What treatment is recommended for diffuse osteopenia, levoscoliosis, and severe lower lumbar facet arthrosis with moderate multilevel degenerative changes?

From the Guidelines

The recommended treatment for diffuse osteopenia, levoscoliosis, and severe lower lumbar facet arthrosis with moderate multilevel degenerative changes typically involves a multimodal approach, with bisphosphonates such as alendronate (70mg weekly) or risedronate (35mg weekly) as first-line medications, along with calcium supplementation (1000-1200mg daily) and vitamin D (800-1000 IU daily) 1.

Treatment Approach

The treatment approach should prioritize reducing the risk of fractures, managing pain, and improving function.

• Bisphosphonates, such as alendronate or risedronate, are recommended as initial pharmacologic treatment to reduce the risk of fractures, with a certainty of evidence 1.
• Calcium supplementation and vitamin D are essential for maintaining bone health and preventing further bone loss.
• Physical therapy focusing on weight-bearing exercises and core strengthening should be implemented 2-3 times weekly for at least 8-12 weeks to address both the osteopenia and spinal issues.

Pain Management

For pain management, the following options can be considered:

• Acetaminophen (up to 3000mg daily) or NSAIDs like naproxen (500mg twice daily) if not contraindicated.
• Facet joint injections with corticosteroids and local anesthetics for more severe pain.
• A lumbar orthotic brace may provide temporary support during acute pain episodes.

Lifestyle Modifications

Lifestyle modifications, including:

• Maintaining proper posture
• Ergonomic adjustments
• Weight management are essential components of treatment, as they can help improve function and reduce the risk of further degenerative changes.

This comprehensive approach addresses bone density concerns while managing pain and improving function by targeting the underlying degenerative changes and structural abnormalities in the spine, as supported by the most recent and highest quality study 1.

From the FDA Drug Label

Osteoporosis is characterized by low bone mass that leads to an increased risk of fracture. The diagnosis can be confirmed by the finding of low bone mass, evidence of fracture on x-ray, a history of osteoporotic fracture, or height loss or kyphosis, indicative of vertebral (spinal) fracture Alendronate reduces bone resorption with no direct effect on bone formation, although the latter process is ultimately reduced because bone resorption and formation are coupled during bone turnover

The recommended treatment for diffuse osteopenia, levoscoliosis, and severe lower lumbar facet arthrosis with moderate multilevel degenerative changes is alendronate sodium.

• Alendronate sodium is a bisphosphonate that binds to bone hydroxyapatite and specifically inhibits the activity of osteoclasts, the bone-resorbing cells.
• The treatment with alendronate sodium 10 mg/day reduced urinary excretion of markers of bone resorption and increased bone mass at the lumbar spine, hip, and total body.
• Alendronate sodium is effective in preventing bone loss and reducing the risk of fractures in postmenopausal women and men with osteoporosis 2, 2, 2.
• Key benefits of alendronate sodium include:
  • Reduced bone resorption
  • Increased bone mass
  • Reduced risk of fractures
  • Effective in preventing bone loss and treating osteoporosis in postmenopausal women and men.

From the Research

Diffuse Osteopenia, Levoscoliosis, and Severe Lower Lumbar Facet Arthrosis

• Diffuse osteopenia refers to a condition where there is a widespread loss of bone density, making bones more fragile and prone to fractures 3.
• Levoscoliosis is a type of scoliosis where the spine curves to the left, and when combined with moderate multilevel degenerative changes, it can lead to severe lower lumbar facet arthrosis 4.
• Severe lower lumbar facet arthrosis is a condition where the facet joints in the lower lumbar spine become inflamed and degenerated, causing pain and stiffness 5, 6.

Treatment Options

• For diffuse osteopenia, treatment options may include medications to slow down bone loss, exercise, and lifestyle changes to reduce the risk of fractures 3.
• For levoscoliosis with moderate multilevel degenerative changes, treatment options may include physical therapy, bracing, or surgery to correct the curvature and relieve pressure on the spine 4.
• For severe lower lumbar facet arthrosis, treatment options may include:
  • Facet joint injections to reduce pain and inflammation 5, 7.
  • Radiofrequency or cryoablation to destroy the pain-causing nerves 5.
  • Physical therapy to improve mobility and strengthen the surrounding muscles 6.
  • Surgery to fuse the affected joints or replace them with artificial ones 6, 7.

Important Considerations

• The relationship between degenerative changes and osteoporosis in the lumbar spine is complex, and patients with severe osteoporosis may also have severe degenerative changes in the discs and facets 3.
• A diagnostic positive facet joint block can indicate that the facet joints are the source of chronic spinal pain, and patients may benefit from specific interventions to eliminate facet joint pain 5.