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Spine in Osteoporosis

- Discussion:
    - vertebral bodies are the skeletal elements most at risk of frx in this disease;
    - progressive loss of stature results in progressive shortening of paraspinal musculature which therefore requires more prolonged active contraction for maintenance of posture (resulting in pain of muscle fatigue);
          - this is the major cause of back pain in spinal osteoporosis;
    - spinal compression fractures are insidious and are indicated only by modest back pain early in the course of disease;
    - vertebral frx occur more frequently in type-I osteoporosis than type II;

- Exam:
    - spine itself is not tender;
    - most patients indicate that pain is paraspinal;
    - development of so-called dowager's hump in the upper thoracic spine;
    - types of osteoporosis fractures:
         - biconcave central compression fracture (lumbar spine)
         - anterior wedge fracture (thoracic spine)
         - symmetrical  transverse compression fracture;

- Radiographs:
    - loss of horizontal trabeculae & thinning of cortices of vertebral end-plates, which are finely delineated in contrast w/ fuzzy and indistinct markings;
    - associated w/ osteomalacia or hyperparathyroidism;
    - in worst case of axial osteopenia, the intervertebral disc may appear denser than vertebral body, producing confusing optical illusion;

- Treatment:
    - pts who have back pain due to vertebral frx benefit from analgesic drug therapy, PT, and orthopedic garment for back support;
    - all should receive supplemental calcium & 1,25(OH) Vit D;
    - whether estrogren is indicated is controversial