Hello,

Thank you for reading my message. I apologize in advance for the length of the message.

My father is 74 years old, 5 ft 3 inches in height and weighs 126.5 lbs and lives alone in India. In October 2009, he visited my brother in the US. After urination at about 5 am in the morning, he had ad had a fall in the restroom of my brother's home. He fell backwards on his neck and back. He was taken to the ER and after a slew of tests, he was told that it was a case of micutrition syncope. The impressions in the CT scans of the cervical and throacic spine taken during Oct 2009 described the following:
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Cervical spine:
a) Straightening of the cervical spine with extensive regenerative disc, facet and uncovertebral joint regenerative changes with atleast mild bony narrowing of the cervical canal at the c6/7 level secondary to posterior osteophytes arising from the c6/7 level.

b) No evidence of fracture or suvluxation of the cervical spine.

Thoracic spine

a) No evidence of acute fracture or malalignment in t-spine
b) Anterior oesteophytes with marginal syndesmophytes
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Follwing his fall, he had a moderate neck and lower back pain for a couple of weeks which subsided immediately after treatment with painkillers. When he left to India in Dec 2009, he had a recurrence of neck pain. His orthopedic specialist took x-rays , gave him painkillers and asked him to undergo six weeks of physical therapy. He neck pain subsided completely after that.

A month ago, he had a recurrence of the lower back pain. The pain was moderate. His orthopedic specialist took an x-ray and gave him pain killers and advised heat treatment at home. His pain subsided quite a bit in the following two weeks. On a scale of 1-10, he says its now 2. This pain refuses to go away. He saw his specialist again and the specialist ordered a DEXA bone scan of his spine and both the hips. Following is the summary of the DEXA scan:


1) Site: DUALFEMUR     
Region: NECK LEFT          
BMD (g/sq.cm) - 0.808          
T-Score =      –2.0
Z-Score =      –0.2
Fracture Risk : HIGH
          

2) Site : DUALFEMUR          
Region : NECK RIGHT     
BMD (g/sq.cm) - 0.856     
T-Score =       –1.6          
Z-Score =      +0.2
Fracture Risk : MODERATE



3) Site : DUALFEMUR          
Region : TOTAL LEFT
BMD (g/sq.cm) - 0.992
T-Score =      –0.8          
Z-Score =       +0.5
Fracture Risk : LOW

4) Site : DUALFEMUR          
Region : TOTAL RIGHT
BMD (g/sq.cm) - 0.981
T-Score =      –0.8          
Z-Score =       +0.5
Fracture Risk : LOW

5) Site : DUALFEMUR          
Region : TOTAL RIGHT
BMD (g/sq.cm) – 1.035
T-Score =      –1.5          
Z-Score =       -0.1
Fracture Risk : MODERATE



My questions:

a)Based on the above background, test results and a recurrence of the back pain, how serious is my father's case? I am specifically worried about the moderate and high fracture risks in the above table.

b) He walks about a mile every day and spends thirty minutes on the exercise bike. What other recommendations would you have for my father? Do you recommend any weight-bearing exercises at home? If yes, I was concerned about further injuries as he has not done any weight-bearing exercises most of his adult life.



Thanks a lot!
Hop