Effects of inflammation on bone

Long-term inflammation can have the effect of removing calcium from the bones, weakening and shrinking them. According to one web site, "Inflammation-mediated bone loss is a problem of major clinical and economic significance; it occurs in various diseases such as periodontal disease, osteo- and rheumatoid arthritis and some forms of osteoporosis."

In dentistry it is recognised that bone loss caused by gum inflammation can eventually lead to teeth falling out. Also inflammation and the resulting loss of bone can cause dental implants to fall out.

Years of inflammation around the coccyx can have the same effect. Several people who have had their coccyxes removed have been told by their surgeons that the coccyx crumbled when they removed it.

My coccyx didn't crumble when my surgeon was removing it, but I have two reasons for believing that it was very weak:

  • I asked my surgeon for my coccyx, and he gave it to me in formalin. I boiled it up for hours to clean the tissue off it. When I did this, some pieces of bone fell off the side (see the picture). This doesn't normally happen if you boil up some meat on a bone, so I suspect that in my case the bone was weakened by the years of inflammation.
  • My coccyx is in two segments, with a portion of broken bone above those two. I asked my surgeon whether the piece of broken bone could be part of the sacrum. He said that he had taken the coccyx off with a scalpel, and he thought he had cut through the joint between the coccyx and the sacrum. But he agreed that it looks as if he has taken off the bottom few millimetres of the sacrum as well. I am sure that the surgeon could not have cut through the sacrum with a scalpel unless it was already very weak. (The surgeon told me that this will make no difference to my recovery, and my local doctor says that broken bone normally heals over within days.)

Another cause of loss of bone strength that could be of interest to coccydynia sufferers is the use of corticosteroids. It is known that these drugs can cause loss of bone in sufferers from inflammatory bowel disease (IBD), who have to take these drugs daily. I don't know whether the injections of corticosteroids given to relieve coccyx pain could also cause bone loss. Possibly these drugs will not have any serious effect on the coccyx because they are usually given no more frequently than once every three months.

One site about inflammatory bowel disease says: "In IBD patients who require corticosteroids, the effects on bone mineral density are seen within the first three to six months... Alternate day dosing does not protect bone. . . Gastroenterologists should determine baseline bone mineral density in all IBD patients and give them calcium and vitamin D," said Dr. Cohen. Weight-bearing exercise, and eliminating smoking and excessive alcohol are important to preventing bone loss as well. Dr. Cohen reviewed the medical options for preventing and treating osteoporosis. These include: hormone replacement therapy; calcitonin, which is now available in a nasal spray; and biphosphonates--compounds that inhibit bone loss, such as alendronate. "It's clear from randomized clinical trials that biphosphonates are effective. Compliance is poor, however. You have to take these drugs with a full glass of water, sitting up, and they have been shown to cause esophageal irritation and ulcers."

Updated 2003-04-13

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