33-year-old stricken with degenerative bone disease

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DEAR DR. GOTT: My 33-year-old son has been diagnosed with permanent bone degenerative disease in his lower spine, possibly due to an old injury in high school. He’s been told there is nothing that can be done to stop the continuous damage.

What’s the difference between his condition and osteoporosis which is reversible? He’s in great pain with no hope. Thank you for any suggestions.

DEAR READER: Degenerative disc disease refers to the normal changes in spinal discs as a person ages. Healthy spinal discs are flexible, cushioned and can withstand compression. These discs can be compared with shock absorbers on a car that help ease bumps and bends in a road. While degeneration can occur throughout the spine, it most often is noted in the discs of the lumbar (lower) area of the back or in the cervical (neck) region. The discs become less flexible. Tiny tears or cracks may be present in the outer layer of the discs, causing the jelly-like material within each disc to be forced out. The disc then bulges, and either ruptures or breaks into fragments. As the space between the discs gets smaller, the spine becomes less stable. Bone spurs can develop, resulting in relentless pain and decreased capacity to function. The location of the pain may vary, depending on whether it is in the neck or lower spine. With neck damage, the pain can travel to the upper extremities. When the lower back is affected, the back, buttocks and lower extremities can be affected.

There are numerous reasons for this to occur. Individuals who perform regular strenuous physical exercise at work, smoke, experience trauma such as a fall or automobile accident, or are obese will likely be more susceptible and at greater risk.

Treatment often begins with the application of ice or heat, non-steroidal anti-inflammatory drugs (NSAIDs), over-the-counter acetaminophen, muscle relaxants and stronger narcotic prescription medications such as codeine. Physical therapy and appropriate exercises might be endorsed by an orthopedic specialist. Nerve pain medication is also available to help relieve the pain experienced from nerve damage. Because narcotics can cause sedation, constipation, addiction, and nausea, nerve pain meds might be preferred. If surgery is required, it can involve removal of the damaged disc. In some instances an artificial disc may be inserted, or the bone may be fused to protect the spinal cord. On the home front and coupled with OTC pain relievers and heat or cold packs is the avoidance of excessive bed rest because of resultant stiff joints and weakened muscles. Daytime rest periods should be confined to 30 minutes or so before your son should intersperse that time with minor activity.

In the case of osteoporosis (OP [which I don't believe your son has]), the normal buildup and breakdown of minerals in healthy bones falls out of balance. When the loss is faster than the gain, low bone mass results, leading to changes in the actual structure of bones. When the bone loss is so severe the bones can no longer support the weight of the body, those affected bones become very susceptible to fracture. A loss of height of up to two inches can occur when one or several spinal discs dry up or as a result of compression fractures in the spinal bones. That loss can be a precursor of osteoporosis of the hip that can make a person substantially more susceptible to hip fracture.

Causes of osteoporosis include chronic alcoholism (particularly in men), and a sedentary lifestyle (in both men and women). Post-menopausal women with a history of breast cancer treated with chemotherapy or aromatase-inhibitors are at increased risk for developing OP, while those treated with tamoxifen have been found to have a reduced risk of fracture. Postmenopausal estrogen and progestin deficiencies are the reason many older women suffer from the disorder.

Prescription medication is readily available on the market today to slow bone loss and perhaps even to increase bone density over time. For example, bisphosphonates are a specific class of drugs that inhibit the breakdown of bone, while preserving bone mass and increasing bone density. In short, OP isn’t curable but medication, weight-bearing exercise and a diet rich in vitamin D and calcium will strengthen weakened bones.

In any case, your son is young. He should be under the care of a top-notch orthopedist and rheumatologist so he can tap in to the best sources available for control. If you feel he isn’t getting proper care, ask for a referral to another specialist. There is help out there that hopefully can slow the progression of his disorder.

Readers who would like related information can order my Health Report “Osteoporosis” by sending a self-addressed, stamped number 10 envelope and a $2 US check or money order to my attention at PO Box 433, Lakeville, CT 06039-0433. Be sure to mention the title when writing or print out an order form from my website www.AskDrGottMD.com.

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