Spinal osteoporosis

The data by Mudd et al. also demonstrated that ectopia lends occurred by age 6 years in 50 % of patients with Bg-unresponsive homocystinuria and by age 10 years in Bg-responsive disease [24]. Eighty-six percent of patients with homocystinuria were ascertained on the basis of ectopia lends. Finally, the time to event curves demonstrated a 50 % occurrence of radiographic spinal osteoporosis by approximately age 16 years. 

One in four postmenopausal women have osteoporosis. Osteoporosis, a decrease in bone mass, constitutes the most serious effect of menopause. It has been estimated that following cessation of ovarian function, the loss of bone mass proceeds at a rate of 2 to 5% per year. As a result of osteoporosis, as many as 50% of women develop spinal compression fractures by age 75, and 20% will have hip fractures by age 90. 

Diamond TH, Bucci J, Kersley JH, Aslan P, Lynch WB, Bryant C. Osteoporosis and spinal fractures in men with prostate cancer risk factors and effects of androgen deprivation therapy. J Urol 2004 172 529-32. 

In postmenopausal osteoporosis treatment with calcitriol plus etidronate or calcitonin produced improvement in spinal bone mineral density, but a high rate of nephrotoxic adverse events (17). 

Calcium supplements, along with estrogen and calcitonin therapy, are commonly used in the prevention and treatment of osteoporosis. Bone loss dearly occurs with diets supplying under 400 mg Ca/day, Bone loss can be mirvimized with the consumpbon of the RDA for calcium. There is some thought that all postmenopausal women should consume lOOO to 1500 mg of calcium per day, an amount higher than the RDA, There is some evidence that such supplementation can reduce bone losses of the ulna but have no effect on spinal bone losses Smith and GiUigan, 1990),... 

In adults receiving long-term parenteral nutrition, despite its anabolic effects on other tissues, there is no improvement in bone density. Infants treated with parenteral nutrition from birth also develop low bone density for age, suggesting that parenteral nutrition treatment in some way contributes to the osteopenia (5). A 17% long-term increase in spinal bone mineral content has been shown in patients who have received parenteral nutrition solntions without vitamin D. However, this rise was nearly balanced by a 15% fall in hip bone mineral content (115). In a Danish study of bone mineral content in adults receiving home parenteral nutrition for short bowel syndrome, despite the fact that all were on free oral intake as a supplement to the parenteral nutrition, 47% had mandibular osteoporosis while 33% had osteoporosis in the forearm and radiographic changes of osteoporotic fractures in the vertebral column. Dental and periodontal tissues were normal (116). 

Postmenopausal women are vulnerable to osteoporosis, which largely involves trabecular bones including the spinal vertebrae. Estrogen deficiency plays a major role since estrogen replacement reduces the rate of bone loss. The mechanism for this effect has not been fully characterized but decreased estrogen resulted in increased IL-1 secretion from blood monocytes. IL-1 stimulates osteoclastic activity and bone resorption. Other risk factors include excessive alcohol consumption and smoking. 

Another experimental attempt to reverse osteoporosis was supervised by Khashayar Sakhaee, M.D., professor of internal medicine at the Center for Mineral Metabolism at the University of Texas, Southwestern Medical Center at Dallas, Texas, who tested a. slow-release fluoride in the amount of 25 milligrams together with 800 milligrams of calcium citrate twice daily on 980 volunteer elderly subjects with osteoporosis.The results of the three-year experiment were very encouraging. Dr. Sakhaee reported an average gain in spinal bone density of 5 percent per year every year for the three years of the experiment. 

Musculoskeletal Field concerned with the muscles and the bones of the body. Studies in this area include aging, bone density, bone fractures, chronic back pain, hip replacement, osteoarthritis, osteoporosis, rheumatoid arthritis, spinal cord injuries, and others. 

Tlie vast possibihties of organs and tissues derived from stern cells or ES cells ar e matched by tlie tremendous demand building up in the population. Erorn the standpoint of patients or patients-to-be, stem cell research holds the promise of delivering health to millions of sufferers. In the USA alone, out of a population of 265 million, an estimated 128 million patients may be helped by human pluripotent stem cell research for afflictions such as cardiovascular diseases, autoimmune diseases, diabetes, osteoporosis, cancer, Alzheimer s disease, Par kinson s disease, severe bums, spinal cord injuries and birth defects. ... 

Fractures of the spine, wrist, and hips decrease by 50 to 70%, and spinal bone density increases by 5% (24), in those women treated with estrogen within 3 years of the onset of menopause and for 5 to 1 0 years thereafter (5,11,25). The minimum dose required and that which is considered to be standard therapy is 0.625 mg/day of conjugated estrogens (Premarin) however, a 0.3 mg/day dose of esterified estrogen (Estratab) has been shown to be adequate for the prevention of osteoporosis (5). Estrogen replacement therapy is available in several types of formulations, including transdermal patches (Climera, Estraderm, Menostar, or Vivelle). 

Non-approved uses include treatment of pediatric osteoporosis and treatment of osteogenesis imperfecta. It has also been used to treat refractory pain of lumbar degenerative spinal stenosis. 

Observation of the thoracic spine shouid be performed from the back and from each side. One should observe for any abnormal curvature of the spinal column. Kyphosis, an increase in the normal anteroposterior curvature of the spine, or scoliosis, an abnormal lateral curve should be looked for. Kyphosis is sometimes manifested in the upper thoracic spine as the dowager s hump so frequently seen in osteoporosis, especially in older women. Flattening of the thoracic spine may be seen in the presence of muscle spasm or somatic dysfunction. See Chapters 48, 58, and 78 for a further discussion of these postural changes and their significance. 

Polikeit A et al. (2004) Simulated influence of osteoporosis and disc degeneration on the load transfer in a lumbar functional spinal unit. Journal of Biomechanics 37 1061-1069... 

Keywords— Spinal Cord Injury, Osteoporosis, Orthosis. 

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