Oh, your aching back! Back pain, osteoporosis, and what you can do about them Inside Why does my back hurt? | page 2 Telltale signs you might have osteoporosis or a fracture | page 3 Don’t let back pain keep you down or hold you up | page 4 Protect your bones | page 5 How vertebroplasty works | page 5 Bone up on calcium and vitamin D ` “Bone” Appetit | | page 6 page 7 Brought to you by www.HelpingBacks.com Why does my back hurt? For millions of Americans back pain is a daily fact of life.1 Many blame aging as the cause.1 But for more than 700,000 women and men, the real culprit is vertebral compression fractures (VCFs) caused by osteoporosis.2 In fact, VCFs are the most common complication from osteoporosis,2,3 and often result in prolonged disability.2,4,5 Bone Other risk factors8 • Increasing age Normal • Small frame or low body weight • Caucasian or Asian ethnicity • Family history of osteoporosis • Low levels of sex hormones • Sedentary lifestyle • Diet low in calcium and vitamin D • Long-term use of corticosteroid drugs or anticonvulsant medications • Hyperthyroidism Osteoporotic Back pain can be a surface symptom of a much deeper problem, namely osteoporosis. Osteoporosis causes bones to become weak and brittle – so brittle that even minor strains to the spine like tripping and falling, opening a window, or bending over to pick something up can cause a fracture.5,6,7 Vertebral compression fractures (VCFs) are a hallmark of osteoporosis.5 In most cases, bones weaken when you have low levels of calcium, phosphorus, and other minerals in your bones.7 According to the National Osteoporosis Foundation, fractures from osteoporosis are about twice as common in women as they are in men.7 That’s because women start out with lower bone mass and tend to live longer.6,7 They also experience a sudden drop in estrogen at menopause that speeds up bone loss.6,7 Slender, small-framed women are particularly vulnerable.6,7 Men who have low levels of testosterone or are over the age of 75 also have an increased threat.6 This information is not meant to be a substitute for professional medical advice. Please consult your physician to discuss questions you may have regarding any medical condition and the most appropriate treatment option for you. Telltale signs you might have osteoporosis or a fracture You can’t feel yourself losing bone, but you might feel a spinal fracture – the most common complication from osteoporosis.2,3,5 Acute and chronic back pain are outward signs of such fractures (also known as vertebral compression fractures or VCFs.5) It may be hard to believe, but even simple activities like carrying groceries or bending over to pick up your grandchild can cause a VCF.5,6,7 Your spine is stacked and structured with the precision of dominoes, allowing you to bend over and twist side to side. And just like dominoes, one VCF can change your spine’s alignment and cause other vertebrae to collapse or fracture. Multiple fractures may lead to loss of height and curvature of the upper back – like the hunchback of Notre Dame – called kyphosis or “dowager’s hump.”8 Over time, kyphosis can cause your back to hunch over so badly that it reduces the space in your chest cavity, making it hard to breathe and eat.5 Don’t lightly dismiss new or unusual back pain as a part of growing old. Your backache could be a VCF. Sudden and severe pain or pain that lasts for more than a week should be seen by a doctor. Why do people shrink as they age? As people age, several changes in their bodies can reduce their height by anywhere from one inch to three inches or more. They include VCFs, loss of muscle strength to support the spine, and even weakened arches, which flatten feet and contribute slightly to height loss. The good news is that a diet with enough calcium and vitamin D, together with weightbearing exercise, can spare your spine from significant height loss.5,9,10 Get physical Weight-bearing exercises reduce bone loss and help prevent fractures. Activities such as walking, running, climbing stairs, tennis, and weight lifting put stress on your bones, signaling your body that your bones need to be made stronger. New cells are added to strengthen your bones. That’s why if you’re right-handed, the bones in your right arm are slightly larger and stronger – it’s from the extra use. To get the bone-building benefit from exercise, you must do it at least three times per week for 30 to 45 minutes.9 • Heavy use of alcohol • Cigarette smoking 2 For more information visit www.HelpingBacks.com www.HelpingBacks.com Brought to you by 3 Protect your bones Don’t let back pain keep you down or hold you up Until about 20 years ago, doctors were limited in how they could treat VCFs. Pain medications, bed rest, bracing, and physical therapy were the only options available outside of major spine surgery. Though many of these options are still the first line of defense,2,5 today there is a safe and effective treatment called vertebroplasty, a minimally invasive procedure that relieves the pain caused by VCFs.2,4,11 Vertebroplasty is an outpatient procedure that eases pain immediately, increases mobility, and prevents further collapse of the vertebra – usually within 24 hours to one week.11,12,13,14,15 Clinical studies have shown that vertebroplasty has a high success rate11,12,13,14,15 and a low complication rate.11,12,13,14 Minimally invasive, the procedure is performed on an outpatient basis under local anesthesia and mild sedation, avoiding the possible consequences and expense of general anesthesia and overnight hospital stays. It takes about 30 minutes to perform, results in 80 to 90 percent or better reduction in pain,11 and is covered by Medicare and most private insurers. Vertebroplasty is performed by specialists, including interventional radiologists, neuroradiologists, surgeons, and pain management physicians. It involves injecting bone cement into the vertebra to stabilize the fracture. X-ray guidance is used to ensure accurate placement. 4 You’re never too old – or too young – to improve your bone health. There are many things that you can do to keep your bones strong and prevent fractures. A diet rich in calcium and weight-bearing exercise can prevent osteoporosis.9 So can talking to your doctor. Schedule an appointment today to discuss ways to protect your bones and treat bone-related problems such as vertebral compression fractures. Where can I get more information? For lifestyle suggestions to keep your bones strong and treatment options if you have osteoporosis, visit: www.HelpingBacks.com/Osteoporosis Prevention Review recipes, exercise tips, and dietary guidelines to keep your bones healthy. Detection Learn the signs of osteoporosis and how bone density is measured. Treatment Gain valuable insight into treatment options along a continuum of patient care. Benefits of vertebroplasty • Pain relief 11,12,13,14,15,17 • Increased range of motion11,12,13,14,15 • Return to previous levels of activity 11,12,13,14,15 • Improved quality of life11,15 • Low complication rate11,12,13,14,15 • Outpatient procedure: no overnight hospital stay • No general anesthesia How vertebroplasty works In vertebroplasty, a needle about the width of a cocktail straw is inserted into the fractured vertebra through a small incision. Specially formulated bone cement is then injected. The cement hardens, stabilizing the bone and preventing further collapse.12 This stops the pain caused by bone rubbing against bone. Can you get out of a chair easily? Women who can’t get out of a chair without using their arms have twice the fracture risk of those who can stand up effortlessly.16 Vertebral compression fracture www.HelpingBacks.com Needle is guided into fractured vertebra using x-ray guidance Brought to you by Bone cement is injected Stabilized vertebral body 5 Bone up on calcium and vitamin D “Bone” Appétit! Calcium-rich foods are the secret to maintaining bone strength. Women 50 and under need 1,000 milligrams a day. After age 50, daily calcium requirements jump to 1,200 milligrams.18 Lack of calcium has been singled out as a major public health concern because it is critically important to bone health. The average American consumes far less than the amount required. Calcium supplements are a good way to make up the difference.9 How does your diet measure up? Recipes Calcium-rich and delicious, these dishes benefit your bones Ingredients: 2 tablespoons slivered almonds 8 ounces low-fat vanilla yogurt 1/4 cup low-fat granola without raisins 2 dried figs, chopped into small pieces Fig and Granola Bowl Serves one 1. Preheat oven to 350°F. Spread the almonds on a cookie sheet and bake for about 5 minutes, watching the nuts carefully so they don’t burn. 2. Fill a bowl with yogurt, then top with granola, figs, and toasted almonds. Nutritional Information: 385 calories; 14 g protein; 60 g carbohydrates; 9 g fiber; 13 g fat (2 g saturated); 5 mg cholesterol; 179 mg sodium; 410 mg calcium Be a spine-smart snacker Here are some good sources of calcium:9,19 • 8 oz. low-fat yogurt: 415 mg calcium • 8 oz. milkshake: 300 mg calcium • 24 almonds: 70 mg calcium • 4 oz. instant pudding, made with 2% milk: 153 mg calcium • 1 oz. cheddar cheese: 204 mg calcium • 8 oz. 1% milk: 316 mg calcium • 6 oz. calcium-fortified orange juice: 230 mg calcium • 1/2-1 cup Total cereal: 258 mg calcium Don’t forget to include vitamin D in your diet, too. It helps your body absorb that calcium. Aim for 200 to 400 international units (IU) daily if you’re 50 and under and 400 to 600 IU daily if you’re over 50.19 You can get vitamin D in:20 • 3 1/2 oz. salmon: 360 IU vitamin D • 3 1/2 oz. mackerel: 345 IU vitamin D • 1 cup vitamin D-fortified milk: 98 IU vitamin D • 1 cup vitamin D-fortified cereal: 40 IU vitamin D • 1 whole egg: 20 IU vitamin D You can also get vitamin D from supplements. Often calcium and vitamin D can be found in the same supplement. 6 Ingredients: 1 cup baby spinach leaves Olive oil-flavored cooking spray 1 egg 4 egg whites or 1/2 cup egg substitute 2 teaspoons fresh minced basil leaves 3 tablespoons fat-free milk 1/2 ounce provolone cheese 2 tablespoons feta cheese 1/2 ounce shredded mozzarella cheese Serve with: One 6-ounce container plain, fat-free Greek yogurt 1/2 cup fresh or frozen, unsweetened raspberries Ingredients: 3 ounces firm tofu with calcium-sulfate (it’ll say “made with calcium-sulfate” on the label) 2 teaspoons extra-virgin olive oil 2 shakes table salt 4 tablespoons fava beans For the dressing: 1/2 cup low-fat berry-flavored yogurt 2 teaspoons balsamic vinegar 1 teaspoon poppy seeds For the salad: 3 cups mixed baby greens or arugula 2 pomegranates Ingredients: 2 ripe pears, peeled, quartered, and cored 2 pounds butternut squash, peeled, seeded, and cut into 2-inch chunks 2 medium tomatoes, cored and quartered 1 large leek, pale green and white parts only, halved lengthwise, sliced, and washed thoroughly 2 cloves garlic, crushed 2 tablespoons extra-virgin olive oil 1/2 teaspoon salt, divided freshly ground pepper, to taste 4 cups vegetable broth or reduced-sodium chicken broth, divided 2/3 cup crumbled Stilton, or a blue-veined cheese 1 tablespoon thinly sliced fresh chives or scallion greens www.HelpingBacks.com Three-Cheese Spinach Frittata Serves one 1. Tear the spinach leaves into small pieces and set aside. 2. Spray an omelet-sized skillet with the cooking spray. Whisk together the egg, egg whites, basil, and milk. Pour the eggs into the skillet and heat over low to medium heat. 3. Sprinkle the spinach over the eggs. 4. Tear the provolone cheese into tiny pieces and sprinkle over the eggs. Add the feta and mozzarella cheese over the eggs. 5. Continue to heat the frittata for 6 to 7 minutes or until eggs are puffed, browned, and set. Nutritional Information: 414 calories; 47 g protein; 19 g carbohydrates; 7 g fiber; 17 g fat (8 g saturated); 246 mg cholesterol; 834 mg sodium; 537 mg calcium Mediterranean Salad with Pomegranate and Fava Beans Serves one 1. Cut tofu into squares. Heat a skillet over low to medium heat with the olive oil. Add the tofu and salt and brown for 4 to 5 minutes, then add the fava beans and cook for another minute. Set aside. 2. Whisk together the dressing ingredients. 3. Fill a bowl with the greens. Cut the crown off the pomegranates, slice into sections, and roll out the juice sacs with your fingers. Toss into the salad. Add the tofu and fava beans. 4. Mix the salad with the dressing. Nutritional Information: 495 calories; 18 g protein; 79 g carbohydrates; 7 g fiber; 17 g fat (3 g saturated); 3 mg cholesterol; 346 mg sodium; 495 mg calcium Roasted Pear-Butternut Soup with Crumbled Stilton Serves six 1. Preheat oven to 400°F. 2. Combine pears, squash, tomatoes, leek, garlic, oil, 1/4 teaspoon salt, and pepper in a large bowl; toss to coat. Spread evenly on a large rimmed baking sheet. Roast, stirring occasionally, until the vegetables are tender, 40 to 55 minutes. Let cool slightly. 3. Place half the vegetables and 2 cups broth in a blender; puree until smooth. Transfer to a large saucepan. Puree the remaining vegetables and 2 cups broth. Add to the pan and stir in the remaining 1/4 teaspoon salt. 4. Cook the soup over medium-low heat, stirring, until hot, about 10 minutes. Divide among 6 bowls and garnish with cheese and chives (or scallion greens). Nutritional Information: 235 calories; 10 g fat (5 g sat, 5 g mono); 11 mg cholesterol; 34 g carbohydrates; 6 g protein; 6 g fiber; 721 mg sodium; 20% dv calcium Brought to you by 7 www.HelpingBacks.com Footnotes: 1. 2007 North American Spine Society Back Pain in America survey conducted by Pulse Opinion Research for the North American Spine Society (NASS). 2. Cooper G, Lin J. Nonoperative Treatment of Osteoporotic Compression Fractures. http://emedicine.medscape.com/ article/325872-overview Accessed Oct 30, 2009. 3. Freedman BA, Potter BK, Nesti LJ, Giuliani JR, Hampton C, Kuklo T. Osteoporosis and Vertebral Compression Fractures – Continued Missed Opportunities. The Spine Journal. Sept. 2008; Vol. 8, Issue 5: 756-762. 4. Sherman AL and Razack N. Lumbar Compression Fracture. http://emedicine.medscape.com/article/309615- overview Accessed Oct 30, 2009. 5. Old J.L., Calvert M. Vertebral Compression Fractures in the Elderly. Am Fam Physician 2004;69:111-6. 6. http://www.mayoclinic.com/health/osteoporosis/DS00128 Accessed Oct. 30, 2009. 7. http://www.nof.org/osteoporosis/diseasefacts.htm Accessed Oct. 30, 2009. 8. Johns Hopkins Guide to Osteoporosis. Johns Hopkins Health Alerts. http://www.johnshopkinshealthalerts.com 9. U.S. Department of Health and Human Services. The 2004 Surgeon General’s Report on Bone Health and Osteoporosis: What It Means To You. U.S. Department of Health and Human Services, Office of the Surgeon General, 2004. 10. Ray CC. Long Life, Short Spine. New York Times. March 8, 2005. 11. Jensen ME, McGraw JK, Cardella JF, Hirsch JA. Position Statement On Percutaneous Vertebral Augmentation: A Consensus Statement Developed By the American Society of Interventional and Therapeutic Neuroradiology, Society of Interventional Radiology, American Association of Neurological Surgeons/Congress of Neurological Surgeons, and American Society of Spine Radiology. J Vasc Interv Radiol 2009; 20:S326–S331. 12. Edelman M. Percutaneous Vertebroplasty: A Review for the Primary Care Physician. Comp Ther. 2005; 31(3): 237-240. 13. Layton KF, Thielen KR, Koch CA, Luetmer PH, Lane JI, Wald JT, Kallmes DF. Vertebroplasty, First 1000 Levels Of A Single Center: Evaluation Of The Outcomes And Complications. AJNR Am JNeuroradiol. 2007 Apr;28(4):683-9. 14. Do H, Kim B, Marcellus M, Curtis L, Marks M. Prospective Analysis of Clinical Outcomes after Percutaneous Vertebroplasty for Painful Osteoporotic Vertebral Body Fractures. American Journal of Neuroradiology 2005; 26:1623–1628. 15. McKiernan F, Faciszewski T, Jensen R. Quality Of Life Following Vertebroplasty. J Bone Joint Surg Am. 2004 Dec;86-A(12):2600-6. 16. Parker-Pope T. How Well Will Your Bones Hold Up? New York Times. May 13, 2008. 17. Eck JC, Nachtigall D, Humphreys SC, Hodges SD. Comparison of vertebroplasty and balloon kyphoplasty for treatment of vertebral compression fractures: a meta-analysis of the literature. The Spine Journal 2008; 8:488-497. 18. http://www.nof.org/prevention/calcium2.htm Accessed November 5, 2009. 19. www.ucsfhealth.org/adult/edu/OsteoCalciumCalc.pdf Accessed November 5, 2009. 20. Dietary Supplement Fact Sheet Vitamin D. National Institutes of Health: Office of Dietary Supplements. http:// dietary-supplements.info.nih.gov/factsheets/VitaminD_pf.asp Accessed November 5, 2009. www.HelpingBacks.com Brought to you by This information is not meant to be a substitute for professional medical advice. 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