By Professor Emeritus Charoen Cho
Back pain, and even pain in the bones throughout the body, often disturb people over 50.
Many older people suffer broken hips and limbs in minor falls. The reason the bones break so easily is because they’ve become thin and brittle over time, in a condition called osteoporosis.
Bone is a living tissue, constantly being worn down and rebuilt. When this process is thrown out of balance, as during women’s hormonal changes or a dramatic shift in the daily diet, bones can lose some of the minerals that keep them strong. Diminished bone density is called osteopenia, and that’s when fractures occur easily.
Osteoporosis poses a risk to 9 or 10 per cent of Thais over 60 – that’s six million people, more than half of them women. The US National Osteoporosis Foundation says 10 million Americans have osteoporosis and another 34 million have low bone mass and are thus at risk. Upwards of 80 per cent are women.
Few people at risk of osteoporosis are aware they are, and this is why it’s called a “silent” disease. There are usually no symptoms until a bone gets broken, and then osteoporosis is detected during treatment.
The majority of older people who sustain fractures, particularly in the hip or spine, will suffer significant pain and protracted or even permanent disability. In bygone days such a fracture could even contribute to premature death.
Clearly women, particularly those with a family history of osteoporosis, have a greater chance of developing osteoporosis. They’re at greater risk still if they abuse alcohol, smoke, use steroids or anti-seizure drugs, don’t menstruate or have passed the menopause, and have eating disorders. A diet with little protein and a low body weight are inviting trouble.
The primary test for osteoporosis assesses bone mineral density (BMD). One of the preferred and most accurate methods is a Dexa scan. BMD is usually rated in terms of peak bone mass in young adults. BMD below or about “minus-1 standard deviation” is considered normal. BMD in osteopenia is between -1 and -2.5 standard deviation, while in osteoporosis it’s lower than -2.5.
If osteopenia or osteoporosis is detected, the doctor will recommend medication and lifestyle changes, specifically becoming more active, getting more sun and doing appropriate exercises.
A fractured spine requires an external support brace. If the fracture doesn’t heal, excruciating back pain can result, so an orthopaedic surgeon will suggest a non-invasive spinal procedure called vertebroplasty, or sometimes kyphoplasty.
The basic procedure is to inject liquid “bone cement” into the cavity. In about 15 minutes it will harden into artificial bone, stabilising the fracture internally.
Find out more from the Spine & Joint Centre on the first floor of Samitivej Srinakarin Hospital. The number is (02) 378 9000.