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Can Osteoporosis Cause a Backache?

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Q

I’m 55 and recently started having back problems. My mom had osteoporosis starting in her 50s. Could my back pain be due to osteoporosis?

A

While there are many possible causes of back pain, you may want to get your spine checked for tiny fractures. About one out of every five postmenopausal women has these vertebral spine fractures—and most don’t know it. Thin bones in the back can fracture suddenly during a routine activity, such as opening a window, bending over or even sneezing. In some cases, there is no pain at all, but in others there’s a sharp pain in the back that doesn’t go away. These fractures are a sign of osteoporosis and can eventually reduce your mobility and your quality of life.

Given your mother’s history of early osteoporosis, you may be a candidate for a bone density scan that includes an assessment of your spine. Typically, based on screening guidelines from the American College of Obstetricians and Gynecologists, a bone density test known as DEXA (or DXA) is recommended only for women aged 65 and older. But some women should be screened earlier if they have significant risk factors for osteoporosis such as early menopause…a chronic health condition such as celiac disease (which interferes with absorption of calcium) or (as in your case) a family history of early osteoporosis. When you get a DEXA test, your doctor can use the same machine to give you a vertebral fracture assessment (VFA). Good indications for including the VFA are that you’ve gotten significantly shorter with age (more than one-and-a-half inches since your tallest height), have a stooped posture, have had a previous fracture (of any type) or have…unexplained back pain.

So, yes, get it checked out. But don’t assume this is why your back hurts. There can be many reasons for back pain in a 55-year-old woman! It could be caused by a muscle injury or weakness, for example, or by degenerating discs between vertebrae. Osteoarthritis can also develop in the joints of the spine and cause pain. And a narrowing of the spinal canal can result in a painful condition called spinal stenosis.

To get to the bottom of your back pain, see an internist or a rheumatologist, a doctor who specializes in arthritis and other disorders of the bones, joints and muscles. In addition to the DEXA test, the doctor may use an imaging test, such as magnetic resonance imaging (MRI) or computed tomography (CT), to find the cause of your back pain. Treatment will depend on the cause.

If your DEXA test does indicate thinning bones, your treatment will typically include calcium and vitamin D supplements and weight-bearing exercise like walking for 30 minutes five days a week. Your doctor can also prescribe medications that can slow bone loss. In some cases, especially if these drugs aren’t successful, biologic therapy—genetically- engineered drugs such as denosumab (Prolia, Xgeva)—may be used.

Source: David G. Borenstein, MD, clinical professor of medicine, division of rheumatology, The George Washington University Medical Center, Washington, DC. He is managing editor of The Spine Community website and author of Heal Your Back: Your Complete Prescription for Preventing, Treating and Eliminating Back Pain. Date: January 11, 2019 Publication: Bottom Line Health
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