Wendie Malick

Most women in the U.S. have heard of osteoporosis, but what
are some of the issues related to prevention and then treatment.
How can women avoid seeing the neurosurgeon for this preventable
disease
Following menopause 1 in 2 women will sustain a spinal fracture,
called a compression fracture, if osteoporosis exists. Indeed,
spine fractures are twice as common as hip fractures in this population.
A major problem with spinal compression fractures is that
unless they are devastating fractures that cause significant instability or a neurological
deficit, they can be remarkably asymptomatic. As a patient develops more of
these fractures, he or she will start to develop a “kyphosis” which is
Good Advice
by Matthew B. Kern, M.D.
Spine fractures are
twice as common
as hip fractures.
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a forward curvature of the spine resulting in reduced height and that
“bent over” look. Difficulty with activities of daily living may ensue,
including difficulty walking and breathing. It may not be until multiple
fractures exist that the patient realizes that there is a problem. The
patient may also develop chronic pain that will no longer be amenable
to treatment. These fractures can be caused by a little as a sneeze or
cough or even just reaching for an object in a cupboard.
The diagnosis of osteoporosis and osteopenia (low bone density) is usually made
by a bone density scan of the wrist, femur or lumbar vertebrae. The test is also commonly
called a dexa scan.
The best treatment for osteoporosis and thus hopeful avoidance of all the sequale
of this insidious disease is prevention. The major risk factors for the development of
osteoporosis include smoking, inactivity, low calcium or vitamin D, diet, excess alcohol,
certain medications, and a history of cancer.
In the absence of the above mentioned risk factors, all adult women should be cognizant
of the prevention of the disease. Once a woman reaches menopause methods of
preventing osteoporosis include maintaining a good body weight, remaining active, not
smoking and taking calcium supplements. Women should also consult with their physician
regarding the addition of estrogen or hormone replacement therapy. Both of these
are FDA approved and can slow loss of bone or even help regain lost bone. The difference
between the two is related to whether or not a woman has her uterus.
Once a woman does develop osteoporosis there are a number of medications now
available to help reduce the progression of the disease (Fosamax, Evista, Boniva,
Actonel, Reclast and more recently, Prolia). These drugs are of different classes and
act in different ways so the primary care physician should decide which is best for
his/her patient. Potential side effects should be discussed with the
prescribing physician.
In the event that one develops a painful compression fracture, the
mainstay of treatment is still medication. If, however, the pain is intractable
or intolerable the procedure of choice may be Kyphoplasty.
This is a procedure by which a neurosurgeon or radiologist places
two balloons into the fractured vertebral body and then fills them
with cement thus hopefully regaining some of the lost height of the
fracture. This seems to help ease the pain. If the fracture is more severe and stability
is compromised, or worse, neurologic deficit occurs (leg weakness or bladder and
bowel dysfunction) surgery may be required. The surgery for these problems can
involve removing the entire vertebral body by approaching through the flank. Of
course, since the original problem is weak bone the vertebral body above and below
may also be weak and may further complicate the surgery.
Matthew B. Kern, M.D. is a Neurosurgeon and Spine Specialist with Neurological
Surgery, P.C. Visit www.nspc.com or call 631-828-3001.
To advertise: 516-505-0555 x1 or ads@liwomanonline.com LONG ISLAND WOMAN • September 2011 • 7