I was in a Pilates class, kneeling on my mat. “Let’s switch to a bird-dog rotation now,” the instructor remarked. Please excuse me. I faithfully imitated her, moving one knee up to the elbow on the other side and then back out, until…
Oh no. The most peculiar feeling trembled in my lower back.
What had I done? There was undoubtedly a problem. I thought I had pulled a muscle, so I skipped the remainder of the lesson.
I had no idea that this was when I broke my spine.
I was 62 at the time, and it was the beginning of years of suffering before an examination eventually determined that I had osteopenia, or low bone density. Naturally, getting a fracture while doing Pilates is extremely uncommon. However, nearly anything can cause a stress fracture when your bones are becoming less dense. A sneeze, a simple twist.
In actuality, I should have been aware of my bad bone health, but I failed to do so. Three years before to that Pilates class, in 2019, I had face-planted into a curb after tripping over my pants. Even though it was a little incident, I had to have major surgery on my right wrist after breaking both of my arms. I now understand that these are known as “fragility fractures,” which are caused by small falls that shouldn’t break bones and are a clear indication of low bone density.
In fact, NHS guidelines state that if you are 50 years of age or older and have broken a bone from a small fall, you should be referred to the local fracture liaison service for additional testing. If osteopenia is discovered, therapy can be initiated to prevent it from developing into the more dangerous osteoporosis, which is characterised by extensive bone loss and potentially disastrous fractures.
However, I didn’t experience that in 2019.
After breaking her spine in a Pilates class, Jane Alexander was diagnosed with osteopenia, or low bone density.
It turns out that there isn’t a fracture liaison service at my Devon hospital. Only half of NHS trusts do, according to the Royal Osteoporosis Society, therefore diagnosing and treating low bone density is a terribly unfair postcode lottery.
According to the Royal College of Physicians, 90,000 people are in a similar situation: they are ignorant that they have osteopenia, which puts them at a very high risk of developing osteoporosis and all of its detrimental effects on their quality of life in the future. In 2022, the weeks that followed that Pilates lesson were excruciating. I was always taking medications because my back was having spasms.
In retrospect, I should have gotten medical attention. I didn’t visit my doctor at the time, though, because I believed that my issue was solely muscular. Eventually, after a few months, the discomfort subsided, and I resumed my regular life, albeit cautiously.
Naturally, the dangerous but undetectable weakening of bone loss persisted. When I picked up a skipping rope in a circuits class a year later, in 2023, I took one skip and had that familiar “wrongness” in my back once more. The spasms came back. To be honest, I didn’t visit my doctor either at that time.
Like many others, I didn’t think they could do much and didn’t want to “overburden” the NHS.
I was helping a buddy move in April 2024, the following year, when—you got it—my back began to spasm once more. The worst of all was this moment. The pain was excruciating, and I was unable to stand or even walk for very long. I then scheduled an appointment with my general practitioner the next month in the hopes of receiving more potent pain relief. I was directed to the practice physiotherapist, who prescribed codeine and scheduled an X-ray.
At that point, I discovered that I had many middle-section thoracic spine fractures. My doctor said, “It makes sense why you were in such pain.” “You’ve been carrying around a broken back!” “We need to talk about bone density scans and treatment” was the final magic phrase.
I was just a hair’s breadth away from developing full-blown osteoporosis, according to my DEXA scan, a low-dose X-ray test that gauges bone strength and mineral density. I was informed that the scan will be repeated in a few years and given a calcium and vitamin D3 supplement.
When Jane went to the doctor two years after the Pilates session, she was informed that she had been walking around with a fractured back.
I was genuinely shaken by it. The world feels unstable if you can’t trust on your bones, your very base. I was frightened that my back might spasm and that I would fall again. My trust in the NHS also wavered. Was a supplement of vitamins and minerals sufficient?
I made the decision to have a second, more thorough inquiry and scheduled an assessment at the private Reborne Longevity health center in London. In addition to performing blood and urine tests, they performed a DEXA scan, which provides whole body scanning (looking not just at bone density but also at the breakdown of fat, muscle, and bone in arms, legs, and trunk).
And once more, the diagnosis was horrifying. One of the general practitioners at the clinic, Dr. Hind Abdulkader, stated, “You have a high risk of future fracture and are one-tenth of a point away from osteoporosis.” It is evident that you had severe bone fragility prior to receiving an official diagnosis. In actuality, your fractures are indicative of skeletal weakness even in the absence of the scan.
“Your predicament is not unique.” Sadly, it is perfectly normal.
According to data from the Royal Osteoporosis Society, fracture-related diseases account for just as many fatalities as lung cancer. The biggest risk is a broken hip (up to 30% of persons over 50 die within 12 months of a hip fracture, and the increased risk of death lasts for nearly ten years; major causes include pneumonia, blood clots, and stroke, all of which can result from an abrupt loss of movement).
However, only a small portion of NHS funding is allocated to the illness. According to Dr. Abdulkader, “up to 80% of people who have already had at least one osteoporotic fracture are neither identified nor treated.” “Jane, you spent at least five years in this group.”
She clarified that I had a period of time “during which bone loss was continuing, vertebral fractures were forming and no protective treatment was in place” between 2019 (when I fell and shattered bones) and 2024 (when I was diagnosed with osteopenia). “Early intervention in 2019 could have meaningfully changed the trajectory of your bone health,” she stated in a startling statement.
Even worse, when I transferred to the practice in 2016, my general practitioner had stopped me from taking HRT, which has bone-protective qualities. Despite the fact that I have neither a personal nor a family history of breast cancer, my doctor stated that the risks were too great.
Jane had to have major wrist surgery following a minor fall three years prior to the Pilates class.
According to Dr Abdulkader, “bone loss accelerates sharply in the first five to ten years after your last period, when oestrogen levels fall rapidly, so your skeleton was losing bone at an accelerated rate without hormonal protection.” It will have made an impression. However, many women do not take hormone replacement therapy and may not experience bone loss. Why me?
Dr. Abdulkader stated that it is mostly inherited (my mother had osteoporosis), but she also identified some additional unexpected risk factors. As a young girl who frequently contracted chest infections, I checked the box of taking a lot of antibiotics.
According to Dr. Abdulkader, “heavy antibiotic use, especially in early life, disrupts the gut microbiome, which can reduce lifelong absorption efficiency of calcium, magnesium, and vitamin D from food, even when your diet seems good.” Despite eating a healthy diet, you are not taking in the micronutrients.
In addition, I suffer from a rare auto-immune disease called palindromic rheumatism, which occasionally causes joint inflammation. According to her, “even at low levels, chronic systemic inflammation suppresses the cells that build new bone and activates the cells that break down bone.”
Another factor might be my history of gallstones. Fat-soluble vitamin absorption is hampered by gallstone disease. People with gallbladder disorders often lack vitamin K2, which is necessary for guiding calcium into bone. To sum up, my testing revealed that my levels of DHEA and testosterone, which are both bone-protective hormones and the latter aids in the production of the former, are either dangerously low or nonexistent.
Dr. Abdulkader claims that it’s complicated and that each element exacerbates the others. The good news is that the majority of issues can be resolved. She strongly advised me to start taking anti-fracture drugs, the most popular of which are bisphosphonates, which aid in the formation of new bone. “You’ve missed many years of protection but at least it’s happening now,” she said, expressing her satisfaction that I had insisted on returning to hormone replacement therapy a few years ago at the age of 63. She also advised that it could be worthwhile to supplement with DHEA and testosterone. It would be prudent to do additional testing to determine my vitamin K2 and omega-3 fatty acid (EPA/DHA) levels. I should keep exercising cautiously, preferably under the supervision of a PT who is knowledgeable in osteoporosis.
Now that I have the knowledge I need, I can return to my doctor and create a well-defined plan. Given my history of fragility fractures, why was I not prescribed bone-strengthening medication following that initial DEXA scan?
“This is the gap you fell through: a busy general practitioner with a ten-minute appointment, a patient presenting with a fracture requiring orthopaedic management, and no automated system prompting a bone health referral,” stated Dr. Abdulkader. “It’s not unusual.”
We depend on our general practitioners and hospitals to take care of our bones because very few of us can afford the luxury of private clinics. Additionally, it appears that there is a lot of space for improvement in far too many situations.
In fact, early detection would save the NHS millions of dollars. According to the Royal Osteoporosis Society, if everyone in England had access to a fracture liaison service, it might avoid 74,000 fractures over a five-year period, save the NHS £665 million, and free up 750,000 bed days (even after accounting for the FLS’s cost).
In the meantime, I’m in a state of uncertainty as I wait for a visit with my general practitioner in the hopes of convincing her to start me on medicine (which isn’t a given because I technically don’t have full-blown osteoporosis, even though I’m very close to it).
Additionally, since the NHS only gives testosterone for low libido, it is very doubtful that I will be able to obtain it (I may need to obtain a private prescription for that). To be honest, it has made me feel terrified and apprehensive.
I’m afraid I’ll shatter more bones. There are a lot of decisions that feel risky, like whether or not to attend this workout class. Would it be risky for me to ride a horse? What if I fell? Would I dare take a walk that entails steep descents?
I’m terrified that any twinges may become spasms, so I’m on high alert for them. Naturally, I’m avoiding bird-dog twists as well.
