Some problems naturally seem to go together like high cholesterol and heart attacks or osteoporosis and bone fractures. But sometimes intuitive sense does not detect the possibility of other problems fitting together like breathing problems and osteoporosis. What does breathing have to do with the bones? How can shortness of breath relate to bone fractures? The association between these two problems may not make intuitive sense, but with further details the relationship will become logical. Starting with the fact that chronic obstructive pulmonary disease (COPD) is linked to osteoporosis. Furthermore, loss of lung capacity is associated with osteoporosis. And blockage of lung blood vessels can be associated with a treatment for osteoporosis-related fractures. Understanding the reasons why one thing leads to another may help you put two and two together.
Millions of people live with a chronic feeling of being short of breath. A majority of the time this shortness of breath is due to COPD. When the airways become so constricted, the usual treatment is to use steroids which help to open up the air passages. Either inhaled or taken orally, chronic steroid use is a hallmark of end-stage COPD. Unfortunately, this leads to other problems like glucocorticoid-induced osteoporosis. As many as 10% of those who have chest x-rays to evaluate a COPD exacerbation will also show vertebral compression fractures on the chest x-ray as well. And as many as half of those with these vertebral compression fractures seen on x-ray are not being treated for osteoporosis at all. If more people knew that COPD went hand in hand with osteoporosis, more fractures might be prevented instead of accidently discovered.
Another accidental discovery is that compression fractures in the thoracic spine are likely to cause a loss of lung capacity. Less air is able to move into the lungs in someone who has a collapsed thoracic spine as a result of multiple fractures. Nearly 10% of lung volume (forced vital capacity) is lost for every thoracic vertebral body collapsed. If someone has four vertebral compression fractures, 40% of the lung capacity is most likely gone. A kyphoplasty procedure can help regain some of that lung function. But it sure makes one think about how many people might be living with both osteoporosis and reduced lung function, completely unaware that he/she is at risk more serious problems like pneumonia further down the road.
Speaking of risk, anyone being treated with a percutaneous vertebroplasty for a compression fracture should be aware of a rare but serious problem that affects the lungs. Anyone who has had a vertebroplasty and is experiencing chest pain, shortness of breath, pain with deep breathes, or pain with coughing should seek medical attention immediately. That person needs to be evaluated for pulmonary embolus which means that one or many blood vessels in the lungs might be blocked by cement that moved from the spine during the vertebroplasty procedure into the lungs via the blood circulation system. These symptoms might present immediately or days later. But awareness of this potential link between osteoporosis, vertebroplasty and pulmonary emboli can help uncover a diagnosis and treatment faster.
Putting two and two together is not always intuitive. Many types of breathing problems can be related to osteoporosis in one way or another. Shortness of breath is just the beginning. Pneumonia and pulmonary emboli can be the end, sometimes literally. Paying attention to these lesser known associations can make the difference between life and death.
Specialist in Pain Management and Spine Rehabilitation