Osteoporosis, often referred to as “brittle bones,” is a condition of bone thinning that occurs as we age. 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. While osteoporosis is not painful in and of itself, it can lead to issues with the spine that cause pain and decrease mobility.

While gender is one of the main risk factors for osteoporosis, with women affected at a rate two times that of men, there are other gender-neutral factors that can increase your risk.

  • 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 osteoporosis. Other conditions that cause bone loss can also increase the risk.

The main concern 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.

Fortunately, there are many different treatment options for osteoporosis. Here are ten of our favorites, including treatments to address the pain that may arise as a result of compression fractures.

1. Prevention

Prevention is the best cure for osteoporosis. Even if you are older and past bone-growing age, consume a diet rich in calcium and vitamin D. Supplements can be another way to help ensure adequate nutrition.

2. 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.

3. Protect your spine

If you have osteoporosis, take steps to protect your spine. Lift using your knees instead of your back and take care when twisting. For advanced cases of osteoporosis, exercises that tax the spine such as forward folds and abdominal crunches should be avoided.

4. Pharmacotherapy

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.

5. Vertebroplasty

Vertebroplasty uses acrylic medical cement to increase the height of the vertebrae and stabilize the fracture. Fluoroscopy is utilized to help ensure proper placement of the cement, and the procedure in minimally-invasive.

6. Kyphoplasty

This procedure 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.

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

The patient’s bone tissue (or tissue from a donor) is used to fuse vertebrae together, increasing stability and support of the spine.

9. Bed rest

Often a few days of bed rest is prescribed to deal with osteoporosis-related back pain, especially when in recovery from a procedure or after a treatment. Prolonged rest can be harmful to long-term recovery, but in the acute stages of a painful fracture, rest may be best.

10. Acupuncture

Research on acupuncture continues to prove its efficacy as a pain relief treatment, especially for chronic pain in the low back. Some insurance plans are also beginning to cover this complementary medical treatment, making it a more accessible option.

Thinning of the bones may be a natural part of aging, but back pain due to osteoporosis has a variety of treatment options. Which have you tried?

Image by schnaars via Flickr


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