Over the decades, our lifestyle has changed. Our physical effort to carry out our ADL’s (Activities of daily life) has reduced drastically. For example, walking to grocery store has been replaced by  online shopping. The quality of food that we consume today are very good to look and taste but lack nutrients! Most of our food are genetically engineered such that mass production can happen with good quality for sale. In this process – healthy nutrition has been ignored. With medical revolution, our life expectancy has gone beyond 80’s touching the 90’s. We are now faced with rising aged population. In last couple of decades, the majority focus in health care has been towards Geriatric (Aged) Population. With this prologue, I would like to discuss the issues associated with weak and brittle spines in elderly, here in article 2, from the Series: A stitch in time saves nine (Link for Article 1)

Bones are not inert structures; they continue to change over the course of a lifespan. This process of skeletal change is known as ‘bone remodelling’. Remodelling involves the resorption of old or damaged bone, followed by the deposition of new bone material, along with maintaining the body’s balance of calcium and phosphorus.  Until about age 30, we build more bone than we lose. After age 35, bone breakdown occurs faster than bone buildup, which causes a gradual loss of bone mass. 

Osteoporosis or weak bones, is a natural phenomenon that happens with aging. The word ‘osteoporosis’ means ‘porous bone.’ It cannot be defied, but however, can be postponed and its intensity can be reduced, thereby reducing the suffering from it. Bones are hard structures in our body. But to keep them hard & strong, they need traction from the muscles, good nutrition, hormonal balance, lifestyle, physical activity and rest. Most of the pre-requisites can be tackled by effort from an individual. But hormonal imbalance needs medical attention. Weak bones results in fractures, delayed healing of fractures and often progression of fractures into non-union and deformity, especially in geriatric age group. Osteoporosis is called a “silent disease” because people who develop it may not notice any changes until a bone breaks — usually a bone in the hip, spine, or wrist.

“Walking, healthy nutrition, daily exposure to sun with a disciplined lifestyle and being happy are ways to keep our bones healthy. Happiness produces hormones which in-turn influences our metabolism”

This article focuses on osteoporosis of Spine, the pillar of our body. Spine is a weight bearing structure, which is used constantly during all postures of our body. Our spine is made of series of multiple bones linked together with inter vertebral ‘discs’ that are natural shock absorbers of the spine. The individual spinal bones ( vertebra ) are bound together by the ligaments and are supported by the muscles which are often referred to as ‘core muscles’. The Spinal cord is the nervous bundle which runs from the brain into the Spine and is connected to the body through the peripheral nerves. Osteoporosis increases the risk of fractures in spine, threatening mobility and causing immense pain.

Osteoporotic Fracture of Spine: We would have come across elderly with hunch back and reduced height. These happen because of multiple fractures in our spinal bones and consequent decrease in its height reducing the overall height of a person. The fractured spine can further settle in an angulation, resulting in deformity such as hunch back in the elderly. This incidence is more in women, as bones generally get weak after menopause (stopping of monthly cycles). Multiple child births, and chronically ignoring the nutritional needs (am sure every mother has saved her favorite food for her kid and family, without relishing it) makes women vulnerable for Osteoporosis.

Spinal fractures do not heal as easily as elsewhere. Since rest is required for proper approximation of the fractured bones (we would have seen the cast applied in limbs for fractures). But our Spine is active at rest, sitting, standing or any posture that we assume. Further, we cannot apply a cast and rigidly immobilse it. The braces that are given offer less than 20% of stability. The larger issue is instability of the spine, which in turn can result in injury to the spinal cord and consequent paralysis. An irreversible & miserable condition.

Osteoporotic fractures of the spine are common in elderly. With extended life expectancy, awareness about this osteoporosis and osteoporotic fractures are a must to the public.

A simple trivial fall (or many a times even the incident may be unnoticed) can result in fracture due to weight bearing property of Spine. If a speeding bus or car goes over a speed breaker or pothole, the jerk that happens can result in spinal fracture in a seated elderly person with osteoporosis. Usual clinical presentation is severe pain at the site of fracture, often making them bedridden. Sometimes the pain can travel along the nerve root distribution. Bed-rest often relieves the pain, but any movement brings the pain back in full force. Once the fracture heals in about 4-6 weeks, the pain reduces. But, bedrest further weakens the bone. Being immobile in bed for 6 weeks is not a easy task especially in our current day life. Since the fracture is subjected to physical forces of nature, especially the body weight, the healing always happens with reduced height of the spine. Gradually this reduced height of the bone and its angular shape results in deformity such as hunch back.

The modern-day Solution:

Suffering from Osteoporotic Spinal fractures can be alleviated by simple percutaneous needle procedure, where a silicone balloon is introduced into the fractured spine to impact the spongy part of the bone within the vertebra to create free space surrounded by dense bone. Acrylic (bone cement) is then filled in this space to increase the strength of the vertebrae. This procedure is known as Kyphoplasty. A quick, simple day care procedure, where the patient can return home in the same evening – pain free and walking! This technique has been in practice in last couple of decades. Fearing surgery, many don’t seek medical attention. This article is an effort to create public awareness towards Kyphoplasty, a perfect example of minimally invasive pinhole procedure. This can bring back an individual back to life from pain and suffering.

But if the fracture is not addressed on time and if it progresses further, it can result in compression of the spinal cord resulting in spinal cord injury and paralysis. If the fractured bone is pressing on the spinal cord, this pinhole procedure cannot be done. In these case scenarios, major open spinal surgical procedure with titanium screws and rods are required. What could have been a daycare – 1 day procedure coverts into couple of weeks scenario.

Kyphoplasty is that single stitch which can save nine actual stitches over the spine!

Prevention is better than cure! Practicing healthy lifestyle with good food habits can prevent osteoporotic fractures. But in those who are suffering from it, there are solutions to bring them back to life.

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