Last reviewed: November 2017
Last updated: May  2017

Summary

Definition

History and exam

Key diagnostic factors

  • advanced age
  • previous osteoporotic vertebral compression fracture
  • acute back pain
  • asymptomatic

Other diagnostic factors

  • hx of long-term corticosteroid use
  • kyphotic deformity
  • loss of lumbar lordosis
  • localized tenderness
  • loss of standing height
  • loss of sagittal balance

Risk factors

  • older age (>50 years for women and >65 years for men)
  • previous osteoporotic vertebral compression fracture
  • low body weight
  • recent weight loss
  • FHx of low bone mass/osteoporotic fractures
  • smoking
  • white or Asian race
  • postmenopausal status
  • secondary amenorrhea
  • alcohol (>2 units/day)
  • corticosteroid use
  • glucocorticoid excess
  • hyperthyroidism
  • vitamin D deficiency
  • low calcium intake
  • rheumatoid arthritis and other autoimmune connective tissue diseases
  • endocrine disorders (e.g., hypogonadism, hyperparathyroidism, hyperprolactinemia, acromegaly, hypercortisolism, hyperthyroidism)
  • gastrointestinal diseases (e.g., inflammatory bowel disease, celiac disease, malabsorption syndromes, post-bariatric surgery)
  • liver diseases (e.g., biliary sclerosis, sclerosing cholangitis, alcoholic cirrhosis, autoimmune hepatitis)
  • dietary disorders (e.g., anorexia nervosa/bulimia, inadequate diet, total parenteral nutrition)
  • neurologic disorders (e.g., stroke, MS, Parkinson disease, spinal cord injury, long-term immobilization)
  • renal disease
  • type 1 diabetes mellitus
  • organ transplantation
  • bone-losing medications

Diagnostic investigations

Investigations to consider

  • CT spine
  • MRI spine
  • bone scintigraphy
  • positron emission tomography
  • bone densitometry scan
  • CBC
  • bone profile (including serum calcium and alkaline phosphatase)
  • C-reactive protein
  • blood cultures
Full details

Treatment algorithm

Contributors

Authors VIEW ALL

Consultant Spine Surgeon & Honorary Clinical Associate Professor

Centre for Spinal Studies and Surgery

Queen’s Medical Centre

Nottingham

UK

Disclosures

NAQ declares that his institution has received research support from Medtronic.

Professor of Orthogeriatric Medicine & Consultant Physician

Queen's Medical Centre

Nottingham University Hospitals NHS Trust

Nottingham

UK

Disclosures

OS declares that he has no competing interests.

Professor of Spine Surgery

University of Oxford

Nuffield Orthopaedic Centre

Oxford

UK

Disclosures

JF declares that he has no competing interests.

Peer reviewers VIEW ALL

Chairman

Department of Emergency Medicine

Mount Sinai School of Medicine

New York

NY

Disclosures

SJ declares that he has no competing interests.

Consultant Physician

Wrightington, Wigan & Leigh NHS Foundation Trust

Wigan

UK

Disclosures

MM declares that he has no competing interests.

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