What is osteoporosis of the spine and how to treat it

Osteoporosis is a chronic systemic metabolic disease that is characterized by a decrease in bone mass and structural changes, leading to increased bone fragility and the risk of fractures.

This disease mainly affects older people, and more often older women. It is estimated that more than 200 million people worldwide suffer from osteoporosis, of whom 2.5 million have fractures. Moreover, 18% of women over 60 years of age have one or another stage of spinal compression fractures.

Symptoms of osteoporosis of the spine

Osteoporosis can occur for a very long time without any symptoms. In the early stages, you can determine it by measuring your height and comparing it with what it was at 20-25 years old. Also, changes in posture will indicate osteoporosis of the thoracic spine or cervical spine.

As osteoporosis of the spine develops, the following signs appear:

• Pain. It occurs mainly under compression loads. This could be a fall or lifting something heavy. Osteoporosis of the lumbar spine is manifested by pain with sudden turns of the torso. The pain syndrome may subside 4-6 weeks after onset. If the spine is affected by multiple microfractures, this leads to modification of the vertebrae and their gradual bending. Patients in this case experience periodic pain, which worsens when laughing, sneezing, coughing, or changing body position after sitting for a long time.
• Decreased growth. The difference between previous and current indicators can be 10-15 cm.
• Osteoporosis of the thoracic spine is manifested by a decrease in the size of the chest. Because of this, the arms look unnaturally long.
• Spinal deformity. Occurs when more than one vertebra is affected by the disease. Typically, such symptoms are caused by osteoporosis of the lumbar spine when 1-2 vertebrae are affected. Deformation also occurs when the thoracic region - 10-12 vertebrae - is involved in the process. As a result, the person becomes stooped, and as the disease progresses, a hump or humps may form.
• Reducing the distance between the pelvic bones and the rib area. In this case, a person with osteoporosis of the spine feels pain in the side.
• Pain in the vertebrae on palpation. This symptom occurs with a recent compression fracture.
• The pathological process may involve nerve roots and the spinal cord. In this case, a variety of dysfunctions arise: from loss of sensitivity in some parts of the body to paralysis of the limbs.
• Osteoporosis of the cervical spine causes pain after long periods of sitting or standing, weakness and soreness in the arms, discomfort in the shoulder girdle, headaches, surges in blood pressure, numbness, tingling and cramps in the arms.
• Brittle hair, deterioration of teeth and nails.

Vertebroplasty

Among the methods of surgical treatment of uncomplicated fractures of the vertebral bodies in osteoporosis, it is necessary to highlight the technique of percutaneous vertebroplasty, developed and applied in France in 1984. Deramond EL, Depriester C, Galibert P., Le Gars V. This is a minimally invasive technology for the treatment of pain in the spine caused by various diseases affecting the vertebral body.

All manipulations are performed under X-ray control.

Indications for vertebroplasty are:

• compression fractures due to osteoporosis, both with pain and painless forms;
• tumor or metastatic lesions of the vertebral bodies;
• hemangioma of the vertebral body with its tendency to grow and cause pain;
• multiple myeloma.

The analgesic effect is associated with the elimination of micromobility of fragments, thermal and chemical effects during polymerization, causing dereception of nerve endings. Once hardened, the bone cement restores the supporting function of the vertebra. This allows you to avoid traumatic surgery or long-term wearing of an uncomfortable corset. Correction of deformity and strengthening of the vertebra occurs through direct injection of cement into the vertebral body through a special needle, usually under local anesthesia.

Contraindications to the procedure:

• Hemorrhagic diathesis;
• Infections;
• Damage to the posterior wall of the vertebra makes the procedure dangerous due to the risk of cement leakage into the spinal canal and compression of the spinal cord.

The manipulation is performed through a skin puncture. The patient can be discharged the very next day after surgery.

Causes of osteoporosis

There are many reasons for the development of this pathology:

• disturbances in the functioning of the endocrine system;
• lack of physical activity, sedentary work;
• deficiency of calcium and vitamin D in the body;
• chronic gastrointestinal diseases;
• negative heredity;
• long course of glucocorticosteroids (more than 1 month);
• menstrual irregularities in women, amenorrhea;
• alcohol abuse;
• smoking;
• drinking more than 5-6 cups of coffee per day;
• excessive physical activity;
• a metabolic disorder in which the bones do not receive enough necessary vitamins and microelements;
• poor nutrition – osteoporosis of the spine can be caused by both a long-term and poorly designed diet, and the predominance of fatty foods, which interfere with the absorption of important nutrients.

Prevention

To protect your body from the development of a disease such as osteoporosis, you should be more attentive to your health. To do this you need to play sports. It is best to choose gymnastics, swimming, yoga, fitness. It is important that the body receives a sufficient amount of vitamin D. Therefore, it is recommended to stay in the fresh air as much as possible in sunny weather.

Avoiding bad habits will help minimize the risk of developing osteoporosis. At the same time, it is important to fully rest and get enough sleep. Then it will be easier for the body to recover after physical activity. Proper nutrition is of particular importance.

Stages of development of spinal osteoporosis

Kyphoplasty

A new method for treating compression fractures due to osteoporosis. The peculiarity of this technique is that a balloon is inserted through a needle into the broken vertebral body on both sides, and by symmetrically injecting contrast liquid into this balloon, the lost height of the vertebral body can be partially or completely restored. Then bone cement is injected into the formed cavity. This operation is also performed through a skin puncture (that is, it does not require surgical incisions) under local anesthesia. The duration of kyphoplasty is on average 30-60 minutes. After such an operation, the patient can be discharged from the hospital on the same day.

Kyphoplasty allows you to:

• stop or significantly reduce back pain, prevent further “subsidence” of the broken vertebra, which helps stop the progression of spinal deformity and related problems in the long term;
• restore the physiological curves of the spine and maintain normal posture.

Kyphoplasty should be considered as the procedure of choice for the treatment of patients with back pain and vertebral deformity resulting from a pathological compression fracture.

Results of kyphoplasty surgery:

Clinical studies have shown that in 90% of patients with a compression fracture of the spine due to osteoporosis, back pain is significantly reduced or disappears immediately or within 2 weeks after kyphoplasty. In 70-90% of patients, almost complete restoration of the normal height of the broken vertebral body occurs.

Types of osteoporosis of the spine

Osteoporosis of the spine, treatment of which must begin immediately when the listed symptoms are detected, is classified according to several criteria.

Based on localization, the following types of osteoporosis are distinguished:

• cervical region;
• thoracic region;
• lumbar region.

According to the severity of the consequences, the disease is:

• with the presence of pathological fractures;
• without pathological fractures.

The main three types of spinal osteoporosis are:

1. Senile. This is an age-related type of disease, which is associated with a gradual disruption of the process of bone tissue restoration and its destruction.
2. Postmenopausal. This type appears in women after the onset of the last menstruation in the first 5-10 years of menopause.
3. Combined. It combines both types and only affects women.

According to the mechanism of occurrence, osteoporosis is:

• Primary. It develops as an independent pathology and is systemic in nature. Accounts for up to 94% of all types of osteoporosis.
• Secondary. It is caused by various reasons and factors, develops against the background of other diseases, after organ transplantation, etc.

Primary osteoporosis of the spine is divided by origin into:

• genetically determined - occurs among members of the same family, is inherited;
• juvenile – the so-called “teenage”, the causes of which are currently unknown to medicine;
• involutive - occurs in the process of general aging of the body, includes postmenopausal, senile (that is, senile, appearing after 70 years), presenile (develops mainly in men and at an earlier age - after 50 years);
• idiopathic - appears in men over 25 years of age and in women before menopause; the etiology of this disease is unknown.

Based on prevalence, osteoporosis is divided into:

• localized – affects one part of the spine;
• diffuse - a common pathology that affects not only the entire spine, but also other bones of the skeleton.

Secondary osteoporosis is divided according to the factors that caused it. These are disturbances in the functioning of the following body systems:

• digestive;
• endocrine;
• hematopoietic;
• urinary (kidney disease);
• collagenosis.

General information about the disease

According to WHO experts, osteoporosis today is one of the most common diseases, along with myocardial infarction, cancer pathology and sudden death, it occupies a leading place in the structure of morbidity and mortality of the population. The social significance of spinal osteoporosis is determined by its complications - fractures of the vertebral bodies, which cause a high level of disability and mortality among the elderly and, accordingly, high material costs in healthcare. Among all fractures in people of older age groups due to osteoporosis, vertebral body fractures range from 20 to 30%.

There are several clinical variants of this disease. This is postmenopausal or postmenopausal osteoporosis, affecting women during menopause. The disease here is associated with age-related involutive processes in the ovaries, with a decrease in the secretion of parathyroid hormone and a deficiency in the body of the active metabolite of vitamin D3 - calcitriol, which significantly regulates calcium metabolism.

Senile or cyanotic osteoporosis affects older people, over 75-80 years of age. A third of them are men. Asymptomatic, that is, as if invisible to the patient, spinal fractures are determined in every fourth case. In such patients, the level of calcitriol, a product of vitamin D3, is reduced, and therefore bone calcium metabolism is impaired. Here, too, a huge role is played by calcium deficiency, sunlight, and limitation of physical activity, which contribute to the synthesis of vitamin D3 in the body.

At the same time, about 80% of patients sharply limit basic household activities due to pain, they experience exacerbation of chronic diseases, most of the victims require care, and mortality increases significantly.

How is osteoporosis diagnosed?

The most informative, simple, painless and fastest diagnostic method is ultrasound densitometry. This study allows you to determine bone density and the level of risk of fractures in literally 5 minutes. Densitometry can detect osteoporosis at an early stage and even minimal bone loss. During treatment, it is carried out to determine the effectiveness of therapy and the dynamics of changes in bone density.

Laboratory research:

• determination of TSH level (in osteoporosis it is elevated);
• general blood test (reduced hemoglobin level);
• a blood test to check calcium levels (it will be elevated because calcium is washed out of the bones in the blood);
• determination of alkaline phosphatase in the blood (will be increased);
• urine test for calcium (any deviation may indicate pathology);
• determination of testosterone levels in men (in osteoporosis it is reduced);
• markers of bone destruction - deoxypyridinoline, pyridinoline, C- and N-terminal telopeptide, beta-CrossLaps (these indicators will be increased in the presence of the disease).

Additional instrumental and hardware studies:

• radiography (reveals a severe stage of osteoporosis of the spine, the treatment of which will be difficult);
• osteoscintigraphy (an isotope method that allows you to exclude other causes of pain in the spine and detects recent fractures);
• bone biopsy (needed for atypical types of osteoporosis);
• MRI (can detect fractures and bone marrow swelling).

Possible complications

If you do not take any measures, you may encounter serious complications in the future. Height decreases and posture is impaired. A backward bend of the spine in the thoracic region becomes noticeable, and sometimes the cervical vertebrae begin to protrude strongly forward. Many women with this disease experience scoliosis.

Osteoporosis provokes frequent fractures, which are advanced in nature and can result in disability for a person. This disease also contributes to the displacement of the vertebrae and compression of the spinal cord.

How to treat spinal osteoporosis

Therapy for this disease includes significant dietary adjustments, taking special medications, lifestyle changes and, in some cases, physical therapy.

Features of nutrition for osteoporosis

The main thing is the high calcium content in food. To restore bone tissue, a person needs 1000-1200 mg of calcium per day. For comparison: usually the daily dose when consuming dairy products is 600-800 mg. Therefore, it is necessary to add calcium supplements. In addition, calcium can be “raised” by eating as many foods high in calcium as possible: nuts, dried fruits, dairy products, vegetables, olives, celery, white cabbage, onions, fish.

Important! If you drink 0.5 liters of milk, you will satisfy the daily need for protein by 20%, phosphorus by 10%, calcium by 72%, iodine by 22%, and various vitamins by 30%.

If a person is lactose intolerant, then other foods containing calcium should be consumed. This is a glass of calcium-fortified orange juice per day (500 mg of calcium), ¾ cup of cereals (200-250 mg), ½ cup of boiled soybeans (90 mg), 1 orange (50 mg), ½ cup of boiled broccoli (35 mg) .

In order for calcium to be better absorbed, vitamin D is necessary. It is synthesized in the body under the influence of ultraviolet radiation. However, in the middle zone, people often experience a deficiency of it due to the small number of sunny days per year. Therefore, it is necessary to consume more foods containing vitamin D: meat, eggs, butter. However, it is possible to get up to 100 IU per day from food, which is not enough, because you need from 600 to 1000 IU. Therefore, vitamin D is added in tablet form.

Vitamin A, phosphorus and magnesium are also needed for good calcium absorption. The latter element is found in large quantities in buckwheat, bananas, oatmeal, millet, peanuts, sunflower and pumpkin seeds, cheese, peas, beans, and green peppers. If you simply consume magnesium, then 2/3 of the amount received will be excreted from the body. You can increase digestibility with vitamin B6.

The diet should contain enough protein - 1 g per kg of weight per day. To do this, you need to eat more meat, egg whites, and green vegetables. You can include protein shakes in your diet.

The balance between phosphorus and calcium is important. There should be twice as much calcium. The content of these substances in the body should be regularly checked by donating blood as prescribed by a doctor. Phosphorus is found in large quantities in veal, beef, millet, hard cheese, pumpkin seeds, egg whites, beef and pork liver, milk, white beans, nuts, grain bread, chicken, turkey, and duck. Your doctor should also explain how to maintain proper sodium levels.

In women, osteoporosis most often develops when estrogen production is disrupted. To maintain the level of female hormones, you need to eat foods containing phytoestrogens - all types of greens, soy, legumes, raw nuts.

Rehabilitation time for spinal fractures

The prognosis for a spinal fracture is usually good. The decisive factor is the extent to which the fracture affects the spinal cord and nerves. For a stable spinal fracture, the recovery period usually ranges from several weeks to several months. In the case of unstable fractures, the recovery process is increased.

Diagnosis and treatment

Types, causes and treatment of back pain
Back pain

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How to get rid of pain from osteoporosis

The causes of pain due to osteoporosis vary. They can be caused by fractures, osteoarthritis, and degenerative processes in the intervertebral discs.

Emergency care for acute pain

The patient is prescribed analgesics that have a peripheral effect. They are more effective than centrally acting analgesics. Peripheral painkillers are paracetamol, aspirin, metamizole. NSAIDs (non-steroidal anti-inflammatory drugs), such as ibuprofen, are also good for relieving acute pain.

Important! NSAIDs negatively affect the gastric mucosa. Therefore, they need to be taken in short courses. To reduce harm, prescribe Omeprazole - 20 mg at night or 2-3 times a day, 20 mg with meals, if unpleasant symptoms such as heartburn have already appeared.

Bone pain is well eliminated by bisphosphonates, which are included in the course of treatment.

With a recent fracture

In this case, the pain is relieved with opioid analgesics. These include Tramadol. Such drugs also need to be used against the background of Omeprazole and with caution, because they can cause dizziness, which provokes falls and new injuries. Sometimes the drug Pregabalin is prescribed. It is effective if nerve endings are damaged or pinched.

To eliminate the consequences of a fracture and strengthen the spine, a new and effective “cementing” technique is used. A special substance is injected percutaneously into the vertebrae, which hardens and strengthens the bone tissue.

Chronic pain and long term outlook

When the pain syndrome is under control, the patient should direct all efforts to strengthening the muscle corset. For this purpose, physiotherapy and special gymnastics are used. The exercise and physical therapy program is developed individually for each patient. One of the best methods of relieving stress from the spine and simultaneously strengthening the back muscles is swimming.

"Silent" disease

Osteoporosis is a condition in which bone mass decreases, causing loss of bone structure and strength, resulting in an increased risk of fractures. The most common method for diagnosing osteoporosis is densitometric assessment. To determine bone mineral density (BMD), the gold standard is dual-photon absorptiometry (DPA). To evaluate the T-score, a patient's BMD is compared to a reference BMD standard from a normative cohort aged 20 to 30 years. According to WHO recommendations (1994), osteoporosis is considered to be a decrease in BMD according to the T-criterion below -2.5; severe osteoporosis - a decrease in T-score below -2.5 in combination with one or more fractures [10].

The primary forms of osteoporosis include postmenopausal and senile, which make up 80% of all types, as well as juvenile and idiopathic. Postmenopausal osteoporosis, or type 1 osteoporosis, is characterized by predominant damage to trabecular bone tissue, a predominance of accelerated bone resorption, and develops in women from the onset of menopause to 65–70 years of age. Senile osteoporosis, as a rule, develops in people over 70 years of age, in bones with a cortical type of structure and in spongy bone; There is predominantly a decrease in bone formation, but variants with increased bone resorption are not uncommon. One in three menopausal women and more than half of the entire population aged 75–80 years suffer from osteoporosis. The prevalence of osteoporosis and the financial costs of treating associated fractures are steadily increasing, with 40% of the increase in prevalence due to the aging population [10, 11].

Secondary forms of osteoporosis occur against the background of somatic diseases or long-term use of drugs that cause calcium metabolism disorders.

In osteoporosis, the density of bone and vertebral bodies is reduced to 70% and 50%, respectively. A decrease in bone mass, as a rule, is asymptomatic, even with the development of vertebral body deformity and a decrease in disc height. While extremity fractures are usually painful, some types of vertebral fractures, especially wedge fractures, may not cause pain. Osteoporotic fractures with pain in the lumbosacral spine are more common in women: 25% of postmenopausal women have compression fractures of the spine, and 40% of those over the age of 80 years. The risk of vertebral fractures in osteoporosis varies greatly depending on the presence or absence of pre-existing vertebral fractures [12, 13].

The WHO FRAX score is used to estimate the 10-year probability of fractures associated with changes in bone density and bone quality (clinically significant vertebral fracture, distal forearm fracture, proximal femoral fracture, or humeral fracture). The FRAX algorithm is used in postmenopausal women and men 50 years and older. The scoring model takes into account age, sex, presence of rheumatoid arthritis and secondary causes of osteoporosis: type 1 diabetes mellitus, osteogenesis imperfecta in adults, long-term untreated hyperthyroidism, hypogonadism or premature menopause (<40 years), chronic malnutrition or malabsorption, chronic liver disease, as well as previous osteoporotic fractures (including clinical and asymptomatic vertebral fractures), parental hip fractures, smoking, low body mass index, alcohol consumption (≥3 drinks per day), use of oral glucocorticoids ≥5 mg/day prednisolone for >3 months ., decrease in BMD (if it is possible to evaluate it).

BMD correlates with bone strength and is the best predictor of fracture risk. Measurements in the central (lumbar spine and Ward's area of ​​the hip) and peripheral areas of the skeleton (forearm, heel, fingers) allow us to assess the risk of fractures. In postmenopausal women and men over the age of 50 years, the WHO diagnostic T-criterion (normal, osteopenia and osteoporosis) is determined by measuring BMD using the DPA method in the lumbar spine and femoral neck [14].

According to the recommendations of the American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE), BMD assessment is indicated:

All women ≥ 65 years old.

For postmenopausal women:

with fractures without serious injury;

with osteopenia detected by x-ray;

taking glucocorticoid therapy (≥3 months)

Peri- or postmenopausal women with risk factors for osteoporosis such as:

low body weight (<57 kg or body mass index <20 kg/m2);

long-term systemic glucocorticoid therapy (≥3 months);

family history of fractures due to AP;

early menopause (<40 years);

smoking;

excessive alcohol consumption.

For secondary osteoporosis [15].

The presence of osteopenia should not be considered as an independent disease; the indication of osteopenia is intended solely for epidemiological description. Additional risk factors for fractures include decreased height (>4 cm) and thoracic kyphosis. Bone markers - serum procollagen type I amino-terminal propeptide (s-PINP) and C-terminal telopeptide of type I collagen (s-CTX) as indicators of formation and Bone resorption accordingly has some prognostic value for fractures in situations where BMD measurements are not available [16].

Radiologically confirmed vertebral fractures (even asymptomatic ones) are a sign of impaired bone quality and strength and a strong predictor of new fractures, regardless of BMD, age and other clinical risk factors. Having one vertebral fracture increases the risk of subsequent fractures by 5 times, and the risk of hip and other fractures by 2-3 times. A vertebral fracture confirms the diagnosis of osteoporosis, even in the absence of a pronounced decrease in BMD, and is an indication for pharmacological treatment to reduce the risk of subsequent fracture. Most vertebral fractures are asymptomatic when they first occur and often go undiagnosed for many years. Vertebral imaging is the only way to diagnose these fractures:

All women aged 70 years or older and all men aged 80 years or older if spine, total hip, or femoral neck BMD T-score is ≤ -1.0.

Women aged 65 to 69 years and men aged 70 to 79 years if the spine, total hip, or femoral neck BMD T-score is ≤ -1.5.

Postmenopausal women and men aged 50 years and older with specific risk factors: in the form of a traumatic fracture in adulthood (50 years and older), with a decrease in height by 4 cm, treatment with glucocorticoids.

Repeat imaging is indicated only if there is ongoing height loss, pain, or spinal deformity [14].

Features of lumbar pain in osteoporosis

Osteoporosis of the vertebrae without fractures is not a source of pain. Changes in the configuration of the vertebrae are often an incidental finding during radiography. According to the literature, pain in the lumbar region with osteoporosis does not differ from pain in patients without osteoporosis, with the exception of cases of acute pain from fractures [3]. Compression fractures (a decrease in the height of the vertebral bodies by more than 20%) most often occur in the lower thoracic and upper lumbar regions. Fractures are typically characterized by the occurrence of acute local pain after a minor injury or even habitual movement; the pain intensifies with movement and coughing [8]. Provocation of pain during percussion of the spinous processes of the affected vertebra is typical. Difficult to diagnose are cases of sacral fractures, usually small ones. For such patients, pain in the lumbosacral region, deep pain in the gluteal region, sometimes radiating to the leg, without convincing radicular symptoms, which often occur after minor injuries or awkward movements, are typical. The pain intensifies with palpation and percussion in the projection of the fracture; small fractures are not visible with standard radiography; they are better visualized on CT or MRI.

A feature of radicular symptoms in osteoporosis is more frequent damage to the upper lumbar roots with irradiation of pain in the abdomen, groin, along the anterior and inner surface of the thighs. Relatively rarely, paresis of the lower extremities, pelvic disorders, and conduction disturbances of sensitivity are detected. There are indications of the possibility of chronic pain, predominantly of a muscular nature, against the background of severe spinal deformity, but the level of evidence for this data is very low [8, 10].

My own experience of studying the characteristics of low back pain in osteoporosis

On the basis of the Clinic of Nervous Diseases named after. AND I. Kozhevnikov, we conducted a pilot study, the purpose of which was to study the characteristics of pain syndrome in patients with chronic vertebrogenic lumbar sciatica and suffering from osteoporosis. 20 patients were examined, of which 10 patients (average age 65.2±5.27 years) were diagnosed with osteoporosis, and 10 patients (average age 63.9±5.67 years) without osteoporosis, who formed the control group. The objectives of the study included assessment of pain syndrome and neuroorthopedic status to identify the dominant source of pain, assessment of neuropsychological status and severity of spinal deformity. Diagnosis of osteoporosis was carried out using the method of quantitative ultrasound densitometry using the Omnisense 7000S device with a decrease in T-criteria -2.5SD

and below. Other methods of instrumental examination included: radiography of the lumbosacral spine in direct and lateral projections, CT and MRI of the lumbar spine. As part of the study, the disability index was assessed using the Oswestry Low Back Pain Disability Questionnaire and pain was assessed using the VAS. Taking into account the effect of osteoporosis on the biomechanics of the spine, the angle of kyphosis, lordosis and scoliosis was measured using a flexible rod according to the method proposed by M.A. Katbleen. To assess the severity of depression and anxiety, the Beck Depression Inventory, the Hospital Anxiety and Depression Scale, and the Hamilton test were used.

When studying the curvature of the spine, a statistically significant increase in the angles of thoracic kyphosis, lumbar lordosis and thoracolumbar scoliosis was found in patients suffering from osteoporosis (p<0.001). The level of pain according to VAS did not differ significantly between the groups and was 6.2±1.8 and 5.9±1.4 mm in patients with osteoporosis and patients without osteoporosis, respectively (p>0.5). Pain characteristic of dysfunction of the sacroiliac joint was detected in 8 patients with osteoporosis and 7 patients in the control group, pain in the facet joints at the lumbar level was detected in 6 and 4 patients, respectively. All 20 patients in both groups had muscular-tonic syndrome of varying severity, which manifested itself in tension and soreness of the paravertebral muscles, piriformis syndrome - in 3 and 2 patients of the corresponding groups. Radicular symptoms were detected in 1 patient with osteoporosis and 2 in the control group. When assessing anxiety and depression, the degree of disability in the 2 groups, no statistically significant differences were obtained, but there was a tendency for them to predominate in the group of patients with osteoporosis.

In summary, our pilot study demonstrated that osteoporosis per se is not a cause of chronic low back pain in elderly patients. There were no statistically significant differences in sources of pain, pain intensity, degree of anxiety-depressive disorders and degree of disability in patients with chronic lumbar pain syndrome, with and without osteoporosis.

Osteoporotic deformity of the vertebrae leads mainly to severe postural disorders, accompanied by an increase in thoracic kyphosis, flattening of the lumbar lordosis and S-shaped lumbar-thoracic scoliosis, which can also be the cause of secondary muscle spasm. Given the small size of the patient groups included in the study, this issue requires further study.

Drug treatments for osteoporosis

When the diagnosis has already been confirmed and bone density has been proven to be reduced, the doctor selects special medications:

• calcium supplements to stop the loss of bone density;
• bisphosphonates, which prevent bone loss;
• anabolic agents that strengthen bones;
• antiresorptive drugs that stop spinal deformation;
• supplements that contain vitamin D, as well as both vitamin D and calcium.

What are pathological fractures

Fractures in osteoporosis are called pathological because they occur with the slightest physical impact against the background of reduced bone density. You can break an arm or leg even when lifting a load or shaking while riding in public transport. In complex cases, fractures occur even under the influence of one’s own body weight. The most commonly diagnosed fractures are femoral neck fractures and vertebral compression fractures, which in some cases lead to complications, disability and even death.