Known as a silent disease, osteoporosis gradually thins and weakens bones,
often without people being aware they have it. If not detected early, the first
symptoms of osteoporosis can be a broken bone or fracture.
Men as well as women are susceptible to this disease. The good news is that
osteoporosis can be treated. When diagnosed early through screening tests,
minimally invasive treatments are available that achieve fracture stabilization.
“We are now doing procedures such as kyphoplasty earlier and earlier so that
patients don’t have to suffer the consequences of prolonged pain,” says Cheryl
Hoffman, M.D., director of interventional radiology at the UCLA-Santa Monica
Medical Center.
Smart Business spoke with Hoffman about who is most likely to
develop osteoporosis, what types of back problems are most commonly associated
with this ailment and what types of treatment options are available.
Who is most at risk for developing osteoporosis?
The population most at risk for osteoporosis is any man or woman over the age
of 50. One in three women over the age of 50 has osteoporosis and one in eight
men over the age of 50 has it.
Specific things that may increase your risk of osteoporosis, besides just
age, would include things like taking steroids, whether it’s because of a
pulmonary-related illness or an auto immune disease. Inactivity can also lead to
thinning of the bones, or osteoporosis, in particular. People of a small body
caliber are at an increased risk. Exercise decreases your risk of having
osteoporosis and so does having estrogen.
How does a person know if he or she has osteoporosis?
Frequently, they do not know. Most people aren’t aware of the fact that
osteoporosis is so common in the general population over age 50. Now, everyone
is being encouraged to get a baseline bone density test, which is a good way of
discovering if you have osteoporosis. Frequently, until you either have a
vertebral compression fracture or another type of osteoporoticrelated fracture,
many people do not know.
What types of back problems are most commonly associated with this
ailment?
Osteoporosis contributes to 1.5 million insufficiency fractures per year in
the United States. Approximately 700,000 of those fractures are back fractures,
which can produce severe back pain. These fractures can occur from something as
simple as sneezing or coughing. Once you have an insufficiency fracture to your
back, your posture may change, your breathing could become more restricted, and
the pain can be very limiting. After a short period of time, patients can become
quite incapacitated and experience prolonged pain that could require pain
medicine, bed rest and hospitalization — all of which can produce other types of
illness.
What are some treatment options?
Conservative therapy has frequently been done in the past: bed rest, pain
medicine and back bracing. However, patients have suffered. Now, some new, very
simple outpatient procedures can be performed, such as kyphoplasty. Once cement
is placed inside a vertebral body that has been fractured, the heat kills the
nerve routes, and therefore, dramatically decreases the pain. More than 90
percent of patients report a significant decrease in pain from their back
fracture after this procedure. It fixes the fracture, strengthens the vertebral
body and decreases the pain. Now there is no reason for patients to go for any
length of time with significant back pain from an osteoporotic fracture.
If surgery is required, how should a person decide which option is
best?
As an interventional radiologist, I perform procedures that are easily
tolerated and are minimally invasive. In consultation, we can look at the MRI or
bone scan films, and from there, decide if patients are a candidate for
kyphoplasty. Usually they are, but occasionally the bone fracture is so severe
that they should be referred to a back surgeon, who would do a much larger
procedure.
What advancements do you envision in treating osteoporosis in
upcoming years?
Making people aware of how common it is should help with decreasing the
number of people who experience fractures. There are medications now; not just
calcium and vitamin D, but also bisphosphonates. All of these can be taken if
osteoporosis is present so that people are at less risk for experiencing an
osteoporotic fracture. I’m hoping that instead of having 1.5 million
insufficiency fractures per year, that number will start to decrease as everyone
becomes more aware of the frequency of this condition.
CHERYL HOFFMAN, M.D., is director of interventional radiology at the
UCLA-Santa Monica Medical Center. Reach her at (310) 319-3840 or
chhoffman@mednet.ucla.edu.
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