Strengthen Your Fight Against Osteoporosis With Physical Therapy
Physical Therapy Services for Osteoporosis
Tackling Osteoporosis the Smart Way
Osteoporosis means porous bone and is a condition wherein bones thin and become weaker and thus more susceptible to fracture. Throughout childhood and early adulthood, our bones gradually strengthen until we reach peak bone mass in our 20s. After that, the continual process of bone resorption and renewal begins to skew in favor of faster resorption and slower renewal. As the process of resorption exceeds the deposition of new bone minerals, two conditions develop, osteopenia and osteoporosis. Osteopenia refers to a reduction in bone mineral density which is less severe than that seen in osteoporosis.
Bone mineral density is assessed via DXA Scan (dual-energy x-ray absorptiometry). This type of scan measures the bone mineral density of any bones but is most often used to assess the spine and hip bones. A T-score for each bone is developed based on the results of the DXA scan of that bone. Osteopenia, as defined by the World Health Organization (WHO), is a t-score between -1 to -2.5, while values less than -2.5 are diagnostic for osteoporosis.
As bone mineral density declines, the risk for fractures increases. Fractures cause pain, loss of mobility, increased need for assistance and elevated fear of falling. Osteoporotic fractures can be difficult to heal and lead to a decline in health from which it is difficult to recover. The personal and social costs of osteoporotic fractures are also high. According to the latest Compendium of Osteoporosis published by the International Osteoporosis Foundation (2019), the 2025 annual projected cost of fragility fractures due to osteoporosis in the U.S. is $25 billion.
Preventing and treating osteoporosis and preventing falls is essential for combating the effects of osteoporosis. Lifestyle modification, medical management and physical therapy are three tools to accomplish this goal. The first step, however, is identifying those at risk for having or developing osteoporosis.
DO YOU KNOW YOUR RISK OF DEVELOPING OSTEOPOROSIS?
Osteoporosis is a silent disease. Bones begin to weaken in the body with few outward signs until an unexpected fall or motion causes a brittle bone to break. There are just two outward signs that you may have osteoporosis. First, if you have lost more than four centimeters (just over an inch and a half) of body height, you should be screened for osteoporosis. Similarly, you should talk with your doctor about a bone density scan if you have developed a stooped or curved upper back.
In the absence of outward signs, you can assess your chances of having osteoporosis by the presence or absence of certain risk factors. Having a risk factor for osteoporosis does not guarantee you will develop the condition, though the more risk factors you have, the more likely you are to do so. Do you know your risk of developing osteoporosis?
Risk factors for osteoporosis are divided into modifiable and nonmodifiable risk factors. As the name suggests, modifiable risk factors can be modified by making lifestyle changes or taking certain actions. Let’s discuss some of these risk factors.
First, dietary habits are a modifiable risk factor. Disordered eating conditions such as anorexia or bulimia, which result in extreme weight loss, can cause low estrogen and calcium intake resulting in rapid bone loss. Having a BMI less than 19 is a significant risk factor for osteoporosis. Even athletes who fail to consume enough calories to accommodate their high activity levels can experience bone mineral density loss. A poor diet that lacks sufficient fruits, vegetables, calcium, fat and protein can also lead to malnutrition and reduce bone density. As we age, our ability to absorb calcium declines. Without sufficient calcium in the diet, our body stores will decline and affect bone density.
Lifestyle habits can also fall under the category of modifiable risk factors. Ingesting more than two units of alcohol per day, for example, increases your risk for fracture and smoking almost doubles your risk for sustaining a hip fracture. Additionally, older adults tend to stay indoors more which decreases their exposure to the sun causing low vitamin D levels. Low vitamin D levels increase your risk for developing osteoporosis. Finally, lack of activity, especially weight-bearing activities can contribute to bone and muscle loss and increase falls and risk for fractures.
Nonmodifiable risk factors are out of our control but are important to understand and recognize. For instance, we cannot change our family history but genetics play a role in developing osteoporosis. Age is also a nonmodifiable risk factor. The older you get, the more likely you are to develop osteoporosis. 75% of osteoporotic fractures occur in adults 65 years and older. Those who have experienced fractures from a minor fall should be screened for osteopenia and osteoporosis.
Next, women, especially women who have been through menopause or had a hysterectomy, are at elevated risk for osteoporosis. The hormone estrogen has a protective effect on bones. Women who undergo a hysterectomy or experience early menopause (<45yo) are at higher risk for developing bone loss due to the rapid loss of estrogen.
Finally, certain medications and diseases can hasten bone loss. For instance, certain endocrine disorders or cancers can increase your risk of developing osteoporosis. Medication intake such as long-term steroid or proton pump inhibitor use can also affect bone density. For a comprehensive list of disease and medication risk factors, check out the International Osteoporosis Foundation website.
WHAT YOU CAN DO TO FIGHT OSTEOPOROSIS
Combating osteoporosis often takes a multi-pronged approach. Addressing modifiable risk factors is an important first step. Next, speak with your doctor about whether calcium and vitamin D supplements are right for you. Depending on the severity of osteoporosis or osteopenia, your doctor may also recommend you begin drug therapy. There are several drugs available on the market that either reduce the destruction of bone or promote the formation of new bone.
Finally, working with a physical therapist is a great tool for treating and preventing osteopenia and osteoporosis. Physical therapists treat these conditions in a few ways:
Fall Prevention: Osteoporosis significantly increases the risk for fractures caused by a fall. Addressing risk factors for falls is an important way physical therapists treat osteoporosis. Interventions to address balance, improve strength in the muscles that help you regain or catch your balance and education on how to modify your environment and use assistive devices to prevent falls is key.
Postural Re-education: Having a strong, well-aligned spine can reduce the risk of spinal fractures as a result of osteoporosis. A series of strength and mobility exercises to improve your posture while educating you on how to protect your spine during movements like lifting heavy items is an important part of a care plan for osteoporosis.
Resistance and weight-bearing exercises: Bone mineral production is stimulated in response to proper loading. Resistance training and weight-bearing exercises have been shown to help increase bone mineral density. Generally, these exercises are performed 2-3x per week as part of an overall fitness program and your physical therapist will ensure that they are just right for your fitness and experience level.
If you have been diagnosed with osteoporosis or osteopenia, there are ways to fight back. If you are looking for help to improve bone density, slow the loss of bone density or prevent fractures, call Evolve Physical Therapy today to schedule an evaluation with one of our team members.
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