Osteoporosis

Osteoporosis is categorized as primary or secondary. Primary osteoporosis has no relation to other diseases or conditions and is more common than secondary type. Osteoporosis can occur at any age, however, is more common in post-menopausal women or older men. Secondary osteoporosis is a side effect of medication or another condition or disease or exposure to radiation.

What is Osteopenia?

Osteopenia is a milder form of bone loss and refers to a decrease in bone density or low bone mass. People who have been diagnosed with osteopenia may be able to slow down its progress or even reverse it with proper diet, supplementation, and activity. Genetic factors are known to have a role in developing osteopenia or osteoporosis.

How is osteoporosis diagnosed?

A bone density test is usually ordered by physicians to confirm the diagnosis of osteopenia or osteoporosis. World Health Organization (WHO) defined a normal bone mineral density score (T-Score) as -1.0 or higher, -1.0 to -2.5 for osteopenia, and -2.5 or lower for osteoporosis. It is believed that the lower the bone mass, the higher the fracture risk. Since many factors such as genetic background and age affect individual bone quality, the Fracture Risk Assessment Tool, FRAX, has become a more accurate way to measure 10-year fracture probability.

Signs and Symptoms of osteoporosis

Osteoporosis by itself does not cause pain or any other symptoms. In fact, many patients are only diagnosed after having a fall and fracture. The pain is usually experienced due to changes in posture and muscle weakness causing imbalance and decreased flexibility and activity level.

Below are the common symptoms associated with osteoporosis:

• Back pain: Episodic, acute low thoracic/high lumbar pain
• Compression fracture of the spine
• Bone fractures
• Decrease in height
• Kyphosis
• Dowager’s hump
• Decreased activity tolerance
• Early satiety

Many diseases increase an individual’s risk of osteoporosis:

• Eating disorders
• Cancer and cancer treatment
• Chronic renal failure
• Osteogenesis imperfect
• Rheumatic diseases
• Chronic pulmonary disease
• Cushing’s Disease
• Male hypogonadism
• Hypothyroidism
• Hyperparathyroidism
• Type 2 Diabetes Mellitus
• Gastrointestinal Disease
• Hepatic disease

How can Physiomobility team help?

Whether you have been diagnosed with Osteoporosis, had a fall, or have concerns about your balance, taking a proactive step toward prevention or treatment is absolutely the right action to take. With our osteoporosis program, we have undertaken a collaborative approach to addressing these needs.

The physiomobility team of physiotherapists, Exercise therapists, Massage therapists and  registered dietician work collaboratively to manage the pain experienced, minimize the effects of osteoporosis and osteopenia, prevent fractures and educate patients for proper diet and supplements. More severe cases of osteoporosis would require medical intervention in the form of medication to minimize bone loss and optimize Calcium uptake by bones.

Physiotherapy for osteoporosis

Physiotherapy for individuals with osteoporosis or osteopenia includes treating pain and symptoms but mainly is focused on exercise routines by our physiotherapists and Kinesiologists and commonly include:

• Weight-bearing exercises such as walking, hoping to increase loading on tall bones and increase calcium uptake
• Flexibility exercise to improve individuals physical function and postural control and minimize the risk of falls
• Strengthening exercise using light weights to increase traction of bones and improve muscle strength.
• Postural exercise to prevent changes due to compression of vertebrae and causing thoracic kyphosis. The exercise program includes spinal extension exercises such as; chin tucks, scapular retraction, and hip extensions. Flexion exercises are contraindicated for individuals with osteoporosis since it increases the risk of vertebral compression fractures.
• Core stability exercises that include lower back and hip muscle strengthening to create a strong foundation and prevent falls
• Balance exercise

Dietary Management

Diet rich in calcium is proven to have a direct correlation to bone growth. As we age, our bones’ ability to absorb calcium diminishes which increases the risk of developing osteoporosis. By including a variety of calcium-rich foods, such as milk, cheese, almonds, broccoli, and cauliflower you can make sure that you are getting the amount of calcium that your bones need. It is also recommended that a person with osteoporosis should not have a high-protein diet. When the kidneys flush out excess protein they also flush out calcium. Caffeine is also known to inhibit calcium absorption. Other vitamins that are recommended to retain bone strength are vitamins D and K and fish oil.

Our registered dietician can assist you to learn about your conditions and dietary needs and also the right amount of supplements to manage your condition successfully.

Summary

Osteoporosis is a condition where there is a thinning of bones and they become brittle and fragile leading to increased risk of fractures, cracks, and breaks compared to normal bones. It occurs when less calcium is deposited in the bone and more is taken out from the bones. This leads to honeycombing of the bones leading to reduced bone density.

Osteoporosis is generally pain-free and has no major symptoms in the early stages. Therefore it can go undetected until it is progressed to a degree that causes a fracture. There are some signs that may indicate a problem with bony structures and when investigated, can confirm a diagnosis of Osteoporosis These include:

• Backache usually due to a compressed fracture of vertebrae
• Fractures of the hip, wrist or spine
• Loss of height
• Stooped posture

The risk of osteoporosis increases with the following

• Old age
• Menopause
• Overactive parathyroid or thyroid glands
• Chronic kidney or liver disease
• Cancers
• Diabetes
• Lack of exercise
• Smoking
• Alcohol consumption
• Lack of calcium in the diet
• Lack of exposure to sunlight leading to deficiency of vitamin D
• People with smaller structure are more prone to developing osteoporosis as there is not a lot of weight on their bones

A physiotherapist can work with you and create an individualized exercise plan that includes regular resistance and weight-bearing exercises that help in the production of new bones.

Common Treatment Options

• Medication to regulate calcium uptake and deposit in the bones such as Bisphosphonates
• Parathyroid hormone
• Vitamin D and calcium supplements
• Testosterone treatment
• Selective estrogen receptor modulator
• Hormone replacement therapy
• Clinical Yoga and Pilates with a qualified instructor

Weight-bearing exercises such as walking and light weight resistance exercises are one of the most important factors in managing and even reversing osteoporosis in early stages. Postural exercises are a major part of exercises for osteoporosis. When the diagnosis of osteoporosis is confirmed, a physiotherapist can also help you to monitor for signs of possible fracture and provide treatment for pain and return to normal activities.

A Physiotherapist can help to manage complications related to Osteoporosis

At Physiomobility, we have a team of qualified professionals who offer specialized treatment for various musculoskeletal conditions. Whether you have a chronic medical condition, such as arthritis, or you have experienced a sports injury, or suffer from dizziness and vertigo our experienced physiotherapists will provide you personalized treatment, offering you relief from pain and discomfort and enabling you to get back to your usual activities quickly