Any risks having scoliosis surgery with osteoporosis?

Hi,

I am 22-years-old and found out in December that I have severe osteoporosis due to taking omeprazole for acid reflux for two years. I have since stopped the medication and have continued taking calcium and vitamin D.

I also have severe scoliosis. I found out that my curvature increased from 38 to 50 degrees in five years and my doctor now wants me to have the scoliosis rod surgery.

I was just wondering if anyone here knows anything about any of the topics I have discussed. At first I thought the surgery would be a good thing because my back will be stronger with the rods; however, now I am worried that the insertion of the rods will cause the actual bone to crumble and I will be left disabled for life :(

If anyone could ease my worries or give me advice, I'd appreciate it!

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At 22, you do not have osteoporosis. You haven't even reached the age where your spine would have acheived peak bone mass. T-scores, if they were used to diagnose your "osteoporosis" were only meant to measure bone loss compared to peak in later years. Further, DXA normative data (T and Z scores) were collected on NORMAL subjects. People with scoliosis were excluded from the database, and no one really knows what a normal bone density is is someone with scoliosis. Your hip scans should also be taken with a grain of salt, as one hip will most likely be lower in density than the other, depending on which way your spine is curved and which leg you lean on more. (Usually the lower hip).

It is also unlikely that two years of omeprazole would have reversed 18 years of normal growth and skeletal development. Did you have a bone density test BEFORE you started the PPI or did you just assume your bone density was normal?

Surgeons planning scoliosis surgery will use different designed hardware if they know the bones are softer. But I would be very hesitant to make a diagnosis of "osteoporosis" based on comparing scoliotic spine density to patients with staight spines. You need to consider your own statement: "At first I thought the surgery would be a good thing because my back will be stronger with the rods; however, now I am worried that the insertion of the rods will cause the actual bone to crumble and I will be left disabled for life.:

If you don't straighten your continually increasingly curved spine, you will be disabled for life anyway, only a lot sooner, even if what you predict about bone crumbling later, right? I would think that the surgery will buy you time. WHo know, in 10 years, when this becomes an issue, there will be far better treatments for osteoporosis than we have now. Or don't have the surgery, try conservative treatments like physical therapy, wear external braces etc and hope for the best. Sometimes we have no clear cut answer to medical conditions. But you need to be comfortable in whatever decision you make. (Not making a decision in this case, is making a decision to allow your scoliosis to continue to deteriorate BTW). You have to believe you made the right decision and remain positive, because mental attitude is one of the most powerful medicines we have, and the mind can help us heal. Keep your glass half full, not half empty.

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Thank you for taking the time to write that thought-out response. You really lifted my spirits!

I had one bone scan when I was 14 years old due to being a little underweight (right before I found out about my scoliosis). I never found out my T- or Z-scores but was told that I had low bone density to begin with. I was braced from ages 15-18 and told I no longer had to wear my brace when I was skeletally mature (although my curvature had continued to worsen with the brace and I grew two inches after discontinuing it). I had my last bone scan in December because a doctor mentioned that absorption issues can be caused by the omeprazole and the results were alarming: I don't have them in front of me, but I believe my T-score was -4.4 and my Z-score was -3.6. Maybe I will call the doctor who ordered the scan when I was 14 to to compare those results to now. I know I have time to lay down more bone mass, but I have gotten mixed results on when exactly bones stop growing (age 25 or 35?).

Thanks for all of your knowledge!

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I am alarmed by the fact that 2 years of omeprazole caused you osteoporosis. I am taking pantoprazole going on 2 years and already had osteoporosis when I started the treatment. What are you doing for your stomach? Are you substituting the omeprazole by another better drug? Please let me know.

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I know. I wasn't told by my doctor that taking omeprazole for an extended period of time can cause absorption problems (and I was taking double the dosage every day!). I see a homeopathic doctor as well and she suggested a supplement called Lactic Acid Yeast (by Standard Process) that I take with meals - it really helps me!

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Thank you for sharing. I am going to try it also. I hope all goes well with you and you can recuperate some of that bone denisity you have lost with the omeprazole. Stay well.

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Scolioporosis,

Haven't you had any testing done to see why your bone density was low at age 14? I would be concerned that you have malabsorption of some sort or something else that must be corrected, to allow your bones to build up to a more normal density.

Perhaps Dxaguru could help you if you gave him your actual density numbers rather than T/Z scores, I wonder. It sounds like you need a lot more professional help before making such an important surgical decision. I am ignorant of how scoliosis happens to kids, so please excuse me if I've stepped off the deep end so to speak.

Tom

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I would get a second opinion before agreeing to surgery, and I would want it from the best orthopedic center available even if I had to travel. Reason being, I am assuming they are talking about rodding, and the bones have to be strong enough to not crumble or fracture during rodding because then you are in a heck of a mess which would be very difficult to repair, if even possible.

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http://www.medicinenet.com/scoliosis/page4.htm

here are some resources that should be able to help you find a qualified second opinion. But do ask around, about rodding with the bone as it is, I think your concerns are valid. I would also ask your doc to discuss this as well as getting the second opinion. I have a severe kyphosis, which is a forward curve, which has progressed to 80 degrees. I also have a blood vessel tumor in the operative site, so bleeding risk with no way to control it is high. I opted to care for it with bracing and learning to do things differently.

Best of luck to you

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http://www.scoliosis.org/resources/medicalupdates/pain.php

Minnesota Spine clinic is about the best in the nation if you can manage going there

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Bone density changes in children and growing adolescents is problematic because the areas we typically measure, )hip and spine) are not the same size and shape when they come back for a second measurement. No way to compare apples to apples because all the apples have changed into pears.
The best method we have is to measure total body bone mineral content in grams (BMC) not bone mineral density in grams per square centimeter, because during a growth spurt, for example, the size of the bone (area) grows at a much faster rate than the mineralization front and it is normal for bone density to go DOWN during a growth spurt. But mineral accretion of a growing skeleton is a continuously upward process.
But that requires a whole-body DXA scans, and comaring Z-scores for BMC not BMD in a growing skeleton. THe caveat here is that all the normative database excluded subjects with scoliosis. So, while we may not know if your z-score is normal just because it was negative, it should not be getting worse as your skeleton develops (the trajectory is at a rate consistent with normal development).

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