Ask the Doctors August 2019 Issue

Ask The Doctors: August 2019

Q: I'm 65 years old and taking the antibiotic ciprofloxacin. Should I be worried about a ruptured tendon?

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Arthritis Advisor Editor-in-Chief Steven Maschke, MD, Department of Orthopaedic Surgery, Cleveland Clinic Orthopaedic & Rheumatologic Institute.

A: Ciprofloxacin is a type of antibiotic called a fluoroquinolone, and taking these antibiotics does increase the risk for tendon problems during the time you take the drug and for several months afterward. Tendons are fibrous bands that connect bone to muscle. Tendonitis is swelling of the tendon, and a tendon rupture is a partial or complete tear of the tissue.

A tendon problem is most likely to occur in the tendon at the back of the ankle (Achilles tendon) or a tendon in the shoulder (bicep tendon). Other tendons in the body can be affected as well. A tendon rupture occurs in six to 37 per 100,000 people who take ciprofloxacin, and the risk increases with age.

People who take a corticosteroid drug while taking ciprofloxacin or another fluoroquinolone antibiotic have the greatest risk for tendonitis or tendon rupture. Corticosteroids are powerful anti-inflammatory drugs that may be used for a variety of medical conditions, such as asthma, psoriasis, ulcerative colitis or rheumatoid arthritis. The drugs include prednisone, methylprednisolone and dexamethasone.

People who have kidney disease and those who have had a kidney, heart or lung transplant also are at increased risk, as are people with a history of tendon problems. Engaging in strenuous physical activity also ups the risk. Tell your doctor if you have any of the possible risk factors before starting ciprofloxacin.

Anyone taking ciprofloxacin who experiences pain, swelling, tenderness or stiffness in a tendon should stop any vigorous activity and see their doctor right away. If you feel a snap or pop in a tendon area or are unable to move or bear weight, get emergency medical treatment.

Q: My upper spine has become rounded forward. Why is this, and is there anything I can do about it?

A: The rounding in your spine is a condition called kyphosis. There are several possible causes, including osteoporosis. The loss of bone density with osteoporosis makes bones weak. In the spine, weakened vertebrae (the stack of bones in the spine) can develop small fractures that cause them to compress. This can lead to a forward curve in the spine.

Degeneration of the tough cylindrical disks that provide cushioning between vertebrae can also contribute to kyphosis. You also may be hunched over from poor posture. Over time, chronically leaning forward can cause you to develop an abnormal curve in the upper spine. There are other possible causes as well.

You should talk to your doctor to get an accurate diagnosis. If you know you have osteoporosis, be sure you are getting sufficient calcium (1,200 mg a day for women over age 50 and men over age 70 and 1,000 mg a day for men ages 51 to 70) and vitamin D (600 international units [IU] per day up to age 70 and 800 IU per day after age 70). A medication for low bone mass may be needed. Preventing osteoporosis from getting worse will help prevent further compression fractures. If you don't know whether you have osteoporosis and you haven't had a bone density test, see your doctor about getting one.

Kyphosis may not cause any symptoms, or there may be stiffness or back ache. Pain can be treated with medications. If poor posture is to blame or is making the problem worse, work on improving your posture. A physical therapist can help by showing you exercises to strengthen your upper back muscles, which can help keep your shoulders and head in better alignment.

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