Online Health Chat with Dr. Tagreed Khalaf
September 8, 2010
Cleveland_Clinic_Host: Osteoporosis affects millions of people each year. Osteoporosis is a disease of the bones where bone density is decreased and leads to a higher risk of fractures. Causes include hyperparathyroidism, where the parathyroid gland does not regulate calcium and phosphate levels properly, the over consumption of dietary protein, or low calcium intake, along with others. The majority of people who suffer from osteoporosis are post-menopausal women, but it is possible for younger women and males to be diagnosed with it as well.
Out of the 1.5 million osteoporosis related bone fractures that occur each year in the United States, the most common are vertebral fractures. These are fractures of the spine, which can cause back pain and other serious spinal injuries if left untreated. Symptoms of a vertebral fracture include back pain and possible shooting pain, due to spinal nerve compression. More serious symptoms include spinal cord compression or Cauda Equina syndrome, which is a neurological condition that affects spine function in the lumbar region. Also, these fractures can result in stooped posture, chronic pain which reduces mobility, and loss of height. Join us in a free online chat with Dr. Khalaf, a Cleveland Clinic spine doctor, who will answer your questions regarding osteoporosis and vertebral fractures.
Dr. Tagreed Khalaf, MD, is a medical doctor in the Center for Spine Health at the Cleveland Clinic with a certification in Physical Medicine & Rehabilitation, and specialties in Musculoskeletal Medicine, non-operative management of spine, Osteoporosis, and sports medicine. She completed her medical degree at the University of Wisconsin in Madison, Wisconsin, held an internship in internal medicine at the University of Pittsburgh Medical Center, and her residency there as well, in physical medicine and rehabilitation. She then completed her fellowship at Mayo Clinic in Rochester, Minnesota in physical medicine and rehabilitation.
Cleveland_Clinic_Host: To make an appointment with Tagreed Khalaf, MD, or any of the other specialists in our Center for Spine Health at Cleveland Clinic, please call 216.636.5860 or call toll-free at 866.588.2264. You can also visit us online at my.clevelandclinic.org/spine.
Welcome to our Online Health Chat with Dr. Tagreed Khalaf. We are happy to have her here today for our chat on Osteoporosis and Vertebral Fractures. Let’s begin with the questions.
Callandra: What is a vertebral fracture?
Speaker_-_Dr__Tagreed_Khalaf: An osteoporotic vertebral compression fracture typically presents as loss of height, involving the vertebral body (spine) greater than 15-20%. This can occur in the absence of major injury or trauma.
clara: My grandmother walks bent over and has lost quite a bit of height. I understand that this can be caused by spinal fractures or compression. Is there anything that can be done to improve her posture and/or possibly give back some height?
Speaker_-_Dr__Tagreed_Khalaf: There are multiple reasons for height loss. A common reason may be osteoporosis. The first step is to get this evaluated and diagnosed to look into the potential causes which will help better determine a treatment plan.
Chaka: What percentage of the general population has hip fractures as compared to those with osteoporosis? In other words, how much more risk of fracture is there for a person with osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: People who have osteoporosis are also at an increased risk for hip fractures - but the actual risk varies per individual. The actual risk can be individually determined bases on ones T-Score and usage of the FRAX model.
bunnyhop: Does weight have any bearing on the effects of osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: Having a thin body frame or being exceptionally thin (BMI less than 19) can be a risk factor for osteoporosis.
friendly: Can you still get fractures, even under treatment for osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: Unfortunately the risk still exists. Most medications for osteoporosis have been shown to decrease the risk of a vertebral compression fracture by 40-50%.
If you do sustain a fracture while on treatment for osteoporosis, follow-up with your physician is recommended as there are several newer medications available for treatment.
Jamamama: What kind of tests can determine if you have osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: Several technologies are available for measurement of bone density but the gold standard is a DEXA (dual energy x-ray absorptiometry) scan.
bakersfield: Does everyone who has osteoporosis get spinal compression fractures?
Speaker_-_Dr__Tagreed_Khalaf: No - not everyone. But osteoporosis increases the risk of having (spinal) vertebral compression fractures.
playact: How strong a part does genetics play in developing osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: You are at an increased risk for osteoporosis if a family member has osteoporosis OR if a family member has sustained a hip or vertebral fracture.
MammaBear5: Are there specific risk factors or causes of osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: Risk Factors for Osteoporosis include:
- Female Sex, increased age, estrogen deficiency, Caucasian race, low weight and body mass index, family history of osteoporosis, cigarette smoking and history of prior fracture.
- Secondary Causes of Osteoporosis include:
• Endocrine: hyperthyroidism, hyperparathyroidism, hypogonadism, Cushing’s disease
• Medication: glucocorticoids, heparin, excess thyroid hormone replacement, anticonvulsants, omeprazole
• Nutritional: malabsorption, alcoholism, liver disease
• Malignancy: multiple myeloma
blanket: In post-menopausal women with osteoporosis, can the risk of vertebral fractures be reduced?
Speaker_-_Dr__Tagreed_Khalaf: In post-menopausal women with osteoporosis, the risk of vertebral fractures can be reduced by ensuring that you are receiving treatment for osteoporosis. About 50% of women who have sustained a vertebral fracture had never had their osteoporosis treated.
There are multiple medications and classes of medications that can treat osteoporosis. Depending on the medication, the risk of vertebral fracture may be reduced 40-50% depending on the medication.
In addition to the medication, it is important to ensure adequate Vitamin D and Calcium supplementation and/or oral intake.
motherB: Are there any medicines or conditions that would increase my risk for fractures?
Speaker_-_Dr__Tagreed_Khalaf: Yes. There are multiple medications that can increase the risk for osteoporosis and hence possible fracture. Some of the more common ones are: glucocorticoids (steroids, Prednisone); heparin; anticonvulsants (seizure medications) and omeprazole (Proton pump inhibitor used for acid reflux).
Osteoporosis & Men
MikeJ: Can men be diagnosed with osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: Yes, more than 30% of people with osteoporosis are men.
Linderman85: Does alcoholism really increase risk of osteoporosis in men?
Speaker_-_Dr__Tagreed_Khalaf: Yes, commonly osteoporosis is a result of aging. However, it is recently been shown that in approximately 50% of the time there can be a secondary cause to osteoporosis in males. The most common causes being alcoholism, glucocorticoids (GC) usage (steroids) and hypogonadism (low testosterone).
Signs & Symptoms
CrisNicky08: What are the signs or symptoms of osteoporosis?
Speaker_-_Dr__Tagreed_Khalaf: Osteoporosis is often compared to hypertension as it is a disease that is usually silent and does not have many signs and symptoms. Unfortunately the first sign that one may have osteoporosis is a vertebral/hip fracture. Therefore early screening is important.
Most clinical guidelines recommend screening healthy women for osteoporosis at age 65 and healthy men at 70 and testing higher risk women/men earlier.
Screening is also recommended for those with radiographic evidence of osteopenia or vertebral fracture and people who have diseases associated with bone loss such as rheumatoid arthritis as well as people initiating long term corticosteroid therapy
jollywell: How will I know if I have a spinal compression fractures? What symptoms should I be looking for? Is it very painful, like a broken bone or is it a chronic ache?
Speaker_-_Dr__Tagreed_Khalaf: Most people do not realize that they have sustained a compression fracture and it is incidentally found on an X-ray. In someone with osteoporosis who present with new onset of spine pain even without major trauma should be evaluated.
marybrad: I have some numbness and tingling down my legs. I have heard that this can be a symptom. Is it? How do I know it is not related to something else?
Speaker_-_Dr__Tagreed_Khalaf: There are several reasons for having numbness and/or tingling down your leg. An evaluation by your family physician or a spine physician is recommended to help determine the cause and get appropriate treatment.
Lor4520: How are vertebral fractures treated?
Speaker_-_Dr__Tagreed_Khalaf: Typical treatment of an osteoporotic vertebral fracture includes pain control with relative rest provided one does not have any neurological deficits on examination. At times, your physician may also consider using a brace.
In some cases vertebral augmentation i.e. Kyphoplasty or Vertebroplasty may be considered. This is typically recommended for people with severe pain and significant limitations in function despite pain management.
In addition, with the treatment of vertebral fractures it is important to not only treat the vertebral fracture but to also identify and treat the underlying cause. Unfortunately it has been shown that approximately 50% of people who sustain an osteoporotic compression fracture do not receive osteoporosis treatment.
Chaka: What about the latest studies that some drugs such as actonel only work for a few years.
Speaker_-_Dr__Tagreed_Khalaf: Typically, the duration that you take a bisphosphonate is determined by your physician as well as the severity of your osteoporosis. In some women, studies have shown that your physician may choose to stop treatment after 5 years.
tulips: What are the complications of spinal compression fractures? Can I be bedridden or have loss of mobility?
Speaker_-_Dr__Tagreed_Khalaf: Generally with vertebral compression fractures, most people do well with pain control and rest. If pain control is not achieved one may find they are more sedentary at which time depending on consultation with your physician one may want to consider vertebral augmentation to help with pain control and increase activity level.
If one is bedridden or has loss of mobility a physician evaluation is necessary for a neurological examination and appropriate treatment. Surgery might be necessary.
In some people with multiple compression fractures, they may note increase in abdominal girth leading to increase in satiety (you feel full easier.) Individuals with multiple fractures may develop chronic back pain and kyphosis (hunched forward.)
Annabon5089: Are there any simple solutions to osteoporosis that do not involve surgery that can prevent vertebral fractures from occurring?
Speaker_-_Dr__Tagreed_Khalaf: Multiple medications are available for the treatment of osteoporosis and studies have demonstrated a decreased risk of vertebral osteoporotic fracture by about 40-50% depending on the medication used.
In addition to medications, ensuring adequate calcium and vitamin D supplementation/intake is essential to the treatment of osteoporosis. Most recommend about 1500mg/day of calcium from all sources.
The optimal dose of vitamin D may be based on one’s vitamin D blood level but typically ranges from 400 to 1000 IU/daily.
Being active in weight-bearing exercise such as walking should be encouraged. Back extensor strengthening exercises have been shown to decrease the risk of vertebral fracture as well as falls.
KathyH: I know dairy foods have calcium to combat osteoporosis, but what are other good food sources?
Speaker_-_Dr__Tagreed_Khalaf: Dairy is an excellent source of calcium but other sources include: green leafy vegetables, soy beans, dried fruits and nuts. Also look for calcium-fortified orange juice, cereals, breads and other foods.
CMB: If you have a family history of osteoporosis, how much vitamin D and calcium should I be taking? At what age should I start?
Speaker_-_Dr__Tagreed_Khalaf: Vitamin D and Calcium supplementation/intake are important for adequate bone health. Typically you should take 1500mg Calcium per day (oral and supplement. For Vitamin D, supplementation depends more on your Vitamin D level which is determined by a blood test. Vitamin D supplementation is 400-1000 iu twice a day (oral and supplementation).
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Tagreed Khalaf is now over. Thank you again Dr. Khalaf for taking the time to answer our questions about Osteoporosis and Vertebral Fractures.
Speaker_-_Dr__Tagreed_Khalaf: Thank you for your participation and your excellent questions.
- Cleveland_Clinic_Host: To make an appointment with Tagreed Khalaf, MD or any of the other specialists in our Center for Spine Health at Cleveland Clinic, please call 216.636.5860 or call toll-free at 866.588.2264. You can also visit us online at my.clevelandclinic.org/spine.
- A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit eclevelandclinic.org/myConsult
- If you need more information, contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!
- Some participants have asked about upcoming web chat topics. If you would like to suggest topics, please use our contact link clevelandclinic.org/webcontact.