Monday, January 28, 2008

Case of the Week - Osteoporosis

Patient: 57 year old female. Works as a rounds nurse.

Complains of low back pain attributed to an osteoporosis, diagnosed several years ago with a spinal x-ray. She denies having had a DEXA scan to confirm the diagnosis. The pain is local and does not radiate to the extremities. Pain increases with weigh bearing and is relieved by rest. Pain is least in the morning and increases as the day progresses. OTC Ibuprofen alleviates. Patient is reluctant to continue usage of OTC meds for fear of stomach and kidney complications. Denies previous fractures. No other meds.


Decreased range of motion in the lumbar and thoracic spine. Tight and tender paraspinal muscles in the low and mid back, bilateral piriformis hypertonicity. Orthopedic tests are negative for fractures, sprains, strains and disc herniations. No signs of nerve involvement. No circulatory problems.


Ms. Doe is a typical middle-aged woman concerned about her health. In this case, we see a common presentation: Someone took and x-ray of her back looking for a cause of her low back pain and told her she had osteoporosis. There are several problems here. One: Osteoporosis does not cause pain! The only way there is pain is if the bones are so weak that they fracture under the weight of the body, or with minor trauma like stepping heavily from a bus. Since the x-rays taken did not show any fractures, it is unlikely that Ms. Doe’s pain is related to her bone density. Two: x-ray is not a great way to diagnose osteoporosis. An error in taking or processing the x-ray can make bone appear osteoporotic that is actually healthy. To really diagnose osteoporosis, you need a bone-density test called a DEXA.

What really happened here is this: The doctor who took the x-ray couldn’t find anything wrong with Ms. Doe’s bones and joints that would explain her back pain. The only finding on the film was something called osteopenia. This means that it LOOKS like the bones are not as dense as they should be. It is NOT a diagnosis and is certainly not a reason for pain.


Ms. Doe underwent several chiropractic treatments for mechanical low back pain that involved chiropractic adjusting of her low back and pelvis, therapeutic massage and a home-care regime focused on flexibility and preventing future osteoporosis. Her back pain resolved and she has continued with her home-care to maintain her results.

Visit the National Osteoporosis Foundation for more information on the condition, its diagnosis and treatment.

Weight-bearing exerciseWhen an exercise is weight bearing, your spine and legs are holding up your body weight. That causes the muscles in your legs and back to contract, pulling on your bones, which causes the bones to grow a little thicker and helps prevent osteoporosis. The best exercises for osteoporosis combine weight bearing and balance-challenges. In addition to helping increase bone mass, the balance-challenge helps with stability. Better balance means less falls, which in turn can helps prevent broken hips and wrists. This is significant because 2/3 of women who break a hip due to osteoporosis die within one year of the break. The more breaks we can prevent, the better!Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.

Sink exercises are a great program for osteoporosis patients. They involve various balance-challenges while holding on to the edge of your kitchen sink for balance. Try this one: Stand facing the sink. With both hands holding onto the edge, rise up on your toes. Now, bend one knee so only one foot is touching the ground. Hold for 3 seconds. Repeat on the opposite leg. Do 10 reps on each side once per day. Remember never to engage in an exercise without first consulting your chiropractic physician to see if it is safe for you and your unique conditions.