Five Key things to know about Osteoporosis
1. How do you evaluate your patients for osteoporosis prior to spinal surgery?
I use x-rays of the spine to look for evidence of prior compression fractures and to get a rough estimate of bone density. In patients requiring surgery using instrumentation, I usually order a DEXA scan, which stands for Dual-Energy X-ray Absorptiometry. It is a low-level x-ray examination measuring the density of three important bone sites and it is probably the most common technique used to assess bone density. It is completely painless, non-invasive and takes only minutes to complete.
2. What does the DEXA scan T-score mean to the patient?
The DEXA scan bone density test will report bone density in numbers. These numbers are sometimes reduced to an overall number which is called a patient’s T-score. In a DEXA scan, the amount of mineralized tissue within a section of spine or hip is measured and expressed as grams per cm2 (square centimeter). Values are often compared to others of the same age and gender (called a Z score) or to healthy 35-year-olds of the same gender who are felt to have attained peak bone mass (T score). These scores are then expressed as measurements of deviation from the average indicating how far above or below normal one’s bone quality lies.
3. What numbers do you consider diagnostic of osteoporosis?
In our practice, we utilize the established World Health Organization (WHO) criteria to determine osteopenia and osteoporosis in our patients.
-Individuals within one standard deviation of peak bone mass (T score 0 to -1.0) are considered to have normal bone density. -If bone mass is between one and 2.5 standard deviations below peak bone mass (T score -1.1 to -2.5), osteopenia is diagnosed. -If bone mass is 2.5 standard deviations below peak bone mass (T score less than -2.5), osteoporosis is diagnosed.
4. What type of calcium supplement do you recommend for your patients?
The two types of calcium which are available over the counter are calcium carbonate and calcium citrate. Either type of calcium is an acceptable supplement for patients with normal bone density or patients attempting to increase mineralization of their bones. There is some thought that the calcium citrate is better absorbed from the gastrointestinal system. It can be taken either with food or on an empty stomach. Calcium carbonate is better absorbed with meals because it requires the presence of stomach acid to be absorbed. In either case, I ask my patients to adhere to the recommended daily dosing table and to take no more than 600mg of calcium supplement at one time.
5. How are most spinal fractures associated with osteoporosis currently treated?
Most people simply need a protective brace for osteoporotic compression fractures. It generally takes 3 months for such fractures to heal. In other cases of severe pain or development of kyphosis (forward bending of the fractured spine) rapid hardening bone cement may be injected into the fractured spinal. Vertebroplasty involves injecting cement directly into fractured vertebral bodies. This has been shown to decrease pain, increase mobility and improve spine stability. There is no effect on the fractured part of the spine or and deformity associated with the fracture. Kyphoplasty on the other hand, involves using an inflatable balloon to expand the broken bone before filling it with bone cement. In both cases, pain relief is very rapid.
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