It was summer of August 2014 when I sustained a compression vertebral fracture while vacationing with my family in Mackinac Island, Michigan. The diagnosis — a severe case of osteoporosis — was made 3 weeks later.
My T-score was –3.9 at the spine.
The credit for making this diagnosis goes to my mentor and friend Dan Duick, MD (Scottsdale, AZ). I called him with the MRI finding (Schmorl’s phenomenon) and explaining the back pain I experienced.
“Get a bone density,” he said.
“But why would I have osteoporosis?” I replied.
As I explained in a prior post, Schmorl's phenomenon is a herniation of an intervertebral disc into the body of the vertebra beneath it. It occurs in osteoporosis because the bone of the vertebrae is fragile, and so it gives way during minimal trauma, permitting the collapse of the disc. That is apparently what happened to me while I was riding the bicycle, speeding as I was traversing the perimeter of Mackinac island, jumping over road bumps.
Dr. Duick immediately guessed the diagnosis, though it eluded me and my doctor. He was absolutely right; my bone density did show osteoporosis, and a severe case thereof.
My doctor checked me for all the plausible causes. When we encounter patients with osteoporosis who are not at high risk for osteoporosis (older adults or postmenopausal women), we do a workup to rule out secondary causes of osteoporosis. These secondary causes include low vitamin D, overactive parathyroid glands, steroid use, low testosterone in males and premature ovarian failure in females. Strong family history of osteoporosis also increases an individual’s risk of osteoporosis.
Apart from low vitamin D, I tested negative for all major secondary causes. I thought I had a family history; my late mother, who died in her 60’s, most likely had osteoporosis in view of severe kyphosis, but I was not sure since she never had a bone density study.
Whatever my risk was, I had a severe case of osteoporosis.
This disease is perhaps amongst the few diseases that have not seen many advances in terms of diagnosis. Furthermore, osteoporosis medications have not seen significant advances until about a decade ago, with the introduction of anabolic medications and monoclonal antibodies.
Osteoporosis is less common in men, and, certainly, osteoporosis is less common in males who are not old (I was diagnosed in my mid-50s). Yet, I have only seen my very abnormal T-score in perhaps only few of my patients, and I am not sure if I have seen T-scores that were worse.