Question
I am 32 yrs old and I recently injured my back in a fall and after seeking medical attention was initial only put on a high dose of darvocet for pain management. After months of pain X-rays showed nothing broken and after my MRI was told I had a degenerative spine w/ arthritis.

I have a genetic predisposition to having any kind of back condition due to my father and him possibly having been diagnosed w/ degenerative spine. In addition I have been on depo provera for over 10 years to manage endometriosis. Could the depo be a leading cause of my degenerative spine or is it most likely just the genetic predisposition? or both? I could use more information on how the depo provera could have possibly caused this and how calcium or lack thereof could be a factor?

Answer
Hello Cadence,

Sorry to hear of your low back pain and degenerative spine with arthritis.  

First some information on the Depo Provera:

(Medoxyprogesterone)- progestins are usually used with estrogens for contraceptions. Also used for dysfunctional uterine bleeding, dysmenorrhea, suppression of postpartum lactation, endometriosis, and management of endometrial cancer (harvey R and Champe P, eds., Pharmacology, 2nd edition, Philadelphia: Lippincott-Raven 1997 p 267).

Depletions:
Folate, Magnesium, Tyrosine, Vitamins B-2, B-3, B-6, B-12, C, and Zinc

Norethindrone and Norgestrel (with Ethinyl Estradiol)
   Oral Contraceptives depress physiologic levels of B-2, B-6, B-12, folate, C, and zinc (Pelton R, et al, Drug Induced Nutrient Depletion Handbook, 2nd Edition. Hudson, Ohio: Lexi Comp, Inc., 2001, p459-71.)

Folic Acid
   Oral contraceptives increase the risk of folate deficiency, which has been implicated in birth defects, cervical dysplasia and increased homocysteine levels, an indicator of cardiovascular disease. Forty-seven young women with mild to moderate cervical dysplasia who were on oral contraceptives were studied. After 10mg. of oral supplementation of folic acid daily for 3 months, the folate supplemented subjects were significantly better then the folate-unsupplemented subjects. This study indicates that either a reversible, localized derangement in folate metabolism may sometimes be misdiagnosed as cervical dysplasia, or the dysplasia may be reversed by folic acid supplementation. (AM J Clin Nutr 1982;35(1):73-82.)

B Vitamins
   Birth control pills deplete vitamins B-2, B-6, B-12, C, and folic acid, especially B-6 by interfering with vitaminutilization, activity and storage (Lancet, 1975;1:561-564); Curr Concepts Nutr 1983;12:1-12). Oral contraceptives interfere with the metabolism of folic acid and vitamin C, and may also interfere with riboflavin metabolism cases where nutrient deficiencies exist (Clin Ther 2982;4(6):423-440). Another study showed that women who use oral contraceptives have impaired folate metabolism as shown by slightly but significantly lower levels of folate in the serum and the erythrocytes. The vitamin B-12 levels in the serum were also significantly lower than that of the control groups (Can Med Assoc J 1982;126(3):244-247).

Vitamin C
   Plasma, leukocyte and platelet ascorbic acid levels have been shown to decrease in women ingesting oral contraceptives (Am J Clin Nutr 1975;28(5):550-554).

Minerals
   Zinc (Arch Latinoam Nutr 1982;32(1):101-110), magnanese (Holt, GA, Food and Drug Interaction, 1998, 197) and magnesium (Harefuah 1991;121(10):363-364) have all been shown to decrease with oral contraceptive use.

Interactions
Phyoestrogens, vitamin C, iron, copper, licorice and chaste tree berries

Phytoestrogens
   Phytoestrogens are plant containing compounds whose structures are chemically similiar to that of steroid hormones. Examples include dong quai (Angeilca sinensis), red clover (Trifolium pratense), alfalfa (Medicago sativa), black cohosh (Cimicifuga racemosa), and soybeans. Concurrent use may interfere with the biochemical effects of the steroid drugs.

Licorice (Glycyrrhiza Glabra)
   Licorice (Glycyrrhiza Glabra) may inhibit the metabolic degradation of prescriptive steroids, as well as endogenous hormones.

Vitamin C
   High amounts of vitamin C (>1 gram) can possibly increase the effect of estrogen.

Copper
   Oral contraceptives may increase serum copper levels (Arch Latinoam Nutr 1982;32(1):101-110).

Iron
   Birth control pills will decrease blood flow and possibly elevate iron stores. Iron levels should be tested before iron supplementation is given.

Chaste Tree Berries (Vitex)
   There is speculation that chaste tree berries, also known as Vitex, may interfere with the efficacy of birth control pills due to its hormone-regulating activity (Brinker, F. Herb Contraindications and Drug Interactions, Eclectic Medical Publications, Sandy, OR p. 55). More research needs to be done to validate this claim.

Beneficial Nutrients
Multi-Vitamin and Mineral

A multi-vitamin and mineral may be beneficial to replete the nutrients depleted by the hormone replacement therapy.

I do not know if the depoprovera contributes at all to musculo-skeletal complaints/ conditions.  It may, but I do not know of it; or it may not.

Okay,,, enough of that information.

Genetic predisposition to spinal degeneration, lower back pain, herniated disc, osteoarthritis,,, metabolic (organic) cause, or structural/ mechanical cause ( chiropractic lesion known as the Vertebral Subluxation Complex).

Certainly we are all made up of the same genes as our parents. PLUS we learn to eat as they eat (same diet), and our habits, postures, language, movement patterns,,,, all are common.  Is it the genes that cause the same conditions in us as our parents had- or is it the same habits, diets, patterns (since we learn from and copy our parents), or a combination?

I do not think it is the Depo causing your back problem.

I do not think it is genes causing your back problems.  Genes are predispositions or tendencies, environment brings out the tendencies.
Guns have triggers.  Guns are not a problem until the trigger is pulled.  Genes are not a problem until triggered by the environmental milieu surrounding the gene.

You say 'degenerative spine', so I think of osteoarthritis, the 'wear and tear' disease (or as some people mistakenly believe- the disease of aging).

I have composed an information handout I utilize in my Staten Island Chiropractic office, it may be helpful here:

++++++++++++
Degenerative    Disk     Disease

DDD = Degenerative Disc Disease; DJD = Degenerative Joint Disease; = similar/ same OsteoArthritis.

Degenerative Disc Disease  (old term =  DJD) is  actually  a  quite  common  condition.   However,  the course of the condition is highly variable.   Some patients with DJD literally cannot walk, yet other patients with similar X-ray/ MRI findings may be able to run marathons or lift heavy weights.   Some people suffer for only a few days with pain and symptoms, some people suffer for months. Although the course is highly variable, there are certain steps that are always helpful to follow:  Ice the area when painful-  10/ 15minutes on, 30/ 45 minutes off;  avoid certain postures and movements;  bend the knees when coughing or sneezing;  bend the knees when lifting anything;  do not extend legs straight out when sitting, laying down, lifting, or driving.   Avoiding certain movements and postures will prevent aggravation of the condition.   Practicing good postures and movement patterns will help the condition heal and be less painful.  DDD, DJD,  OsteoArthritis, -  deteriorating discs (disk)   is/ are  often caused by,  or often  concurrent with the Vertebral Subluxation Complex.  VSC is a misalignment which hastens deterioration of the joints involved.

         Vertebral   Subluxation   Complex    (a.k.a.  憇ubluxation?
The vertebral subluxation complex is the underlying cause of many healthcare problems.
A subluxation interferes with the proper functioning of joints, and can cause osteo-arthritic degeneration, Degenerative Disk Disease, degenerative joint disease, etc.
A subluxation interferes with the proper functioning of the nervous system (the master system which controls and coordinates all function within the body) and may cause various other conditions, symptoms and problems.

Subluxation  is  a  serious  condition  identified  by  its  five  parts:

    Spinal Kinesiopathology:
         This is fancy way of saying the bones of the spine have lost their normal motion and position. It restricts your ability to turn and bend. It sets in motion the other four components.

    Neuropathophysiology:
         Improper spinal function can choke, stretch, or irritate delicate nerve tissue. The resulting nerve  system  dysfunction  can  cause  symptoms  elsewhere  in  the  body.

    Myopathology:
          Muscles supporting the spine can weaken, atrophy, or become tight and go into spasm. The  resulting  scar  tissue  changes  muscle  tone,  requiring  repeated  spinal  adjustments.

    Histopathology:
         A rise in temperature from an increase in blood and lymph supplies result in swelling and inflammation.   Inflammed  Discs can easily bulge,  herniate,  tear,  or  degenerate.   Other  soft tissues  may  also  suffer  permanent  damage.

    Pathophysiology:
         The VSC contributes to  OsteoArthritic  degeneration.  Bone spurs and other abnormal bony growths attempt to fuse malfunctioning spinal joints. This spinal decay, scar tissue, and long-term  nerve  dysfunction  can  cause  other  systems  of  the  body  to  malfunction.

The Vertebral Subluxation Complex describes what happens when spinal bones lose their normal movement patterns and position.  When subluxated, joints are in a stressed, vulnerable, compromised condition.  Subluxation may cause Arthritis, Disk Herniation, Disk Degeneration,  or aggravate such conditions.
 
          Vertebral  Subluxation  cannot be corrected through chemicals (medicine), stretching, yoga, vitamins or physical therapy alone.     Subluxation- a neuro/skeletal/muscular-   mechanical-   problem  requires  a   mechanical correction-  -  -    a manipulation,     best performed with the chiropractic adjustment.

+++++++++++++++++

Just as an automobiles front end parts wear out faster when not in proper alignment, so do our joints wear out faster when not properly aligned.  Putting premium expensive gas will not change the alignment.  A mechanical correction is needed for the mechanical problem.

People can misalign their joints many ways- traumatic sudden injury (ie sports, car crash, slip, trip, fall), bad posture habits, poor movement patterns- these cause misalignment, and cause pain.  IF the patient takes chemicals to cover the pain, the problem can progress (while feeling 'good' with the pain masked) with further joint deterioration.  

My recommendation would be to see the spinal specialist- the family Doctor of Chiropractic that sees and treats spinal problems all day, every day.  Have a chiropractic evaluation, and if necessary, the chiropractic treatments for the chiropractic spinal problem.

I hope this helps.

As always, this article is for informational purposes only.  Education, information and conversation only.  For specific evaluation, DX, TX, RX, PX a treating health professional should be consulted in person.

This is your Staten Island Chiropractor signing off and wishing you good luck and good health naturally.

Thanks,

Victor Dolan, DC
http://www.DocDolan.net
http://www.GoodHealthNaturally.info
http://drvictordolan.chiroweb.com  (email newsletter)