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Osteoporosis


What is it: Osteoporosis is a condition in which the bones become brittle and fragile due to a loss of tissue and density. This loss can increase the likelihood of an individual experiencing fractures of the affected bone. During the life cycle of our bones, they experience a remodeling in which bone cells break down and the cellular matrix of the bone go through a resorption phase. This is typically countered by a deposit of new healthy bone cells for the formation of bone. When we are younger, our bones have a higher density due to the body being able to complete formation of the bones at a higher rate than the loss of bone (Resorption). However, as we age the resorption begins to outpace that of formation resulting in a decrease in density.

 

This condition can be experienced by any sex and race, but older women of white and Asian descent are at the highest risk. Other risk factors can include menopause (Lower estrogen levels resulting in weakening of the bones), history of hysterectomy or gastrointestinal surgery, previous fracture, family history, prolonged corticosteroid use, and overactive thyroid, parathyroid, and adrenal glands. Additional modifiable risk factors include: lower activity levels, diet (Low intake of vitamin D and Calcium), eating disorders, excessive alcohol and tobacco use, and low BMI (body mass index).

As mentioned earlier, an increased risk in the fracture can occur with a rate of 1 in 3 women and 1 in 5 men over the age of 50 experiencing a fracture secondary to osteoporosis. These fractures can occur anywhere within the body, but are most commonly experienced in the wrists, hips, and the upper part of the back (Thoracic spine), which can place an individual at further risk of experiencing a fall, back pain, and poor posture due to a deformation of the bone. 

How is it diagnosed: In order to diagnose someone with osteoporosis a bone density scan is typically performed. These scans are used to determine the bone mineral density (BMD) by measuring the amount of x-rays which are absorbed by the bone via a dual-energy x-ray absorptiometry (DEXA/DXA) or bone densitometry. The DEXA provides a T-score which is can be interpreted as -1.0 or greater to be normal bone density, -1.0 and -2.5 as low bone density or osteopenia, and -2.5 or less as osteoporosis. If a fracture has occurred a radiograph (x-ray), CT scan, or MRI can be performed to determine if the cause was due to osteoporosis.

Symptoms: During the early stages of osteoporosis; an individual may not experience any symptoms at all. As the condition progresses they can experience an increase in pain in the back, hips, and wrists. This pain can be further exacerbated if the individual experiences a fracture with reports of increased discomfort and difficulty with standing, walking, and twisting the body and relief when lying down. A fracture may be reported by an individual after experiencing a minor fall, bending over, or even coughing/sneezing. They may also notice that they are shorter in height due to a loss of bone in the spine resulting in increased kyphosis (Excessive outward curvature) of the thoracic spine or Dowager’s hump.

How a Physical Therapist can help: Physical therapy can be provided for someone at any stage of osteoporosis and can even be used as a preventative measure. Each specific treatment plan can differ from one person to another to directly take into account an individual’s age, overall health, activity level, and risk factors.

Overall treatment by a physical therapist focuses on strengthening of the bones through weight-bearing activities (Squatting, walking, stair negotiation, standing tasks, etc.), and resistance activities using your body weight, gravity, machines, resistance bands, and weights. By completing these activities; ann increase in healthy compression of the bone occurs resulting in a promotion of the formation of bone to combat that of resorption. 

Other interventions include postural and balance training. Improving posture can decrease the amount of stress, which is placed on the spine, can reduce the amount of pain that is experienced, and decrease the risk of fracture. Improving one’s balance is important for the prevention of falls and safety during everyday tasks which will, in turn, decrease the risk of experiencing a fracture. Postural training and strengthening of the back, hips, and ankles can also contribute to the improved overall balance. 

A physical therapist can also provide education on performing activities of daily living (ADLs) with proper alignment of the spine, modifying the environment to promote increased safety within the home and community, and providing a home exercise program to be performed outside of treatment sessions.

Additional treatment options: Osteoporosis can also be treated via medications, hormone therapy, and supplements/vitamins. These are determined by an individual’s doctor and are specific to their overall presentation, health, and risk factors. 
For more information on osteoporosis and how a physical therapist can help refer to the International Osteoporosis Foundation or ChoosePT provided by the APTA (American Physical Therapy Association).