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November/December 2005
Volume 1, Issue 6
In this Issue:
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Osteoporosis: A Silent But Common Disease in Women and Men
An Original Contribution by Frank J. E. Falco, M.D.
Osteoporosis is a disease that leads to low bone mass predisposing the individual to fractures most commonly the spine, hip, and wrist, although a fracture can occur with any bone. In the United States, there are approximately eight million women and two million men with osteoporosis. Although osteoporosis typically afflicts the elderly, it can occur at any age particularly those at high risk such as women who have undergone a total hysterectomy.
There are approximately 700,000 spine, 300,000 hip, and 250,000 wrist fractures in the U.S. annually. The risk of hip fracture in women is equal to the combined risk of breast, uterine and ovarian cancer. The risk of hip fracture in men is greater than the risk of prostrate cancer. Approximately ¼ of patients that sustain hip fractures die from complications, ¼ require long term care and the rest return to independent ambulation.
Calcium, which we lose as we age, is important in maintaining normal bone. So, the more calcium that we ingest through out life the better our chances to prevent the development of osteoporosis. To improve absorption of calcium in the elderly, it is recommended that 600 to 800 i.u. of Vitamin D be taken daily. The National Academy of Sciences recommends daily calcium intake as listed in the following table in milligrams (mg) by age for both men and women:
Avoiding smoking and excessive alcohol consumption are other ways to reduce the risk for osteoporosis. Regular exercise with an emphasis on weight bearing will help to maintain bone mass.
A DEXA or bone density scan is a special and painless x-ray test of the hip, lumbar spine (back) and wrist used to determine if a patient has normal, low, or severely low bone density (osteoporosis).
The medical management of osteoporosis involves the use of a variety of different medications. Bisphosphonates (Fosamax) and calcitonin, a natural hormone, slow the rate of bone resorption. Selective estrogen receptor modulators (Evista) are used in women to slow bone resorption and increase bone density. A new drug teriparatide (Forteo) stimulates bone formation by increasing the number and action of osteoblasts. Parathyroid hormone injections are given to those with severe osteoporosis and a high risk for fracture. Estrogen with or without progesterone reduces bone loss but both are recommended for short term use because of their increased risk for breast cancer, heart attack, stroke, blood clots, and dementia.
Lumbar Spine Disc Degeneration: Disease or Aging Process?
An Original Contribution by Frank J. E. Falco, M.D.
There is confusion as to what constitutes degenerative disc changes from what normally occurs with aging. This often times leads to misinterpretation of normal intervertebral disc and spine aging as findings with degeneration. Fibrous tissue normally replaces the mucoid matrix of the nucleus pulposus over time with aging without leading to a loss of disc height. This is considered to be a non-pathologic aspect of aging that manifests as a small to moderate decrease in the signal intensity of the nucleus pulposus on T-2 weighted MRI images and should be uniformly present throughout the spine.
Intervertebral disc margins do not become irregular as a result of aging alone. Annular pathology, such as isolated radial fissures, are rarely present in those over the age of 40 as a part of normal aging. The presence of small amounts of intradiscal gas on imaging studies is not unusual for older individuals. Osteophytes involving the anterior and lateral margins of the vertebral body are considered a natural part of the aging process whereas the existence of posterior osteophytes and endplate erosions are considered to be degenerative.
Degenerative disc changes begin in response to repetitive micro trauma from eccentric or torsional loading producing early signs of mechanical failure. Tears involving the outer annulus within the region of disc innervation can produce back pain. ("Discogenic Low Back Pain: Under Appreciated and Misunderstood." The Pain Journal. September/October 2005.) Circumferential tears eventually coalesce and the nucleus pulposus loses its hydrophilic properties both of which lead to further disc degeneration. |
