Osteoporosis, Low Back Pain, and Other Bone Disorders

he human skeleton is an intricate framework of 206 bones that give the body its structure and shape. These bones serve as armor for vital organs and soft tissue, a storehouse for minerals, and a birthplace for blood cells. Together, the bones act in concert with the muscles, ligaments, tendons, and other connective tissue to give humans an amazing range of movement.

Most bone diseases are rare, but a few pose serious health problems. Osteoporosis, for example, is a progressive loss of bone substance that affects about 25 million Americans, mostly postmenopausal caucasian women. Osteoarthritis, the most common form of arthritis, is widespread among people over 40. (See Chapter 3, "Coping with Arthritis.") Low back pain, which often results from slipped vertebrae or disks, is the second most frequent cause of lost work for adults under 45 years of age.

How Bones Are Structured

Bones are made of inorganic salts--including calcium and phosphate--imbedded in collagen fibers. Though solid and seemingly completely formed, bones undergo constant renewal and change. The marrow, or soft center, of certain bones serves as a spawning ground for the many different cells that make up the blood.

There are three types of bones--long, short, and flat or irregular. Long bones include the humerus, radius, and ulna of the arm; the femur, tibia, and fibula of the leg; and the phalanges, metacarpals, and metatarsals of the hand and foot. The tarsal in the foot and the carpal in the wrist are short bones. Flat bones can be found in the head and also include the ribs, breastbone, and collarbone. Irregular bones are located mostly in the spine; certain others are situated in the head.

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Osteoporosis

In osteoporosis a loss of calcium and phosphate salts causes the bones to become porous, brittle, and easily broken. The vertebrae in the spine may compress, causing the back to become bent and resulting in such conditions as kyphosis (round back) or scoliosis (spinal curvature). A deformed spine usually affects other body parts, particularly nearby organs.

OUR 206 BONES

We're conscious of our complex skeletal infrastructure only when something goes awry. The joints are particularly problem-prone; and the spine, with its many joints, gives us the most trouble of all. The effects of osteoporosis may first be seen in the spine. Low back pain arises in the spine. Even neck pain may have its source in the spine. Indeed, where our bones are concerned, back problems are exceeded only by arthritis as a source of pain and suffering.

Inadequate dietary intake of calcium, hormonal changes associated with aging, and an inactive life-style have all been implicated in the development of osteoporosis. Drug use, alcoholism, lactose intolerance, an overactive thyroid, and faulty calcium absorption may also put people at risk. Other risk factors include premature menopause and the absence or abnormal halt of menstrual periods; a petite, thin build; smoking; a caucasian or oriental background; scoliosis; and a fair complexion.

Menopause, which is accompanied by a sudden, rapid loss of bone minerals, is a particularly critical point in the development of osteoporosis. It's wise to consult a doctor for guidance at this important juncture. Unfortunately, most people learn they have osteoporosis only after the disease has progressed. Indeed, the first signal is often a sharp pain in the lower back while lifting or bending, which usually indicates the collapse of a vertebra. Some people may show signs of increasing deformity, such as a humped back and a loss of height.

Treatment for osteoporosis is aimed at preventing bone mineral loss. It usually includes physical therapy; an exercise regimen; and estrogen, calcium, vitamin D, and in some cases calcitonin. Return to top

Low Back Pain

The back is a complex structure comprised of vertebrae (irregular bones), disks (cushions between the vertebrae), the spinal cord, nerves, muscles, and ligaments. Back problems may involve any of these components and are usually very distressing and debilitating. Low back pain is one of the most common complaints, affecting four out of five people at some point in their lives.

Osteoporosis or arthritis may be the cause of low back pain. Scoliosis or slippage of one vertebra onto another vertebra (spondylolisthesis) can also cause severe discomfort in the lower back.

Another common cause of low back pain is ruptured, slipped, or herniated disks. Disks have a soft, gelatinous center (nucleus) surrounded by an outer ring (anulus). Trauma, strain, or degeneration may weaken the outer ring so that the center bulges through and impinges on nerve roots in the spine, or on the spinal cord itself.

Herniated disks usually cause severe lower back pain that radiates to the buttocks, legs, and feet. There may also be a loss of feeling and mobility in the affected areas and ultimately weakness and atrophy of leg muscles.

Treatment of herniated disks usually includes a week or more of bed rest, heat treatments, and exercise. Aspirin or another analgesic is usually recommended; cortisone is prescribed in rare instances. Muscle relaxants, such as methocarbamol (Robaxin) or diazepam (Valium), can also be very helpful. If the pain persists, disk surgery may be necessary.

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Neck Pain

Neck pain is another common source of severe discomfort. The neck is less protected than the rest of the spine and thus is more prone to painful and disabling injuries and disorders. As with the lower back, neck pain may result from abnormalities in the muscles, ligaments, and nerves, as well as the joints and bones. Osteoarthritis, rheumatoid arthritis, and cervical degeneration are common causes of pain in this area.

THE CARPAL TUNNEL

Within the complex cluster of bones that form the wrist, a collection of ligaments, tendons, blood vessels, and nerves crowd a narrow passage between the arm and the hand. If repeated stress causes swelling within this tunnel, the main nerve will be squeezed against nearby ligaments and tendons. The well-known carpal tunnel syndrome --pain in the wrist, hand, or forearm -- then may follow.

Whiplash injuries, falls, and contact sports can also do real damage to the neck. Careful diagnosis is essential to determine the correct treatment and rehabilitation program. Treatment usually consists of rest, medication, immobilization, exercise, neck braces, and physical therapy. Medications usually include aspirin, nonsteroidal anti-inflammatory drugs (NSAIDs) such as Motrin, other analgesics, and muscle relaxants.
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Scoliosis

The spine's normal curves produce the rounding of the shoulders and the inward curve of the lower back. Scoliosis is an abnormal "s" curving of the spine that gives a person the appearance of slumping to one side. Usually first noticed in the teen years, and more prevalent among girls, scoliosis often causes one shoulder blade to protrude and one shoulder to be higher than the other. Hips and ribs can also become misaligned.

The treatment of scoliosis is determined by the severity of the deformity and may include exercise, a brace, surgery, or any combination of these measures.

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Carpal Tunnel Syndrome

Carpal tunnel syndrome occurs when the main nerve in the wrist becomes compressed. The compression causes pain and motor difficulties in the hand. The carpal tunnel is a hollow area in the wrist. The median nerve, blood vessels, and flexor tendons of the fingers and thumb all pass through the carpal tunnel. The tunnel is formed by the carpal (wrist) bones and ligaments. Problems arise when the content or structure of the tunnel swells and presses the median nerve against the ligament.

People who use poorly designed tools, assembly-line workers, and typists are prone to carpal tunnel syndrome. This problem can also be brought on by rheumatoid arthritis, pregnancy, kidney failure, acromegaly (a hormonal disorder), menopause, diabetes mellitus, amyloidosis, tuberculosis, myxedema (thyroid hormone disorder), and benign tumors.

Symptoms of carpal tunnel syndrome usually include pain, burning, weakness, tingling, or numbness in one or both hands. Treatment usually consists of wearing braces or splints at night to keep the wrist from bending. NSAIDs and cortisone are often given to reduce swelling. If these methods are not successful, surgery may be required.

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Fractures

Broken bones Faren't always serious, but a break almost always is debilitating in some way. A fracture usually affects surrounding tissue, so there is often swelling and additional pain as a result of the extra damage. Since most broken bones are caused by trauma of some kind, shock and emotional distress often occur as well.

Broken bones can cause pain, swelling, deformity, discoloration, tenderness, and loss of function in the affected area.Whether the broken bone is in the skull, nose, jaw, rib, hip, or a limb, all fractures and breaks require immediate treatment by a physician. Proper medical care includes treatment of shock and the prevention of blood loss and other serious complications. Realignment of the displaced bones and immobilization with a cast or traction are standard measures.

A local anesthetic such as lidocaine is usually all that's needed to set a broken limb. Analgesics such as meperidine (Demerol) are given to relieve pain; muscle relaxants such as diazepam (Valium) help stretch muscles to make it easier to set the bone.

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