Oh, your aching back!
Back pain, osteoporosis, and what you can do about them
Inside
Why does my back hurt?
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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
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page 5
Bone up on calcium and vitamin D
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“Bone” Appetit
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page 6
page 7
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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
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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
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Needle is guided into fractured
vertebra using x-ray guidance
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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
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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
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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.
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This information is not meant to be a
substitute for professional medical advice.
Please consult your physician to discuss
any questions you may have regarding your
medical condition and the most appropriate
treatment option for you.
Literature Number: 1000-025-017 Rev None
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