KUWAIT: Our spinal column is made up of 33 vertebrae that protect the spinal cord, while at the same time help us to stand upright and move around. When one has a spinal fracture, it means that some of the vertebrae have hairline fractures that may lead to a total collapse.
Orthopedic surgeon Dr Abdulrazzaq Al-Obaid, head of the spine unit and ER chief at Al-Razi Hospital spoke to Kuwait Times about a new minimally invasive procedure that can repair spinal fractures, called “balloon kyphoplasty”. The procedure uses a balloon to lift the vertebrae and create a cavity for bone cement to stabilize the fracture.
Another procedure called vertebroplasty is also minimally invasive, where liquid bone cement is injected into the fractured vertebrae to stabilize it and reduce the pain. This is also a good opportunity to speak about osteoporosis now because October is ‘osteoporosis month’, and a conference will be held with lots of educational material for doctors and activities to educate the public. Osteoporosis can be treated by prevention, and the patient can be advised in advance to avoid this disease. Kuwait Times spoke to Dr Obaid to learn more.
Kuwait Times: Is physical activity recommended for osteoporosis patients?
Dr Obaid: Absolutely. Actually some studies recommend that physical activity is even better than medication. People should maintain a good quality of life and be physically active. A classical example is of people who live on farms outside the city – they have less incidents of osteoporosis compared to people who live in the city with sedentary lifestyles without exercise. The types of activities that can help prevent osteoporosis include walking and swimming. Walking is best between 10:00 am to 2:00 pm to get exposure to sunlight, as this boosts vitamin D.
KT: What are the effects of hormones on osteoporosis?
Dr Obaid: It is well known that certain hormones have direct influence on osteoporosis. If you have a patient with deficiency of parathyroid hormone, this prevents the absorption of vitamin D, and it will interfere with vitamin D activity and subsequently with calcium absorption. This leads to osteoporosis. For patients who have hormonal problems and produce large quantities of cortisone in the body system, this will affect bone quality and lead to early osteoporosis. Hormones definitely have a big impact. A classical example of hormones is in women. The groups most at risk of osteoporosis are postmenopausal women, and this is due to hormonal changes.
KT: Can osteoporosis be prevented in women who give multiple births?
Dr. Obaid: It is not about the number, but osteoporosis can be prevented and should be prevented. It is easy to prevent, easy to diagnose and the treatment is simple, either with medications or injections. Not only pregnant women should check their vitamin D level, but everyone is advised to do so. It is more important in pregnant women for the safety of the child, because if she has vitamin D deficiency, then obviously the child will be at risk, so we care for both the mother and child. This can be done by simply correcting the level of vitamin D, provided that there are no other causes such as hormonal diseases or medications that contain cortisone or steroids, or patients who take antiepileptic medications.
KT: What are the ideal means to prevent or delay osteoporosis?
Dr. Obaid: The first thing is vitamin D; secondly, people at risk should have routine Dexa scan, which checks bone quality. It is an easy and advisable test every two years for patients at risk. One needs to stay for around half an hour under the sun with enough surface area exposed. We are talking about the extremities, face and the back. You need three times a week of exposure. Some studies show that the presence of melatonin which causes dark skin in the Middle East prevents the absorption of ultraviolet light. If people are behind glass, exposing themselves to the sun may not benefit them because glass may prevent UV absorption. So one has to be outdoors. The way people dress in the region also does not allow proper exposure to the sun.
KT: What is the prevalence of osteoporosis in Kuwait?
Dr Obaid: Unfortunately, we do not have a solid number at this stage, but are collecting data to check the prevalence and incidents of osteoporosis in the country. The numbers are not confirmed so far, but initial results indicate that they are high.
KT: What is the recommended dose of vitamin D to keep bones healthy?
Dr Obaid: This depends on age, sex and risk factors. It varies according the condition of the patient. If patients have deficiency, we recommend 50,000 IU per week.
KT: What are the warning signs of osteoporosis?
Dr Obaid: Unfortunately, when you start getting signs of osteoporosis, then it’s too late. This is a silent disease, and there are no warning signs. When osteoporosis is established and the bone is weak, people will be exposed to what we call fragility fracture, when a bone breaks very easily.
KT: Can osteoporosis be cured?
Dr Obaid: Yes, if treated properly by correcting calcium and vitamin D levels, and there are tablets and injections that can help improve the quality of bone. Treatment depends on the age. Everything had to be individualized, because there are certain categories of patients who cannot use regular medications, like patients with kidney problems, those with borderline renal function and patients with a history of cancer. Most of the anti-osteoporosis treatments can actually stimulate cancer cells, so we have to be careful.
KT: Can chronic diseases’ medication cause osteoporosis?
Dr Obaid: Yes, they cause many problems, and part of them is osteoporosis. Examples are diabetics, the obese and anorexics. Smoking is a risk factor, along with patients on antiepileptic medication. Technology nowadays has evolved big time. If the patient is not diagnosed with osteoporosis early, when he sustains a fracture, it can be treated by an advanced method. For example, spinal surgeries are dealt with minimal invasive techniques with minimum amount of anesthesia without big scars. Such procedures are balloon kyphoplasty, which is now the standard procedure for spinal surgeries.
By Abdellatif Sharaa