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New treatments for osteoporosis

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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