I suffer with back pain which I had assumed was caused by my osteoporosis.
The absence of fractures in your case means that you fall into the osteoporosis range in terms of bone density but the X-ray has not identified any broken bones which can be a consequence of osteoporosis. Although fractures can be painful low bone density causes no pain or other symptoms. Without broken bones the chances are that your back pain may be caused by degenerative changes in the joints. The term ‘degenerative change’ is often used to explain the root cause of back pain and this encompasses a number of conditions associated with ageing such as osteoarthritis or general wear and tear. Osteoarthritis is another very common condition, so it could be that you have osteoarthritis as well as osteoporosis and it is the osteoarthritis that is the cause of your pain rather than osteoporosis. As we age, the fibrous discs that cushion in-between the vertebrae in the spine can narrow and even erode away causing bone to contact bone due to the loss of the protective disc on the joint surface. Bony overgrowths may also form adding to the pain, stiffness and loss of function in the affected joint. Pain in the absence of disease is not a normal part of ageing but back pain is associated with a number of medical conditions. It is a complex phenomenon, and an obvious cause is not always present.
Back pain can also be caused by soft tissue damage (tendons, ligament and muscle) and inflammation rather than osteoarthritis of the spinal joints. Your GP will be able to assess your pain and give appropriate advice. Nonsteroidal anti-inflammatory drugs are sometimes given to relieve the pain of osteoarthritis but can be associated with side-effects such as indigestion or stomach ache. Other pain relievers that combine paracetamol and increasing strengths of codeine are also commonly prescribed. Non-drug management of pain could also be explored including physiotherapy, heat, cold, massage, acupuncture and transcutaneous electrical nerve stimulation (TENS). Physical activity such as dance can increase the production of chemicals called endorphins which decrease pain and improve feelings of well being. Physical activity also improves joint function and flexibility, and increases strength of the supporting muscles in the spine. For further information about osteoarthritis contact Arthritis Care by logging onto www.arthritiscare.org.uk or calling 0808 800 4050. Alternatively for information on back pain contact Backcare (The charity for Healthier Backs) at www.backcare.org.uk or by phoning 020 8977 5474.
My doctor has told me that my bones are “soft” because I have very low levels of vitamin D. Is this osteoporosis?
It is likely that this isn’t osteoporosis, and might instead be another condition called osteomalacia. Bone is living tissue that continually renews itself by a process called bone turnover. The new bone that is made is initially a soft substance called collagen, which then needs to be coated in minerals such as calcium (through mineralisation) to make it hard and strong. Adequate levels of vitamin D are essential to enable good bone mineralisation with calcium, and so people who lack vitamin D may develop osteomalacia.
Most of our vitamin D comes from exposure to sunlight. Only a small proportion (around 10 per cent) comes from foods, such as oily fish, eggs, margarine and some cereals and fortified foods. Older people, those who do not go out much and people who cover up for religious or cultural reasons may become deficient in vitamin D. Ten minutes of sun exposure on your face and arms (without sunscreen) once or twice a day during May to September, taking care not to burn, is thought to provide enough vitamin D for most people.
Unlike osteoporosis, where fractures (broken bones) may occur due to reduced bone strength, osteomalacia (‘rickets’ in children) actually makes bones soft, and these bones can bend and crack. Osteomalacia is also very different to osteoporosis in that it can cause generalised bone pain (even when there is no fracture), stiffness and muscle weakness. For some people the pain and stiffness may be severe enough to make moving about very difficult.
As the symptoms caused by osteomalacia can vary it may not be diagnosed for some time, perhaps even years. It is often the continued pain that alerts a doctor to the possibility of osteomalacia as a diagnosis, and then a simple blood test can be done to diagnose the disease. It would be sensible to return to your doctor to discuss your symptoms and the possibility that this could be osteomalacia. Happily though, treatment for osteomalacia is likely to cure the condition, although it may take some time for the pain to ease completely. Treatment with higher doses of vitamin D supplementation than would be used for osteoporosis (and possibly calcium if necessary) is often all that is required for the majority of people with osteomalacia caused by a vitamin D deficiency. For those who have the rarer forms of osteomalacia (either inherited or caused by kidney failure), more specific treatment and monitoring under the care of a specialist may be required.
Does osteoporosis mean you have “brittle bones”?
It’s not strictly correct to say that osteoporotic bone, which has lost its structure and strength, is “brittle”. Technically, “brittle bone” is actually very hard – so hard that it breaks or shatters very easily. This occurred with one of the very early osteoporosis drug treatments, called sodium fluoride, which turned out to actually make bones more, rather than less, likely to break.
Another problem with the word “brittle” is that it has been used for many years to describe a different medical condition, called “osteogenesis imperfecta (OI), often termed “brittle bone disease”. This disease is congenital (present from birth) and affects bone collagen, the protein that forms the framework for the bone structure. In OI, the collagen may be of poor quality or there may just not be enough to support the mineral structure of the bones. This makes fractures much more likely and often causes multiple and disabling fractures, especially in children.
It can be very confusing when the term “brittle bones” is used in relation to both conditions, so the osteoporosis world talks about “fragile bones” rather than “brittle bone”, and “fragility fractures”, to make this distinction clear.
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