Osteoporosis

Introduction

Osteoporosis is a condition that happens because of the loss of bone mass and debilitating of the bones, which, in turn, increases the risk of fractures, such as hip fractures, crushed vertebrae (spine), or a broken wrist. Osteoporosis-related fractures are often called fragility fractures that occur with little or no trauma.

According to a survey, approx. 25 million Indians are affected with Osteoporosis. Even though, it can occur at any age, it is more common in older adults. It is estimated that about 500,000 vertebral fractures, 300,000 hip fractures, and 300,000 fractures of other bones happen every year. Mostly 80 percent of these fractures happens due to moderately minor falls or accidents.

Facts

It is estimated that about 25-60% women, over the age of 60, develops the compression fractures of the spine.

The risk of developing an osteoporosis-related hip fracture is almost equal to the combined risk of developing uterine-breast and ovarian cancer in a woman. According to a data, by the age of 90, one-third of all the women, and 17% of the men have a hip fracture.

Normal bone tissue not afflicted with Osteoporosis
bone cross-section showing impact of Osteoporosis
  • Between 25% and 60% of women over age 60 develop compression fractures of the spine.
  • Risk of developing a hip fracture related to osteoporosis is a woman like her combined risk of developing uterine breast and ovarian cancer.
  • By age 90, one-third of all women and 17% of men have suffered a hip fracture.
Progressive degeneration of spine due to Osteoporosis

Diagnosis

Diagnosis includes physical examination, symptomatology, radiography, blood tests, CT scan and MRI.

Causes

Disuses

  • Prolonged bed rest or inactivity
  • Prolonged casting or splinting
  • Paralysis, space travel, etc.
  • Diet

  • Low calcium, protein, vitamin C in the diet
  • Chronic alcoholism
  • Anorexia nervosa
  • Chronic illness like

  • Rheumatoid arthritis
  • Cirrhosis
  • Sarcoidosis
  • Renal tubular acidosis neoplasms
  • Bone marrow tumors (myeloma, lymphoma, leukemia)
  • Drugs

  • Prolonged use of drugs like heparin, ethanol, glucocorticoids, etc.
  • Genetic role

  • It is seen in osteogenesis imperfecta.
  • STAGES OF OSTEOPOROSIS

  • Osteopenia (protein and mineral content of bone tissue is reduced)
  • Osteoporosis but no history of fracture
  • Osteoporosis with a history of fractures
  • Our bone cells go through the cycle of removal and replacement of new bone cells. Adults reach their peak bone mass in their teens or early 20s, but in the mid-30s, the cells that form the bones, become less efficient. Bone loss that is greater than the normal rate can lead to osteoporosis. Some people have a higher risk of developing osteoporosis than others. For example, women are at higher risk after menopause, because estrogen levels decrease significantly, and the rate of bone loss accelerates.

    Risk factors include:

    • A family history of osteoporosis (It is estimated that about 75% of bone bone-mineral density is under genetic control)
    • A lightweight bodybuilding (small bones)
    • Smoking
    • Eating disorders like anorexia
    • Low intake of dietary calcium
    • Others factors
    • A fragility fracture after age 40
    • Vertebral compression fracture
    • The apparent osteopenia on radiography
    • Medical conditions such as hyperparathyroidism or mal-absorption.

    Talk to your doctor if you have any question about your risk of developing osteoporosis.

    Prevention

    You can reduce the risk of developing osteoporosis by choosing lifestyle habits that help build and maintain strong and healthy bones. A well-balanced diet with enough calcium consumption, along with regular physical activity in childhood, plays an important role in developing and maintaining good bone health.

    Steps if you are at risk of or diagnosed with osteoporosis:

    A dietary intake of 1500 mg / day calcium and 800 IU / day of vitamin D. In addition, to optimize the bone health, 30 minutes of exercise, at least, three times a week, is highly recommended.

    Here are the some exercises to reduce the risk:
  • Regular walking - join a walking club
  • Classes of low-impact exercise
  • Dancing
  • Strength training
  • Physiotherapy in osteoporosis

    Physical therapists can help reduce the risk of developing osteoporosis. They can also help you in managing the osteoporosis-related problems, including the issues of balance and fractures. Once you are diagnosed with the disease, proper exercise can help improve the bone mass, or slow the rate of bone loss.

    A well-designed exercise program is important, which works excellently in maintaining the optimum bone function. According to the research, exercise is one of the prime keys to slow down some of the functional loss, associated with aging.

    Bone cross-section showing multiple stages in Osteoporosis

    For instance:

  • If you have broken a bone because you have osteoporosis, a physical therapist can help control the pain of the fracture, and plan a treatment program to restore strength, mobility, and function; and help you get back to your ADL (activities of daily living).
  • If you have a balance problem and have fallen or afraid of falling, a physical therapist can prescribe a program that meets your needs. The exercise programs have proven more effective than general programs to help people in regaining a good balance.
  • Physiotherapy Management (current best evidence):

    Physical therapy intervention for people with osteoporosis, or osteopenia should include:

    • Flexibility exercises
    • Strengthening exercise
    • Weight-bearing exercise
    • Postural exercise
    • Balance exercise

    The exercises like walking or jumping have been shown to improve bone density in elderly. Strengthening exercises with weights or resistance bands can also help improve the bone density in the location of specific muscle attachments. Joint stability is extremely important to maintain the bone health, especially in the elderly people.

    Flexibility and strengthening exercises

    These can help improve overall physical function and postural control. Improvement of joint mobility and postural control are important to reduce the risk of falls. Falls often result in fractures in frail elderly people. Balance exercises are also important to reduce the further risk of falls.

    Postural exercises

    It is crucial to avoid the structural changes that often accompany with osteoporosis, such as thoracic kyphosis. Each program should include exercises such as scapular retractions, and chest and hip extensions. The strengthening of the extensor muscles promotes better posture and better balance. Flexion exercises are contraindicated. Previous compression forces to the vertebrae can contribute to the compression fractures.

    Back pain

    A physical therapist can treat osteoporosis for patients with back pain. Agility training, strength training and stretching have been shown to decrease pain and related disabilities.

    High intensity

    According to the research, it is important to get trained in the high-intensity exercise and practice those regularly to prevent the bone loss, particularly in the early period of menopause and post-menopausal period. The high-intensity training includes running, body-weight resistance exercises. Always remember, this type of training is often inadvisable for the people with low bone mass.

    High intensity physiotherapy and bone loss prevention