Osteoporosis, Cervical and Lumbar spondylosis in the Asian Population

by Edwin Chang, M.D.

(presented at the 2005 CAMS Annual Scientific meeting)

                Asians, along with Caucasians, are at a higher risk of acquiring osteoporosis compared to the African-Americans and the Hispanic populations. Risk factors include women of post-menopausal age, a positive family history, cigarette smoking, and alcohol consumption. There are dietary differences between the Asians and Caucasian populations. Asians tend to consume less of the calcium rich dairy products while they do take in tea, soy, and vegetable rich in bioflavonoid and phytoestrogen. The lesser bone mass of a slender individual also is a risk factor. Epidemiologically, Asians have less hip fractures than vertebral fractures from osteoporosis. Urban more than rural populations are at risk.

                 Responses to various treatments are similar between the two populations, although some studies seem to suggest a better response rate in Asians to vitamin D analogs. Medical treatments include calcium supplements, vitamin D, Risedronate (Actonel), Alendronate (Fosamax), and exercises. Calcitonin, parathyroid hormone, estrogen are also given in individual cases. Bone density test can be used to assess risk before treatment. Advances ib surgical treatment wuch as kyphoplasty and vertebroplasty have helped immensely in alleviating severe pain in acute and subacute osteoporotic compression vertebral fractures, thus enabling the patients to mobilize sooner and reducing pulmonary and vascular complications, these surgical procedures are quite brief, and usually very well tolerated by elderly patients. Compression vertebral fractures can be diagnosed by plain X0ray (usually thoracic or lumbar spine), although the acuity of the fracture can best be confirmed by bone scan or preferably, MRI.

                 Cervical and lumbar spondylosis mainly affects patients of middle age and up, irrespective of racial backgrounds. The economic burden from lost wages and needed medical care for the osteoarthritis of the spine is tremendous. Although technically not considered part of spondylotic disease, ossification of posterior longitudinal ligament (OPLL) involves mainly the cervical and thoracic spine and shares some of the same signs and symptoms of spondylotic diseases related to spinal cord and nerves compressions. OPLL is much more prevalent amongst Asians. Treatment rationales and modalities are in general same as for spinal spondylosis.

                 Conservative treatments such as anti-inflammatory medications, muscle relaxants, pain medications, physical therapy, pain managements (e.g., epidural steroid injection, facet blocks, trigger point injections, acupuncture) and exercises (e.g., swimming) should be tried first unless there are signs of impending irreversible spinal  nerves or spinal cord damages under which circumstances, surgical options should be carried out as soon as possible. Signs and symptoms such as foot drop, spastic gait, urinary or fecal incontinence, paraparesis or quadraparesis, Lhermittes sign, sustained clonuses, and Barbinski sign are all indicative of significant  spinal nerves or cord involvement, In addition to addressing the often neurocompressive element of  cervical and lumbar spondylotic diseases, surgery also frequently is needed to stabilize/fixate and fuse the particular spondylotic segment(s) so that pain control can potentially be achieved. Advances in spinal instrumentation over the last 10 to 15 years, along with intraoperative neurophysiological monitoring have made spinal surgery very safe and efficient together with improved outcome.

Dr. Chang is Chief of Neurological Surgery at St. Vincent’s Catholic medical Center at Staten Island, NY.