What is osteoporosis?
Osteoporosis is a progressive condition that causes a weakening of the inner structure of the bone. Your bones are made up of minerals such as calcium and phosphorus amongst others that create a hard outer shell with a matrix of minerals, collagen, bone marrow and blood vessels inside. The inside architecture of a bone looks close to that of honeycomb with lots of little holes in between the different elements of the bone. The bone density is maintained by the intake of calcium, vitamin D and many other hormones and minerals. As we grow through our younger years our bones are continuously breaking down and remodeling to change size and shape according with the development of our body, this process is called bone turnover. The process of breaking down and rebuilding bone is continuous up until our early thirties, at which point our bones are incredibly dense and are at their strongest. After thirty the remodeling phase of this process starts to slow down whereas the breaking down and removal of bone continuous at its previous rate. This results in a natural decrease in the bone architecture making the structure weaker as we age. This is a slow and natural process of aging that happens to everyone, however in cases of osteoporosis the bone density is greatly reduced at a much faster rate. This means that the honeycomb matrix of the bone develops larger holes weakening the inner structure and leaving the bone more fragile to fractures at an earlier stage than would happen with natural aging.
What is cervical osteoporosis?
Cervical osteoporosis is osteoporosis that affects the spinal vertebrae bones of the neck in particular the vertebrae bodies which form the spinal column. Your cervical vertebrae surround the spinal cord to protect it from damage. Above and below each vertebra are soft cushioning discs that act like shock absorbers which dissipate any weight or compressive forces down the spine evenly. There are facet joints either side that link each spinal vertebrae to each other not only to allow but also to control the movement of your neck. Now consider how much your head weighs and how much you move your neck on a daily basis and then imagine how much stress these discs and vertebrae must incur over your lifetime. In cases of cervical osteoporosis the weakened vertebrae cannot always sustain the amount of compressive forces resulting in a vertebral compression fracture. A compression fracture is a fracture of the vertebral body where the front of the body is crushed but the back of the vertebrae stays intact forming a wedge shape. A compression fracture can cause a lot of neck pain, but usually the pain is not nerve pain and the spinal cord is rarely affected.
What does cervical osteoporosis feel like?
Cervical osteoporosis is a silent and gradual condition that emits no symptoms. There is often no way of knowing you have osteoporosis until you experience a minor fall or knock that results in a fracture which normal healthy bones would have been able to withstand. Not all spinal fractures are painful it is estimated that two thirds of patients who have a compression fracture don’t actually experience any pain or symptoms. For those who do experience pain it is normally sudden and severe pain in the neck with immediate onset after or during the injury. The pain levels are aggravated by any lifting or standing and walking for two long. Flexing and twisting the head is also painful. There may be muscle spasm either side of the spine. After one or two compression fractures in close proximity to each other you will notice a reduction in height and a hunched or stooped posture will start to develop. This is a classic sign of osteoporosis in the spine. Multiple fractures may happen simultaneously and in this situation the pain levels will be severe and will take much longer to calm down. The pain levels are fluctuating aggravated by movements and lifting but relieved by rest.
Why & when does cervical osteoporosis happen?
Osteoporosis affects over 3 million people in the UK with women being three times a likely to be affected than men. There are two main types of osteoporosis: primary, which develops spontaneously, and secondary which is normally the result of an underlying condition. The primary type of the condition is the most common and is subdivided into three subtypes, postmenopausal, senile and idiopathic osteoporosis. Postmenopausal osteoporosis affecting women over 50 is caused by a lack of estrogen in the body, after menopause your body has dramatically lower levels of estrogen. As estrogen is the main female hormone that regulates the calcium uptake into the bone this results in a higher risk of developing osteoporosis. There is an even higher risk in cases where menopause has begun early (before 45) or for some reason there has been a hysterectomy at a young age. This increased risk is also seen in men with low levels of testosterone although most men produce testosterone well into their later years.
Senile osteoporosis affecting people over 70 is associated to the natural aging process described above or to a lack of vitamin D or calcium deficiency. Often women will demonstrate levels of both senile and menopausal osteoporosis. Idiopathic Osteoporosis can occur in otherwise healthy adults and children. This is a very rare type and as the name suggests its cause is unknown.
The secondary type of osteoporosis can be related to hormonal disorders such as Cushing disease or hyperthyroidism. Long term use of certain medications has been known to increase the likelihood of osteoporosis such as corticosteroids and barbiturates. Rheumatoid arthritis and malabsorption conditions such as Crohn’s disease are also factors in developing the condition. Lifestyle factors such as smoking, high levels of alcohol intake, a low BMI and a lack of strenuous activity during your twenties can leave you at a higher risk of developing the condition. Cervical compression fractures can happen extremely easily from simply lifting a heavy shopping bag to minor falls and even coughing and sneezing suddenly.
How is cervical osteoporosis diagnosed?
Your GP or therapist will be able to diagnose you as being at risk of having osteoporosis by both listening to your history and examining you. In particular cases of unexpected or multiple fractures indicate the possible presence of osteoporosis to your GP. An X-ray of the affected area is not effective enough to see the extent of the osteoporosis so your GP will most likely send you for a DEXA scan. A DEXA scan is normally recommended to confirm the diagnosis as it evaluates the bone mineral density it is a painless scan that take 5-10 minutes. The result will be a number; -1 is normal; between -1 and -2.5 classed as having osteopenia (which is a weakening of the bone but not enough to be classed as osteoporosis) and -2.5 and below is an indication of osteoporosis. The DEXA scan will also be used for monitoring purposes throughout your treatment for osteoporosis. Further blood tests and other investigations may be necessary to rule out any other factors or conditions.
How is cervical osteoporosis treated?
Prevention of osteoporosis is always better than treatment. Your GP will be able to advise you of the steps you should take to maintain a healthy bone mineral density. This will normally include a healthy balanced diet with plenty of calcium and vitamin D intake (possibly from supplements), lots of weight bearing exercise and in some cases medications to boost the levels of estrogen in the body.
Treatment of osteoporosis is dependent of the level of bone density, your age and your risk factor of incurring a fracture or whether you have already sustained a fracture. You Gp will devise what medication or supplements you should be taking. Often a medication called Bisphosphonates is prescribed as it has been proven to increase the bone mineral density helping to reduce the incidence of fractures. Vitamin D and calcium supplements are often advised along with treatment of any underlying condition or hormone imbalance. In severe cases of cervical compression fractures a neck brace may be advised and in a small number of cases of collapsed vertebra surgery may be necessary.
If your diet is a concern then it is advisable to consult a dietician or nutritionist who can examine your daily diet and suggest where and what improvements you could make. A Naturopathic therapists will be able to advise you further regarding the right supplements. It is important to let you GP know what supplements you are taking in case they have any negative effects on prescribed medication. Massage therapies can be useful to loosen up certain joints however it is advised that you refrain from heavy or manipulative treatments in the area of the osteoporosis particularly if you have a recent fracture.