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    Back Pain in Patients with Osteoporosis

    Paul Harries, MD Deaconess Comprehensive Pain Centers 06/11/2019
    Osteoporosis and back pain are both common issues in patients over the age of 65, and these problems can exist separately or in combination. As a physician, it’s my job to determine the source of a patient’s back pain and figure out the best way to treat it. This is an important step because different causes of back pain require different treatments. 
     
    Osteoporosis
    For reference, osteoporosis is a condition where bones become less dense and strong, increasing risk of fractures. Osteoporosis can lead to back pain due to bones in the vertebra weakening and compressing, leading to a variety of possible symptoms and pain.

    Osteoporosis is more common as we age; it is closely linked to changes in hormone levels, which can be after menopause in women, or caused by low testosterone in men. Other hormone problems may include abnormal thyroid function or taking steroids repeatedly. 
     
    Evaluating Back Pain
    To begin an evaluation for back pain – due to osteoporosis or an unknown reason - I ask about symptoms. The answers help me determine the possible or likely cause (and rule out some causes as well).

    My typical questions include:
    • How severe is the back pain?
    • Low long has it been present?
    • Did it come on gradually or was it of sudden onset?
    • If it came on suddenly what were you doing at the time?
    • Does the pain spread into your legs?
    • What makes the pain better?
    • What makes the pain worse?
    • Have you had cancer, unexplained weight loss, fever, night sweats, or pain that keeps you awake at night? (All of these are what we call red flags and increase the risk that there is a serious underlying problem.)
    • Does the pain limit your day-to-day ability to function? Do you need help with bathing, shopping, cooking, cleaning, laundry, etc.? If you do need help with the above, how long have you relied on others for assistance?
    • What treatments have you tried?
    • After I complete these evaluation questions, I perform a physical examination, which may help me determine the source of the pain. I am in particular looking for diffuse vs. localized pain and for things that make the pain worse.
    Depending on what the exam reveals, some additional testing may be needed to confirm a diagnosis. Those tests could include imaging and/or labs.

    Imaging: X-rays and/or MRI scans may be helpful, as they can help with diagnosis both in terms of showing any abnormality or ruling out an abnormality.
     
    Labs: Patients with known osteoporosis can develop severe low back pain if their vitamin D level is low. It is important we check this--even if you take vitamin D--as it is possible you may not be absorbing it correctly. If you have not had your thyroid and calcium levels checked, we may order these tests as well.
     
    Treatment
    Patients with a diagnosed case of back pain due to osteoporosis have multiple treatment options. For some, this may be as simple as taking prescription strength vitamin D!

    A research paper from Australia and New Zealand has proven that simply treating the facet joints above and below a fracture can be effective at eliminating pain.

    For severe cases, specialized medical cement can be injected into the bone to stabilize a fracture. This procedure is called kyphoplasty. While appropriate for some patients, kyphoplasty is not an automatic treatment for patients with osteoporosis and back pain. As a matter of fact, Medicare’s policy emphasizes that not all patients with fractures require kyphoplasty.

    Lastly (with very few exceptions), unless back pain is cancer or infection-related, treatment is never an emergency.

    As a physician, I think it is important we look at every option for every patient and start with the least invasive, effective treatment option. Having said that, it is always the patient’s decision about what treatment to have. There shouldn’t be any pressure related to having a specific treatment for your back pain.
     
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