Answers to Questions about Chiropractic:
Can Spinal Manipulations Help Osteoporosis?

Samuel Homola, D.C.

Question

Six months after a chiropractor manipulated my spine, I was diagnosed as having severe osteoporosis with a T score of -5.57 SD. The chiropractor in question didn't know me from Adam. I stupidly walked into his office seeking treatment for a painful lower back. A few questions were asked at the reception desk. Fifteen minutes later, he manipulated my spine. I was in and out in about twenty minutes. I was 65 years old.

My question is this: How can chiropractors do these treatments without knowing the conditions of a person's back? The chiropractor could have paralyzed me. Is there any way that an osteoporotic spine could benefit from spinal manipulation? At my age, shouldn't an x-ray have been done before treatment?

Answer

Osteoporosis is the bugaboo of every practitioner who uses spinal manipulation to treat elderly patients. It's very important for a chiropractor to evaluate history and symptoms to determine whether there is a condition that warrants use or avoidance of spinal manipulation. People with osteoporosis should not have their spine manipulated. Your T score, a measure of bone density, shows that your bones are extremly frail and that you should never undergo spinal manipulation. You were indeed lucky that the manipulation did not fracture a vertebra.

An x-ray examination is not usually needed in cases of simple back pain during the first month of symptoms. However, before considering manipulation for an elderly persons with back pain, an x-ray examination, a bone scan, or a mineral density test should be done to rule out osteoporosis, bone disease, or a compression fracture.

Physical treatment methods such as moist heat, electrical stimulation, or massage can often relieve symptoms. Special exercises can be used to strengthen muscles and bones. An adequate supply of calcium and vitamin D is important. A medical doctor might prescribe hormones, such as alendronate or calcitonin, to reduce bone loss. In some cases, a cement-like substance can be injected into a collapsed vertebra (vertebroplasty) to fill cracks and crevasses and to relieve pain and compression.

Even if someone with osteoporosis has a chiropractor who uses physical treatment methods appropriately, it's important to seek evaluation by a medical doctor who can order special tests or provide treatment that goes beyond what chiropractors can do.

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Dr. Homola is a second-generation chiropractor who has dedicated himself to defining the proper limits on chiropractic and to educating consumers and professionals about the field. His 1963 book Bonesetting, Chiropractic, and Cultism supported the appropriate use of spinal manipulation but renounced chiropractic dogma. His 1999 book Inside Chiropractic: A Patient's Guide provides an incisive look at chiropractic's history, benefits, and shortcomings. Now retired after 43 years of practice, he lives in Panama City, Florida.

This page was posted on August 27, 2002.