PT Tip of the Month

Osteoporosis

Osteoporosis is a slowly progressing disorder that results in decreased bone mass. As bones become weak and brittle, individuals have an increased risk of fracture. Anyone can develop osteoporosis, however it is more common in women. About half of women and a quarter of men over the age of 50 will break a bone due to osteoporosis. Fortunately, changes in lifestyle can help to prevent the loss of bone and help to strengthen weakened bone.

 

 

Causes and Symptoms

Many individuals do not realize bone is a living tissue. In fact, throughout our life our body is constantly remodeling our bones. Old bone cells are broken down while new ones are formed. In earlier years, our body makes new bone tissue quicker than bone is broken down. This helps us to grow in height and size. Peak bone mass is usually reached in our early 20's. From here, the speed of renewing bone tissue will slowly and gradually decrease. Therefore, the higher your bone mass is when you are young (at its peak) the lower your risk is of developing osteoporosis.

As this disorder is a weakening of bone, symptoms are not typically present. Common causes of fracture related to osteoporosis are falls, stress from bending over, or in severe cases, forceful coughing. Finally, a loss of height with age or a stooped posture, known as a Dowager's hump, is a warning sign that decreased bone density is present.

Risk

There are a number of risk factors that can increase the likelihood of developing osteoporosis.

  1. Age - The most highly correlated risk to developing osteoporosis is age. As we get older our risk increases. Particularly when over the age of 75.
  2. Gender - Women are at an increased risk of developing osteoporosis compared to men
  3. Race - Osteoporosis occurs in people of all races, however those of European and Asian descent are at greater risk.
  4. Family History - Heredity also plays a role. Those with a family member that has a history of osteoporosis or fracture, particularly of the hip, are also at higher risk.
  5. Body Structure - Those with small frames, both men and women, have an increased risk of osteoporosis as they frequently have less bone mass (small bones) to begin with.
  6. Hormone Levels - Reduction of sex hormones can lead to weaker bones. The decrease of estrogen during menopause is another strong risk for developing this condition. In men with low testosterone or those who receive certain treatments for prostate cancer, a higher risk is present when compared to their peers. Additionally, our thyroid gland manages our metabolism and many body processes. Hyperthyroidism, resulting in high levels of thyroid hormones, can result in bone loss.
  7. Diet - Those with low levels of calcium intake will also have weaker bones, increased risk of fracture and earlier bone loss. Additionally, those who have had gastrointestinal surgeries or who suffer from eating disorders have a lower intake and absorption of nutrients needed for bone health.
  8. Lifestyle - Individuals with a more sedentary lifestyle have a higher risk compared to their peers as weight bearing exercises help to rebuild bone. Finally, excessive alcohol use and tobacco use have also been linked to osteoporosis.

Diagnosis

Physicians may order a bone density test to diagnose osteoporosis. During this test, a machine uses X-rays to assess the thickness, or proportion of minerals, in your bone. Frequently, three parts of the body are measured and compared. Most commonly the hip, wrist, and spine are examined as these are common fracture sites linked to osteoporosis. If your bone density is diminished,but not 2.5 standard deviations or more below the average bone density for your age bracket, you may be diagnosed with osteopenia. Osteopenia is a precursor for osteoporosis as your bone density is less than average, but not by a considerable enough amount to be classified as osteoporosis.

Classifications

Osteoporosis can be diagnosed and classified in three ways.

  • Primary Type 1 - This form is the most common form of osteoporosis in women as it results from decreased estrogen levels following menopause. For this reason, it is also called postmenopausal osteoporosis.
  • Primary Type 2 - Type 2, also known as senile osteoporosis, occurs in both men and women after the age of 75. Women have double the odds of developing this type of osteoporosis compared to men.
  • Secondary - Secondary osteoporosis may occur at any age and is equally as common in men and women. This results from chronic medical problems, disease, or use of steroids, which slow bone formation.

Treatment

Upon diagnosis, doctors will frequently prescribe medications called bisphosphonates. These medications work by decreasing the rate of bone cell break down, allowing more time for the growth and addition of new bone tissue. Research supports the use of this group of medications to reduce the risk of fracture in post menopausal women.

For those with low hormone levels, hormone replacement therapy can also be helpful. Estrogen can be used, particularly right after menopause, to maintain bone density. This is typically not used long term as it can also increase the risk of blood clots, breast cancer and heart disease in women. Some classes of medication can mimic the positive effects estrogen has on bone without the additional risks. For men, testosterone replacement therapy can be used, however the use of medications specific to osteoporosis are more widely prescribed.

Lastly, certain lifestyle changes can also be helpful for reducing the risk of and progression of osteoporosis, and therefore reduce the risk of fractures. First, the elimination of smoking and reduction of excessive alcohol intake will slow the decrease of bone loss, as well as improve general health. Increasing activity is also a great way to promote bone growth. Many doctors will refer patients to physical therapy if they are at an increased risk of falls from deconditioning and are diagnosed with osteoporosis. Patients will also be referred to physical therapy if they have experienced a fall and require rehabilitation after the fracture heals. There are a number of exercises that a physical therapist can prescribe or that can be added into your regular exercise routine to address bone health. Weight bearing exercises, such as walking, using an elliptical, or running put large stresses on the bone. This stress then signal the body to increase bone production so that the bones maintain the strength required to perform these exercises regularly. While biking and swimming may be great for cardiovascular health, these forms of exercises are not helpful to improving bone health as they are low impact and non weight bearing activities. Strength training will also put added stress on the bones where muscles attach, having a similar effect. Additionally, the added strength of muscles will both absorb some of the forces put on our bones and joints, as well as improve functionality. Finally, balance training can also be helpful to those with osteoporosis to improve stability, helping to reduce the risk of falls and fractures.

If you feel you may benefit from physical therapy interventions to improve gait, stability, and strength to prevent fractures, or have experienced a fracture related to osteoporosis, call 617-232-PAIN (7246) to schedule an examination in our Brookline office and 617-325-PAIN (7246) for our West Roxbury office.

References:

  1. Available at: http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/risk-factors/con-20019924. Accessed November 21, 2014.
  2. Raisz L (2005). "Pathogenesis of osteoporosis: concepts, conflicts, and prospects". J Clin Invest 115 (12): 3318-25.
  3. Poole KE, Compston JE (December 2006). "Osteoporosis and its management". BMJ 333 (7581): 1251-6.
  4. Simonelli, C et al. (July 2006). "ICSI Health Care Guideline: Diagnosis and Treatment of Osteoporosis, 5th edition" (PDF). Institute for Clinical Systems Improvement.
  5. Kohlmeier, Lynn Kohlmeier (1998). "Osteoporosis - Risk Factors, Screening, and Treatment". Medscape Portals.

For previous PT Tips of the Month, visit the archive.

33 Pond Avenue, Suite 107B Brookline, MA 02445 Tel: (617) 232-PAIN (7246) Fax: (617) 232-5196
1208B VFW Parkway, Suite 202 West Roxbury, MA 02132 Tel: (617) 325-PAIN (7246) Fax: (617) 325-7282