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Ask The Experts: How to tell if back pain is due to ageing or a sign of spine fractures

Spine surgeon Hee Hwan Tak explains how osteoporosis increases the risks of spine fractures in the elderly and what can be done to prevent them

Osteoporosis increases the risk of elderly getting spine fractures as bones lose density and strength due to ageing. PHOTO: GETTY IMAGES

Q. My mother is in her early 60s and has been complaining about back pain, especially when she is carrying groceries. How can I tell if her back pain is a normal part of aging or something more serious, such as a spine fracture?

Back pain caused by aging is more gradual and occurs over a period of weeks or months due to wear and tear. Such pain is likely brought on by spinal disc protrusions, osteoarthritis of the facet (connecting) joints of the spine, and malalignment of the spine.

In a spine fracture, the pain is sudden, sharp and severe. Osteoporosis makes the elderly more susceptible to spine fractures as their bones are weaker. Trivial falls may also lead to spine fractures.

In contrast, spine fractures in young persons are almost always caused by high velocity or high impact trauma.

If your mother's back pain is constant and worsens when she moves, bends or twists, you should take her to the doctor.

Q. How does the doctor diagnose a spine fracture?

Fractures caused by osteoporosis most often occur in the spine. For elderly patients, your doctor will conduct a clinical examination to check if your mother's back movements are severely curtailed.

The doctor will also check the movements, sensation and reflexes of the legs to see if there is any deviation from the norm.

Patients often ask if the condition is serious or if they will become paralysed. Your doctor may use imaging methods such as an MRI to check if there is any compression of the nerves in the spine.

An MRI can also tell the age of the spine fracture. With this information, the doctor can recommend an appropriate course of treatment.

Q. What are the causes of a spine fracture?

For the elderly especially, any trivial trauma from bending, twisting, lifting, a minor sprain or even a jerky car ride, may cause a spine fracture. They must be careful when doing activities out of their usual comfort zone such as excessive housework, lifting heavy objects or even gardening.

They can still do low impact activities such as brisk walking or line dancing, but must take care to not overdo them.

Q. Who is at risk of spine fractures?

Women aged 50 and above are more affected by spine fractures as they experience a sharp drop in bone density after menopause. Menopause also increases the risk of osteoporosis.

Men have higher bone density than women and as such have fewer osteoporosis-related issues.

Those with fractures in the past are also five times more at risk of having spinal fractures, as well as those with a family history of fractures, especially hip fractures.

Unhealthy lifestyle habits such as smoking and drinking, plus a low calcium and vitamin D intake, also put one at higher risk of spine fractures.

Those on long term steroid medications are also predisposed to spine fractures as steroids may lead to bone loss.

Q. What are some ways to reduce spine fractures from occurring?

Your lifestyle plays a big part in reducing your risk of spine fractures. Adopt a healthy diet rich in calcium and vitamin D by eating food such as milk, dairy, oily fish and egg yolk. Reduce your intake of caffeine, salt and alcohol, and avoid smoking.

If possible, do low impact exercises to build up the bones and strengthen them. Getting an adequate amount of sunlight, which is a natural source of vitamin D, is also crucial.

You can also make your home more fall-proof for the elderly. Make sure there are no loose rugs or carpet, and ensure your home is properly lit.

Women can get a bone density check when they reach menopause to measure the strength of their bones. Based on their results, they can change their diet, get more sunlight or take calcium and vitamin D supplements.

Q. What are some treatment methods for spinal fractures?

There are medications such as romosozumab, a new type of osteoporosis medicine that performs two functions - to form new bone and slow down bone loss. It is suitable for patients with severe osteoporosis, a previous history of fractures, and for those who have tried other medications unsuccessfully.

Romosozumab is given as a monthly injection for up to 12 months. Possible side effects may include muscle, joint and neck pain. Patients can then switch to antiresorptive medications after 12 months, which function to slow down bone loss.

Examples of some common antiresorptive medications - drugs which aim to slow down bone loss - are bisphosphonates, a type of oral medication, and denosumab, which is given as an injection once every six months.

However, oral bisphosphonates have side effects such as stomach irritation, heartburn and bone, muscle or joint aches, while the side effects of denosumab include back, arm and leg pain and muscle aches. Your doctor will assess which type of drug is more suitable for your condition.

For those with a serious spine fracture and do not respond to conservative treatment such as medications and a brace, they may need surgery called kyphoplasty.

Kyphoplasty is a type of minimally invasive surgery involving injecting a balloon to stabilise the spine, followed by bone cement to restore the structural integrity of the fractured spine.

Q. What advice do you have for managing the pain caused by spinal fractures?

Your doctor will assess the degree of pain. If it is minimal, no pain medication is needed. If the pain is severe, your doctor may prescribe oral painkillers, muscle relaxants or a nerve stabiliser to contain the pain.

Some patients may require a brace for three to four months to keep the spine upright to stabilise the fracture so it can heal itself in a proper manner. It's important to keep the spine in an optimal position because if the fracture heals when in a hunched position, the patient may experience chronic back pain and may have leg pain due to nerve compression.

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