If you have severe low back pain, you may be suffering from osteoporosis or an osteoporosis-related fracture.
Bone tissue constantly undergoes the process of remodeling (a sequence of formation and destruction). Bone cells responsible for the building of the new bone are called osteoblasts and those responsible for removing the calcium and other minerals from the bone are called osteoclasts. In childhood and adolescence, bone formation exceeds destruction, resulting in continued skeletal growth and heavier bones. Maximum bone density is attained at about 30 years of age. As the person grows older, activity of bone-forming cells (osteoblasts) slows down compared to bone destruction cells (osteoclasts) and leads to increased bone destruction and poor bone health.
From the mid-thirties onwards, bone destruction is higher compared to bone formation. The loss in bone density is rapid and bones become more porous, weak and fragile. Even a sudden strain, bump, or fall can cause the hip, spine or wrist to fracture. A fractured or collapsed vertebra may cause severe back pain, loss of height, and/or spinal deformities such as kyphosis (stooped posture).
Prevention is better than cure in case of osteoporosis. Here are some tips:
- Get enough calcium in your diet or through supplements (1000-1500 mg/day).
- Get enough vitamin D (800-1000 IU/day) or sun exposure for 10-15 minutes at least 2-3 times a week as sunlight is a very important source of vitamin D.
- Avoid excess alcohol intake.
- Stop smoking.
- Engage in regular weight-bearing exercises throughout life.
- Prevent fall.
In case of osteoporosis treatment, there are two major options:
- Acceleration of bone health – Stimulate the formation and activity of bone forming cells (osteoblasts)
- Reduce the bone loss – Inhibit the formation and activity of bone destruction cells (osteoclasts)
Osteoporosis can be detected by your doctor through clinical observation and/or bone mineral density (BMD) measurement.
- X-ray :- Traditional X-rays can’t measure bone density, but they can identify bone health.
- Bone Mineral Density :- It is measured by a procedure called dual energy x-ray absorptiometry (DEXA), often performed in the radiology or nuclear medicine departments of hospitals or clinics. The measurement is painless and non-invasive and involves low radiation exposure. Measurements are most commonly made over the lumbar spine and over the upper part of the hip. The forearm may be scanned if the hip and lumbar spine is not accessible.
There is a statistical association between poor bone density and higher probability of fracture. Patient is considered to have osteoporosis if they have a T-score of –2.5 or less as per DEXA reading.
Patient is considered to have osteoporosis if they have a T-score of –2.5 or less as per DEXA reading.
Teriparatide is the recombinant formulation of the N-terminal 1-34 amino acid sequence of human parathyroid hormone (PTH), and is the only anabolic drug approved by the US FDA for the treatment of osteoporosis and related fractures as it stimulates the development and activity of bone forming cells (osteoblasts), thereby promoting an increase in bone mass and improvement in skeletal architecture. Teriparatide restores bone architecture, reduces fracture risk and accelerates the fracture healing.
As per the available clinical trial reports, teriparatide offers a 90% risk reduction of moderate –to-severe vertebral fractures.
The recommended dose for teriparatide is 20 µg subcutaneously once a day into the thigh or anterior abdominal wall. Teriparatide is administered via a multi-dose pen delivery device which contains 28 daily doses of 20µg. Currently, the recommended duration of therapy is 24 months. It is similar to insulin therapy.
Worldwide, over 3 lakh patients have received teriparatide therapy. It has been found to be very safe and effective. Reported adverse effects include nausea, cramps, dizziness, transient hypercalcemia.
Zoledronic acid is the latest bisphosphonate for the treatment of osteoporosis and it is administered by IV infusion once a year.
- No stomach irritation :- Unlike oral anti-resorptive therapy, zoledronic acid bypasses your digestive system.
- As zoledronic acid bypasses your digestive system, you won’t have to wait to eat, or remain upright for half an hour or more before taking zoledronic acid.
- As zoledronic acid is once-a-year osteoporosis treatment, you don’t tend to forget taking your medicine unlike tablet/capsule that have to be taken every day/week/month.
Before you receive zoledronic acid, drink at least 2 glasses of fluid (such as water) as directed by your doctor. You may eat normally before your infusion.
Calcium and vitamin D supplementation should continue regularly while patient is receiving zoledronic acid. Patient should receive 1000-1500 mg elemental calcium and 800-1200 IU vitamin D daily.
If you feel feverish, have muscle or joint pain, or a headache, don’t panic. All these symptoms last for only 1 or 2 days, you can take the medicines for fever or pain.