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Osteoporosis | Image Credit: "Dlx3 deletion in osteoblast progenitors induce increased trabecular bone formation " by National Institutes of Health (NIH) is licensed under CC BY-NC 2.0
Osteoporosis | Image Credit: "Dlx3 deletion in osteoblast progenitors induce increased trabecular bone formation " by National Institutes of Health (NIH) is licensed under CC BY-NC 2.0

May is Osteoporosis Awareness Month.

Did you know that Physical Therapists are an essential member of your interdisciplinary care team?

With life expectancy increasing it is becoming more evident that bone health and fall prevention are key to a good quality of life. Osteoporosis is defined as a decrease in bone mass or a change in the structure of the bone causing the bone to be more fragile.1 If the bone is weak there is a higher chance of a fracture (bone break). The most common areas of fractures are the hip, spine, forearm, and humerus (upper arm bone). Osteoporosis causes more than 8.9 million fractures annually worldwide, affecting predominantly postmenopausal women. The probability of women, at menopause, of having an osteoporotic fracture exceeds that of breast cancer and the likelihood of a fracture is approximately 40%.2

Bone mineral density is measured through a scan called a Dual-Energy X-ray Absorptiometry (DEXA). It can be used to measure the bone mineral density of the whole skeleton as well as specific sites. Approximately 21% of women aged 50–84 years are classified as having osteoporosis.2

Risk factors for osteoporosis are:

  • Sex--Women are more likely to develop osteoporosis
  • Age--risk increases with age
  • Race--Caucasian and Asian descent have a higher chance
  • Family History--having a parent or sibling with osteoporosis
  • Body frame--smaller frames have a higher chance as they have less bone to draw from as they age
  • Lowered sex hormones ie. postmenopausal women with decreased estrogen
  • Increased thyroid hormones can increase risk
  • Low calcium intake
  • Long term use of corticosteroids
  • Certain medical conditions have a higher chance of developing osteoporosis
    • Celiac disease
    • Inflammatory bowel disease
    • Kidney or liver disease
    • Cancer
    • Multiple myeloma
    • Rheumatoid arthritis
Osteoporosis and Bone Health |Image Courtesy of Mehmet Turgut Kirkgoz via Unsplash

Additionally, lifestyle choices can affect the risk of developing osteoporosis:

  • Sedentary lifestyle: Patients that are confined to a bed can lose as much bone in one week that they would otherwise lose in a whole year.2 For thisreason, it is always important to be as active as possible. The most beneficial exercises are weight-bearing exercises that focus on balance and good posture--and physical therapists are your ideal health care partner to address these needs.
  • Excessive alcohol consumption: More than two alcoholic drinks a day increases the risk of osteoporosis.
  • Tobacco use: Tobacco is a toxin to bone and regular use can lead to weak bones.

The important take-home message is to try and modify the risk factors that you have control over, especially if you have genetic factors or medical conditions that increase your risk. The consequence of having osteoporosis is a higher chance of developing a fracture. An osteoporotic fracture can be characterized if it results from a low-energy fall. Low energy is defined as a fall from a standing height or less, or trauma that in a healthy individual would not cause a fracture.3 It is important to understand your fall risk and make sure to modify factors to increase your safety and prevent a fall. A physical therapist has a variety of fall risk assessment tests they can administer to provide patients with a quantifiable measure of their fall risk. A physical therapist can also provide a specific exercise program that is individualized based on the type of balance deficit found on your initial or subsequent visits. It is also important to modify the home environment for safety.

Modifiable factors for fall risk:

  • Increasing lighting at night: night lights or turning the light on when using the restroom
  • Speaking with your doctor about decreasing or changing medications that alter balance and alertness
  • Removing all rugs (as these can be a tripping hazard)
  • Use of handrails next to steps
  • Removing all obstacles and items off the floor
  • Slippery floors5
Osteoporosis and Bone Health | Image Courtesy of Owen Beard via Unsplash

How can you prevent osteoporosis?

Primary prevention of osteoporosis:

The goal is to reach your maximal bone mass and decrease the loss of bone in the early adult years. Women usually reach their peak bone mass at age 30

Secondary prevention:

The focus is to prevent fractures in women who have osteopenia or osteoporosis. Most of the women in this stage are considered peri or postmenopausal.

Tertiary prevention:

In this strategy the goal is to prevent future fractures in women who have already had at least one fracture.

There is extensive evidence supporting exercise to improve bone health and balance performance. Although, it has been shown that excessive rigorous training and restrictive diets in elite athletes can have detrimental effects on bone density. Several different types of exercise have been shown to be beneficial for maintaining and even improving bone density. A large study used specific yoga postures that were modified to be safe with patients that have osteoporosis. Some of these adaptations were avoiding end range of motion for the hips and spine. After the participants participated in a 12 min yoga routine for two years they measured increased bone density in the spine, hips and femur.8 A meta-analysis of exercise interventions--resistance-alone versus combined resistance training with high impact weight-bearing exercise--was compared. The results of the study suggest the combined intervention was most effective at improving bone mineral density at the hips and lower spine.9 Pilates can also be an effective exercise to increase bone mass in postmenopausal women when compared to a control group without an exercise program.10

References

  1. Hernlund E, Svedbom A, Ivergård M, Compston J, Cooper C, et al. (2013) Osteoporosis in the European Union: medical management, epidemiology and economic burden a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 8: 136
  2. Strom O, Borgstrom F, Kanis JA, Compston JE, Cooper C, McCloskey E, Jonsson B (2011) Osteoporosis: burden, health care provision and opportunities in the EU. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos doi:10.1007/s11657-011-0060-1
  3. Kanis JA, Johnell O, Oden A, Dawson A, De Laet C, Jonsson B (2001) Ten year probabilities of osteoporotic fractures according to BMD and diagnostic thresholds. Osteoporos Int 12:989–995
  4. Bonaiuti D, Shea B, Iovine R, Negrini S, Robinson V, Kemper HC, Wells G, Tugwell P, Cranney A (2002) Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev CD000333
  5. Michael YL, Whitlock EP, Lin JS, Fu R, O'Connor EA, Gold R (2010) Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med 153:815–825
  6. Rizzoli R (2008) Nutrition: its role in bone health. Best Pract Res Clin Endocrinol Metab 22:813–829
  7. Kanis JA, Oden A, Johnell O, De Laet C, Jonsson B, Oglesby AK (2003) The components of excess mortality after hip fracture. Bone 32: 468–73
  8. Lu, Yi-Hsueh PhD; Rosner, Bernard PhD; Chang, Gregory MD, PhD; Fishman, Loren M. MD, B Phil (oxon.) Twelve-Minute Daily Yoga Regimen Reverses Osteoporotic Bone Loss, Topics in Geriatric Rehabilitation: April/June 2016 - Volume 32 - Issue 2 - p 81-87 doi: 10.1097/TGR.0000000000000085
  9. Zhao, R., Zhao, M. & Xu, Z. The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis. Osteoporos Int 26, 1605–1618 (2015). https://doi.org/10.1007/s00198-015-3034-0
  10. Angın, Ender, Erden, Zafer, and Can, Filiz. ‘The Effects of Clinical Pilates Exercises on Bone Mineral Density, Physical Performance and Quality of Life of Women with Postmenopausal Osteoporosis’. 1 Jan. 2015 : 849 – 858.
  11. “Osteoporosis.” Mayo Clinic, Mayo Foundation for Medical Education and Research, 21 Aug. 2021, https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968.

What Our Patients Have to Say

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Testimonial by M.N., age 28

A personal journey and testimonial from one of my patients:

I was diagnosed with vaginismus 4 years ago. I never heard of such medical condition until after I got married. At first my husband and I didn't know what to do, we didn't know what the issues were or how to overcome it. Being born and raised in Armenia and being Christian I wasn't that open about talking to sex with others and so it wasn't easy to seek help. But eventually I went to an Ob-Gyn and luckily she knew about the medical condition (not many doctors know). She referred me to a physical therapist and I couldn't believe it and thought it's something I can handle myself. I ordered a kit from vaginismus.com and started practicing with dilators. There was some small progress but wasn't much helpful.

Read more: Testimonial by M.N., age 28

Testimonial by R.S.

I wanted to thank you so much for helping me get through something I thought I may never be able to. We have achieved pain-free intercourse and this has really solidified our marriage. We are so grateful to you for all the work you do! Thank you!!

-- R.S.

Testimonial by Mary L.

I started seeing Heather to treat my Interstitial Cystitis in November 2016. At this time, I was extremely miserable, in constant pain, and felt as though no one was listening or understood what was going on with my body. I have just finished my last appointment and I can honestly say that my life has completely changed for the better because of Heather and her team of PTs! I live almost completely pain free, and when I do have flare ups, I am able to treat them at home on my own. I am so grateful that this office was recommended to me a honestly cannot recommend them enough!

Read more: Testimonial by Mary L.

Testimonial by A.W., age 32

I wanted to let you know that my pelvic floor held strong and gave me no trouble whatsoever in my trail race this morning (12 miles)! In a way, I felt like I ran better than ever because my core feels so rock solid from all the exercises you have me doing. That was especially valuable on the technical downhill - I just flew down the trail because I had confidence in my balance and form. Thank you for helping me get back to doing what I love.

-- A.W., age 32
(completed Post-partum Renewal Program using the InTone biofeedback/stim unit)

Testimonial by Lauren B.

Femina PT (née Fusion Wellness & Physical Therapy) has been such an answer to prayer, i'm so glad I found them! I've been struggling with vaginismus my whole life, but didn't have a name for it until about 6 or 7 months ago. Even once I did have a name for it though, I didn't know where to begin in getting help. My OB/GYN had me get a set of dilators, but I couldn't even insert the smallest one by myself. Most times I tried I just ended up frustrated and in tears. I felt really alone, like I was broken and didn't have the energy to keep trying. When I got engaged a few months ago though, I realized I needed to get answers so i wasn't dreading my honeymoon.

Read more: Testimonial by Lauren B.

Testimonial by S.H., age 24

I just wanted to thank you for everything you've done for me for the past 19 months. I literally could not have reached my goals without you and your practice. You gave me the courage to keep moving forth with my treatment no matter how afraid and anxious I was. You were always there to answer questions and made this whole process so much easier than I expected it to be.

It's because of you that my marriage is on the right track, that I can get pregnant and that this part of my life is finally over. I really feel that Fusion Wellness is a team of people you can call family and are there to root for you and cheer you on until you reach your goals. There is nothing better than knowing I accomplished this with you guys by my side and as calmly and patiently as I needed. Thank you from the bottom of my heart for always being there and helping me reach my goals.

S.H., age 24

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