Fact: The foundation of osteoporosis is laid in the teenage years and by the time a person is 20 or so, they have reached a maximum bone mass and strength
My 87-year-old mother has had severe back pain for several months now. An osteopath took an X-ray and said that her spine curved in two directions and that she had a trapped nerve. She spent some time on treatment, but is in more pain than before.
Name specified by e-mail.
How worrying it must be for both of you that your mother's back has deteriorated despite her expensive treatment.
My feeling is that an exact diagnosis would be of great value – and that a specialist in spinal cord disorders could give a more detailed assessment than ordering an osteopath and more sophisticated scans.
At your mother's age there are two common possible causes of her symptoms. The first is osteoporosis, the condition characterized by the thinning of the bones, making them weak and fragile.
They can become so fragile that even something as simple as bending over or coughing can lead to a fracture, with the hips, wrists and spine most affected.
In your mother's case, one or more vertebrae – the bones that stack on top of each other to form the spine – may be cracked or crumbled.
Known as a compression of the spine, this would lead to the curvature of the spine identified on her x-ray and may explain the pain she is experiencing.
The foundations of osteoporosis are set in teenage years and by the time a person is 20 or so, they will have reached peak bone mass and strength when the bones are as good as they can ever be.
Milk and other dairy products are especially rich in the calcium needed in adolescence to make the bones as dense and as strong as possible. However, your mother was in that age group that grew up in years of rationing when the diet was relatively impoverished.
Moreover, her exposure to sunlight may not have been optimal (we need this to produce vitamin D, which is essential for calcium to be used by the body).
Advice: in exceptional circumstances surgery may be needed to move the trapped nerve, but usually the patient is offered supportive care such as physical therapy
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If she has an osteoporosis-related fracture, your mother may be prescribed calcium and vitamin D supplements daily to try to prevent further injury.
It can also benefit from bisphosphonate, resulting in small bone density improvements that will make a big difference in terms of symptoms in the future. The second possible diagnosis – and there may be a combination of both – is degenerative disease of the lower spine.
This is caused by an interplay of osteoarthritis of the facet joints, the buttresses that support both sides of the spine and the thinning of the discs that act as shock absorbers in the spine.
This degeneration can also explain the pain and even the trapped nerve mentioned by the osteopath.
In exceptional circumstances, surgery may be required to move the trapped nerve, but usually the patient receives supportive care such as physical therapy.
It would be completely wrong – and in my opinion unethical – to say that at the age of your mother she should only be treated with painkillers and rest, or even anti-inflammatory drugs, and should not be further investigated.
A specialist can perform a full assessment, including MRI scans and possibly a bone density scan, to assess any degree of osteoporosis. I urge you to ask her doctor for a referral.
Only with a precise diagnosis can the right treatment be applied and plans made to make her healthy again, including the four-kilometer walks that you say in your longer letter that she used to enjoy.
IN MY OPINION: MMR jab must be celebrated, not avoided
On a Sunday evening 50 years ago, as a 19-year-old, I squatted in front of our little black and white TV set to photograph the pretty incredible images of a man on the moon.
The celebration of this month's moon landing reminded me of those pictures, and also reminded me of the amazing advances in medical technology that I have seen the happiness of.
Progress in scanning – from ultrasound scans to CT scans and MRI scans – has revolutionized diagnosis.
Coronary artery bypass surgery has freed countless patients from the pain of angina (one of me was only the 23rd in the world), while the development of keyhole surgery has helped much more.
We saw the arrival of the first effective medicine for ulcers (cimetidine) and the first successful antiviral medicine (acyclovir for cold sores and shingles). We have moved from sequencing the human genome to trying to rewrite DNA to fight disease.
And today, research on our intestinal bacteria opens the possibility of new treatments for everything from obesity to Alzheimer's disease.
There is no doubt that the doctors of my generation and our patients have gone through a golden age.
Yet we should not be complacent: measles is back from revenge. This common viral infection that is not known can cause deafness and brain damage and can even be fatal.
Science has given us a safe vaccine in the form of the MMR (measles, mumps, and rubella) jab – but because of human nature, & # 39; fake news & # 39; and wrong information, some parents don't let their children be immunized. Like others, the vaccine is an advance to celebrate, not to be avoided.
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