When back pain is a sign you have broken bones: Former national athlete discovered fractures in her back due to osteoporosis
- Katrina Langford spent years working through her painful back problems
- While in hospital with a broken ankle, doctors discovered her osteoporosis
- Experts say 58% of those affected by the condition live in constant pain
For years, Katrina Langford — a former national athlete and keen horsewoman — assumed her excruciating back pain was just one of those things and redoubled her efforts to stay super-fit for her sport.
‘The pain was so bad it felt like an electric shock into my spine that was going all the way into the nerves in my teeth,’ says Katrina, 57, a former javelin thrower who won bronze for Great Britain in the 1976 European Athletics Championships. ‘Sometimes I couldn’t get off the floor.’
In fact, Katrina’s spine had fractured in a number of places: she didn’t know it, but she had osteoporosis, which makes bones so fragile they break with minimal impact.
But despite a lengthy history of broken bones, from her fingers to her toes — often after minor trauma — it wasn’t until she broke her wrist that doctors noticed this was the 11th fracture recorded in her notes.
This prompted them to do a scan of her body and the osteoporosis and broken back were discovered.
‘It turned out there were lots of fractures in my spine, all near the spinal cord and all near the nerves,’ says Katrina who lives with her husband Alan, 54, in Gloucestershire.
‘There were also several calcified areas, which meant there had been previous breaks that had healed on their own.’
Bone is a living tissue maintained by a process in which old bones are reabsorbed and replaced by new bone cells.
But in osteoporosis the new bone is not replaced as it should be, resulting in a fragile honeycomb-like structure.
By the time Katrina was diagnosed her spine had been so weakened it was actually disintegrating.
This scenario is shockingly common. While osteoporosis is often associated with fractured hips, it causes three times more spinal fractures, says Dr Andrew Pearson, a consultant radiologist who runs the Borders General Hospital osteoporosis and fracture liaison service in Scotland.
Yet he says these fractures are often not detected and cost the country many millions of pounds in avoidable treatment.
‘You have to be proactive in looking for osteoporosis. One way of doing this is for hospitals to check [for bone weakness] everyone who comes in with an unexplained broken wrist.’
The trouble is that although a broken back can cause excruciating pain, many like Katrina can still walk, so a GP would be unlikely to suspect a fracture.
Yet once a spinal fracture occurs the results can be lifelong, as the bones heal slowly and some may never mend properly at all or might bend — leading to the distinctive ‘dowager’s hump’.
The National Osteoporosis Society (NOS) is calling for urgent action to stop people suffering these kinds of breaks.
While osteoporosis is often associated with fractured hips, it causes three times more spinal fractures, says Dr Andrew Pearson
‘Spinal fractures are a particular problem,’ a spokesman told Good Health, pointing to a survey they conducted two years ago which showed 58 per cent of those affected ‘are in permanent pain’.
Osteoporosis affects three million people in the UK. Women over 50 are most at risk because after the menopause their levels of oestrogen fall (the hormone is important for bone strength).
However hormonal decline in men can also cause it, with 20 per cent of men over 50 affected.
In many cases it can be kept at bay by a healthy diet and plenty of exercise, but those affected still need to be diagnosed in the first place.
However, the majority are, like Katrina, only identified when they have already suffered repeated bone fractures.
Dr Pearson’s special unit is unusual — the NOS says that specialist units are still available in only 37 per cent of the country.
As a result, says Dr Pearson, people who come in for treatment with a fracture caused by osteoporosis aren’t being spotted — the fracture is instead blamed on a trauma and the patient misses out on treatment that could save them from further breaks.
Indeed, a recent study in the journal Bone, funded by the NOS, showed the risk of breaking a bone as a result of the condition varies dramatically according to where you live, with the number of spine fractures considerably higher in regions such as the South-West than in London or the East of England.
This indicates doctors in some areas are less alert to recognising and treating osteoporosis before it leads to fractures, the report said.
Katrina thinks her first spinal fracture probably happened in her early 30s when she was on a bus which went round a corner too fast, throwing her against the side of the vehicle.
‘It was incredibly painful and they discovered I had broken a rib,’ she says. ‘I may well have fractured a bone in my spine at the same time but no one noticed because they didn’t look.
‘After that there were so many breaks. I broke my leg, I fractured my knee, broke another rib on a fairground ride and I had broken toes and fingers.
‘I had repeated X-rays of different parts of my body but no one picked up the damage to my spine.’
Osteoporosis is normally diagnosed using a bone density scan called a dual-energy X-ray absorptiometry (DEXA).
Once it is detected there are various treatment options.
In many cases a healthy diet and exercise, which encourages the laying down of new bone, is enough to keep it at bay.
Other patients may need medication. A once-a-week tablet treatment called alendronate can slow down the process of bone breakdown and in some people it can halve the risk of fractures.
However, it belongs to a class of drugs called bisphosphonates which can cause side-effects including stomach pain and nausea, and up to nine out of ten of those prescribed it stop taking it.
Those who cannot tolerate bisphosphonates may receive a six-monthly injection of a drug called denosumab; another option is an annual infusion of a treatment called zoledronate.
A new alendronate formulation called Binosto, designed to eliminate the gastric side-effects, was launched earlier this year but it costs the NHS £5.70 for the once-weekly tablet compared with 24p for alendronate.
Yet before treatment must come diagnosis, and for those such as Katrina this remains the issue.
When she was finally given a DEXA scan, at the age of 42, it showed she had the bones of someone ‘decades older’.
Yet she should have been identified as being at risk of osteoporosis earlier as she had premature menopause. ‘My periods started when I was 11 but were very erratic and had stopped by the time I was 14 or 15,’ she says.
‘I was told not to worry and that they would come back, but they never did.’
Yet no one thought to check on the impact on her bones.
Since her diagnosis she has been taking bisphosphonates.
As her condition has progressed, she has had to give up competitive riding.
‘I feel very let down by the NHS,’ she says. ‘When I was referred for a DEXA scan they said there would be a long wait, so I went private and have had everything done privately ever since.
‘Luckily I don’t get bisphosphonate side-effects. But I often think to myself: “Please God I don’t end up in a wheelchair.” ’