Back pain in people with osteoporosis, or low bone density, is most often caused by fractures in the spine or lower back. Spinal fractures, most often called vertebral fractures, occur in up to 25 percent of postmenopausal American women, reported Jerry Old, M.D., and Michelle Calvert, M.D., in the “American Family Physician” in 2004. Women are four times as likely to have osteoporosis as men, but vertebral fractures also occur in men with osteoporosis. Treatment of back pain from vertebral fractures can vary, depending on the severity of pain and physical condition of the patient.
The bones in the spinal column are responsible for supporting a person’s weight. When bone loses density, it weakens and is less able to support the body. Even minor trauma, such as sneezing or simple lifting, can cause vertebral fractures in people with osteoporosis.
The vertebrae most often break in the front section of the bone; this is called an anterior fracture. The front part of the bone collapses, while the back portion remains in the same position, resulting in the bend of the spine that’s called kyphosis. Both the fracture and the muscle pain that results from the change in the shortening of muscles around the spine can cause pain, Old and Calvert note.
Types of Treatment
Pain from vertebral fractures and subsequent muscle pain can be treated in a number of ways. Exercises to strengthen bone and muscle may reduce pain by reducing future fractures and by strengthening muscles. Medications to increase bone density, such as bisphosphonates, can reduce the risk of fractures. Anti-inflammatory medications and narcotic medications can decrease severe back pain. Calcium and vitamin D supplementation also help maintain and build bone.
Surgery to stabilize the compressed areas and to decrease pain is very helpful in many patients. Percutaneous vertebroplasty and kyphoplasty both involve injection of a cement-like substance into the spine under local anesthesia. Vertebroplasty does not restore lost height, but kyphoplasty may. Kyphoplasty often relieves pain within a matter of hours, the University of Maryland Medical Center explains. Sacral or low back fractures can be treated in much the same way, Virginia Commonwealth University reports.
If a fracture is stable but pain is severe right after the fracture, short-term bed rest, muscle relaxants and pain medication followed by physical therapy may be enough to subdue pain. If pain continues, vertebroplasty, kyphoplasty or sacroplasty (cement injected into the sacrum) may be considered. In most cases medications and exercise as tolerated to build bone density will be prescribed.
The benefits of different treatments must be weighed. In general, less invasive, conservative treatment is the best option in elderly patients, who may not tolerate certain medications or procedures well. Since many medications used to treat pain can have side effects, especially in the elderly, surgical pain relief may be the best option, if the person is strong enough to undergo treatment.
Even seemingly simple medications and treatments can have side effects. Many older people develop gastrointestinal bleeding when taking nonsteroidal anti-inflammatory medications, Old and Calvert caution. Narcotic medications can cause constipation or an ileus (paralyzation of the bowel). Bisphosphonates have, in rare incidences, caused bone death in the jaw.
In rare cases, cement has leaked from the spine into the bloodstream after vertebroplasty of kyphoplasty, causing an embolism, or a block in blood flow to the heart, brain or lungs. Cement may also leak into the spinal nerves, causing neurological damage, the University of Washington warns, although these cases are extremely rare.