Spine and Osteoporosis

May is arthritis awareness month. Awareness posts and articles feature mostly about the osteoarthritis of the knees or the inflammatory arthritis involving hands and other joints. We often forget that arthritis also affects the very ‘framework’ structure of our body which is the Spine. Starting as early as our 30s, the discs which are the shock absorbers in the spine start to degenerate or wear out, leading to more friction in the ‘facet’ joints of the back, which leads to arthritis over long term. As our body tries to balance the age related degenerative changes, the ligaments hypertrophy and body produces more bone called as osteophytes which can compress on the nerves called as spinal stenosis. This can lead to neurological symptoms like heavy legs and cramping sensation leading to difficulty in walking along with back pain.

And a ‘silent partner’ which worsens the arthritis of the spine is Osteoporosis, thinning of bone tissue causing weakness of the vertebra. If osteoporosis is thinning of the wood, arthritis of the spine is more like rusting of the hinges or the joints. One of the major causes of persistent back pain and disability in the elderly are vertebral compression fractures which happen secondary to fragility of the bones. Across the world, evidence suggests that one in three women and one in five men over the age of 50 suffer from an osteoporotic fracture. Chronic inflammatory conditions spectrum like rheumatoid arthritis also lead to spinal arthritis and medications like steroids used to treat them also further worsens osteoporosis.

Prior vertebral fractures can increase the risk of further fractures by five-fold and cause a ‘fracture cascade’. Compression fractures at multiple levels of the spine can happen as you age and vertebrae crumple upon under the weight of everyday activities which can lead to loss of height.

Sharing some simple tips to keep the spine sturdy using an acronym – BONES.

B – Boosting the intake. Most adults need around 1000-1200 mg of calcium daily to keep the bones healthy. Bones are calcium banks, and if intake is less the body withdraws calcium from them. Vitamin D is also important as it acts as the ‘key’ for calcium to enter into the bones. An anti-inflammatory diet pattern to reduce the systemic flare ups are also useful in inflammatory arthritis.

O – On the feet. This arthritis month’s theme is “Move together”. Bones react to stress and weight bearing exercises helps to improve bone density. A brisk 20-minute walk daily is an excellent start. Focus on flexibility and core strengthening to provide a strong ‘internal corset’ to support the facet joints of the back.

N – No smoking and no prolonged sitting. Smoking affects the bones similar to its lung affection. Sitting is the new smoking and prolonged sitting increases muscle strain and back issues on the long run. Stop repetitive micro trauma by improving ergonomics at workplace for young adults.

E- Evaluate the bone density. Catching the ‘silent thief’ i.e osteoporosis early is the key. Examining the bone density by a low dose radiography technique called as DEXA is recommended for individuals above 50 or with other risk factors like family history, smoking, obesity etc

S- Safety first. Fall prevention is of utmost importance in the elderly to prevent the cascade. Improving the safety by securing the likely places of falls is recommended at home and using support while walking outside.

Think of your spine as a long term large cap mutual fund investment. SIPs of small daily movements, posture correction, active lifestyle and healthy dietary intake compound over time and reap the benefits with a healthy spine at old age.