Osteoporosis is sometimes referred to as brittle bones. It is the loss of bone density, which leaves bones vulnerable to painful breaks and fractures. The best way to avoid pain from osteoporosis is to take preventative steps before developing brittle bones, but there are also lots of ways to live well with this condition, including both at-home and interventional osteoporosis treatments.
What is osteoporosis?
The word “osteoporosis” means “porous bone.”
The body is constantly breaking down bone and replacing it with new bone. As the body ages, the rate at which the body breaks down bone begins to outstrip the rate at which new bone is made. This leads to weakened, brittle bones. The National Osteoporosis Foundation explains this, stating:
“If you look at healthy bone under a microscope, you will see that parts of it look like a honeycomb. If you have osteoporosis, the holes and spaces in the honeycomb are much bigger than they are in healthy bone.”
The larger holes and spaces signal a lower bone density. If bone density levels become too low, even simple actions such as sneezing or lifting something heavy can cause a fracture.
Our bones are getting stronger and gaining mass as we move through our 20s, but when we enter our third decade the process reverses. This process can occur at many different speeds, with certain risk factors influencing the severity of the condition. Roughly 54 million people in the United States have osteoporosis or low bone density. People aged 65 and older are at the highest risk.
What causes osteoporosis?
Several additional risk factors and osteoporosis causes include:
- Gender: Women are generally much more likely to develop osteoporosis than men, at a rate two times that of men. After age 30, both men and women begin to experience bone loss. However, when women go through menopause, the rate of bone loss speeds up fir them. After menopause, though, the rate of bone loss in women slows again, so that both men and women experience bone loss at the same rate by age 65 to 70.
- Genetics: A family history of osteoporosis increases risk, especially in a close relative such as a parent.
- Steroid use: Prolonged use of steroids, regardless of diet and other supportive exercise, puts a person at increased risk for osteoporosis.
- Calcium or vitamin D deficiency: Calcium is crucial to build strong bones, and the body needs vitamin D to process that calcium. A deficit of either during the bone-building childhood years is dangerous because bones are less dense when natural thinning occurs. The process may not accelerate as a result, but the effects could be seen years earlier.
- Smoking and drinking: Chronic, high-volume drinking and smoking impede healthy development of bone and increase risk of osteoporosis.
- Other medical conditions: Hypothyroidism, autoimmune disorders, and gastrointestinal disorders all increase the likelihood of back pain from osteoporosis. Other conditions that cause bone loss can also increase the risk.
What are common osteoporosis symptoms?
Osteoporosis is often called a silent disease, because there are no symptoms in the early stages. It’s impossible to feel bones losing mass, so people often don’t know they have osteoporosis until breaks or fractures occur.
Some symptoms, though, may include:
- Noticeable back pain
- An increase in the curvature of the spine, like a hunch, or a loss of height (due to vertebral compression fractures, or fractures in the spine that cause the vertebrae to collapse inward on themselves)
- Impaired mobility
- Neurological symptoms
- Hearing issues
Interestingly, one group of researchers has found that people with osteoporosis also have a 1.76-fold higher risk of developing sudden sensorineural hearing loss (SSHL), or sudden hearing loss in one ear. SSHL can occur in a single day or over the course of several days, although most people who experience SSHL will regain at least some of their hearing with treatment.
This, according to researchers, suggests that osteoporosis may affect other systems in the body, in addition to the bones, which makes it even more important to pursue screening and treatment.
One of the major concerns for those with osteoporosis is the risk for spinal fracture.
Spinal fractures can occur without pain, but depending on the severity of the fracture they can lead to more fractures and pain. In extreme cases, fractures in the thoracic spine (upper back) can cause kyphosis (also known as dowager’s hump).
Kyphosis is an extreme rounding of the upper spine. This may be accompanied by distension of the stomach and compression of the internal organs, both of which can make eating difficult. This can lead to inadequate nutrition and a deficit of calcium, which helps keep bones strong.
How do doctors diagnose osteoporosis?
The most common way to test or screen for osteoporosis is with dual X-ray absorptiometry (DXA or DEXA), which is a simple, pain-free, low-radiation test. DXA is, as its name suggests, an X-ray with two different X-ray beams, each with different energy levels. The amount of X-rays that pass through the bone is measured for each beam, and the difference between the two beams is used to determine bone density.
People aged 65 and older should undergo regular testing for osteoporosis, although high-risk individuals may be encouraged to undergo testing sooner. As people age, it becomes increasingly important to undergo testing.
One study found that the wrong populations tend to undergo the most testing. Specifically, relatively low-risk women (between ages 50 to 64, without risk factors) tend to get screened for osteoporosis much more regularly than higher-risk women (age 65 and above).
Additionally, because of the strong association between women and osteoporosis, the screening rate for at-risk men is much lower than it should be. Even older, at-risk men who have experienced a broken or fractured bone may be treated for the injury without being screened for osteoporosis.
The bottom line is that anyone who is at risk should be screened. Discuss risk factors with a physician, and carry through with any suggested screenings, supplements, or medications.
How can you prevent osteoporosis?
The best osteoporosis treatments, which we’ll discuss shortly, can only do so much. Better, a healthy lifestyle can lower your risk of osteoporosis and prevent future symptoms.
The best way to avoid pain from osteoporosis is to avoid getting it in the first place. Getting enough calcium, vitamin D, and lean protein, along with plenty of exercise, will help decrease the risk of osteoporosis. However, these changes must occur before you reach peak bone density, typically around age 30. It’s best if these changes happen during childhood, but a healthy lifestyle will be beneficial no matter what age.
During adulthood, follow the same healthy lifestyle guidelines. Additionally, you should:
- Avoid extreme diets or crash diets that can lead to malnutrition and deficiencies of calcium, vitamin D, and protein
- Limit your use of tobacco or alcohol
- Practice regular weight-bearing exercises to help build strong bones
8 of the best osteoporosis treatments
Fortunately, there are many different osteoporosis treatments. Here are ten of our favorites, including treatments to address the pain that may arise as a result of compression fractures. The most beneficial osteoporosis treatments include:
- Weight-bearing exercises
- Practicing prevention from falls
- Supplements, like calcium and vitamin D
- Vertebroplasty and kyphoplasty
- Vertebral augmentation
- Spinal fusion
1. Weight-bearing exercise
Exercise strengthens the muscles surrounding the bones and helps them stay aligned. Weight-bearing exercise in particular helps to maintain bone density.
Activities like yoga and Pilates, both of which focus on proper alignment, can also help to keep the bones in their proper place.
2. Prevention from falls
If you have osteoporosis, take steps to protect your spine and prevent falls.
Lift using your knees instead of your back and take care when twisting. For advanced cases of osteoporosis, avoid exercises that tax the spine such as forward folds and abdominal crunches.
Your doctor will work closely with you to address any mineral and vitamin deficiencies you have. Most people with osteoporosis benefit from calcium and vitamin D supplements.
Never begin taking new supplements without first talking to your doctor about them, as some may interact with other medications you’re using.
Research on acupuncture continues to prove its efficacy as a pain relief treatment, especially for chronic pain in the low back, even that due to osteoporosis. Some insurance plans are also beginning to cover this complementary medical treatment, making it a more accessible option.
Acupuncture alone won’t resolve osteoporosis all together, but it can be used as a minimally-invasive and complementary treatment option to reduce pain and other symptoms.
5. Osteoporosis medication
This can include medications for pain or inflammation caused as a side effect of the fracture (e.g., inflammation in tissues surrounding the spine or inflammation of the nerves in the spinal cord due to compression). While opioids can be a part of the treatment for pain, there is little evidence that prolonged use of opioids is effective for chronic pain and more evidence that it is harmful and increases risks of dependence.
Two types of medications are commonly prescribed to people with osteoporosis. One type, called anti-resorptive medications, prevents the body from absorbing existing bone. The other type, called anabolic medications, stimulates the body to form new bone mass. Physicians may also prescribe calcium and vitamin D supplements.
Additionally, scientists are examining the effects of a protein called PPARy. This protein impacts stem cells, which are capable of developing into one of many different cell types in the body. These scientists have found that in mice with a lowered PPARy level, more stem cells develop into osteoblasts, which encourage bone formation. This research is still in its early phases, but it does provide a potential future treatment for the bone loss of osteoporosis.
6. Vertebroplasty and kyphoplasty
Vertebroplasty uses acrylic medical cement to increase the height of the vertebrae and stabilize any fractures that occur. Fluoroscopy helps ensure proper placement of the cement. The procedure is minimally-invasive.
Kyphoplasty is similar to vertebroplasty but goes one step further. Prior to acrylic cement being injected, an inflatable balloon is inserted. This balloon helps decrease the chance that cement will leak out of the injection site. Kyphoplasty also has a shorter recovery time than vertebroplasty.
Kyphoplasty is associated with reduced cement leakage and shorter procedure duration, while vertebroplasty is associated with increased long-term healing and reversal of osteoporosis effects. Both, however, may increase your chances of future fractures so talk to your doctor to understand all of the risks.
7. New vertebral augmentation: Kiva system
Much like vertebroplasty and kyphoplasty, this new technique of spinal augmentation focuses on returning the spinal height to pre-fracture status while stabilizing the spine to prevent further fractures.
Sean M. Tutton, M.D., FSIR, lead author of the study on this technique and professor of radiology, medicine, and surgery at Medical College of Wisconsin in Milwaukee had this to say about the treatment, which uses a polymer implant:
“This Level 1 trial, which provides the highest quality and most reliable data, is one of the largest to date to compare a new treatment for vertebral compression fractures to standard of care — and the results match or exceed those of the current treatment. This research also adds to the growing body of evidence supporting the efficacy and safety of these treatments.”
8. Spinal fusion
To perform this procedure, a surgeon will use a patient’s bone tissue (or tissue from a donor) to fuse vertebrae together. This can increase stability and support of the spine. Only attempt this after you’ve attempted other osteoporosis treatments. Since it is surgery, there are increased risks of complications and side effects.
Find osteoporosis treatments that work for you
Thinning of the bones may be a natural part of aging, but it doesn’t have to severely impact your quality of life. There are osteoporosis treatments that work.
The best approach is with a dedicated and multi-disciplinary team who approaches the condition holistically. A pain management team can suggest complementary therapies like diet and exercise, along with more advanced osteoporosis treatments to address fractures and pain.
To learn more about your options, click the button below to find a pain specialist in your area.