Osteopenia (Low Bone Mass)
What is Osteopenia (Low Bone Mass)?
Low bone mass is a condition that develops when a person:
May naturally have less-dense bones due to factors such as body size, genetics, or gender.
Has gradually lost bone mass over time due to lack of exercise and poor diet.
Has begun to experience perimenopause, symptoms that signal the onset of menopause or who is in menopause.
Has rapidly lost bone mass due to an illness or use of medication.
How Does it Feel?
There are no specific symptoms oflow bone mass. You may have the condition and not know it. It is important to recognize your risk factors to prevent bone fracture. You should discuss any concerns with your health care provider and physical therapist.
How Is It Diagnosed?
Low bone mass is diagnosed through a quick and painless specialized scan ordered by aphysician. If you are seeing a physical therapist for rehabilitation, the therapist may confer with your physician when detecting a possible need for bone testing.
The results of the scan are reported using T- and Z-scores.
The T-score compares your score to that of healthy 30-year-old women. A T-score between -1 and -2.49 means that you have low bone mass. Those who have a T-score of -2.5 and lower have osteoporosis.
If you have a T score of -1 or less, you have a greater risk of experiencing a fracture. A person with a T-score of -2 has lower bone density than a person with -1.
The Z-score compares your bone mineral density to the average of peoplewho are of the same age, sex,weight,and race as you. A Z-score of -2 or lower might mean that something other than normal bone loss due to age is occurring. Your doctor will likely explore other health issues that might be causing the bone loss.
Other methods of screening bone density include x-ray, ultrasound, and CT scan.If you have risk factors that includecertain diseases, short- or long-term use of steroids, or a recent bone fracture, a DXA scan may be prescribed.
How Can a Physical Therapist Help?
A physical therapist can help you prevent and treat low bone massat any age by prescribing the specific amount and type of exercise that best builds and maintains strong bones.
When you see your physical therapist, the therapist will review your health history, including your medical, family, medication, exercise, dietary, and hormonal history. Your physical therapistwill also conduct a complete physical therapy examination and identify your risk factors for low bone density.
It is important to exercise throughout life, and especially when you have been diagnosed with low bone mass in order to build and maintain healthy bones. Exercise can help to build bone or slow the loss of bone.
Your physical therapist is likely to prescribe 2types of exercise that are best to build strong bones:
Walking at a quick pace (122-160 steps per minute or 2.6 steps per second)
Jumping, stomping, heel drops
Running at least a 10-minute mile
Use of resistance bands
Gravity-resistance exercises (pushups, yoga, stair climbing, etc.)
Your physical therapist will design an individual exercise program for you based on your particular needs. Your physical therapist will test you to see how much resistance is needed and is safe for your specific bone density as well asother physical issues that you may have. Treatment starts at the level you can tolerate. Once you learn how to perform your program, your physical therapist may add more strenuous activity with physical effort to encourage your bones to grow stronger.
Your exercise prescription will include guidelines for weightbearing and resistance training for the hips, spine, shoulders, and wrists. The therapist will prescribe guidelines for the intensity, frequency, and progression of your exercises.
Exercise is only 1component of healthy bones. Your physical therapist will encourage you to pursue a healthy and varied diet, including foods rich in calcium, to reach the amount recommended according to your age and health status. Your physical therapist may recommend that you meet with a dietitian to learn about the many foods that contribute to bone health. Sometimes, medication or hormone replacement therapy may be recommended. Your physician will help guide you to find the best combination of exercise, diet, and medication to treat your condition.
Can this Injury or Condition be Prevented?
Risk factors that you can avoid in order to lower your chances of developing low bone mass include:
Excessive alcohol intake (greater than 1 drink per day for women, 2 per day for men)
Low calcium and Vitamin D levels
Sedentary or low level activity—less than 5,000 steps per day
Real Life Experiences
Allison is a 49-year-old woman in good health. Allison stays active and walks daily. She also occasionally takes a yoga class. Over the past few months, however, she has noticed that when she coughs, she experiences a bit of urinary incontinence. She decides to call her physical therapist.
At her first physical therapy visit, Allison’s physical therapist performs an assessment that includes a medical review for health issues and risk factors, and takes her exercise history. Allison’s physical therapist conducts a physical assessment. She notes that Allison has a slight increase in the rounding of her upper back. She also assesses the muscle strength of Allison’s trunk and pelvis as well as that of her hips and lower extremities. She measures her joint motions for her neck, trunk, arms, and legs. She watches how Allison moves and lifts objects.
Although Allison is not a postmenopausal woman, the typical picture of someone with low bone mass, her physical therapist notes that Allison may be at risk for having low bone mass because of the risk factors uncovered during the health assessment. She has a family history of osteoporosis, late onset of menstruation, and low body weight. The physical therapist also notes that although Allison is active and does exercise quite a bit, it is not the best form of activity to help maintain her bone density.She contacts Allison’s primary care physician; he orders a DXA scan.
Allison’s DXA scan report indicates that she has low bone mass. Her physical therapist designs a plan to treat her incontinence, and adds a separate exercise treatment program to help increase her bone mass.
Her physical therapist shares resources with Allison on where to find good dietary information and learn more about necessary calcium and Vitamin D supplementation.
Allison commits to a regular weight-lifting program, beginning with the amount of weight recommended by her physical therapist, and rigorous aerobic exercise.
Allison discovers that she actually enjoys working with weights, and really likes the idea of getting stronger. She attends sessions with her physical therapist to ensure she is performing her exercises properly, and to learn how to safely increase her exercise program. She continues to practice her exercises daily at home and at her community gym.
Allison returns 1 month later to see her physical therapist, who shares the good news that she sees measured improvements in Allison’s strength and endurance. Allison continues to work with her physical therapist to treat her incontinence, which is a separate condition.
Allison’s course of physical therapy to improve her bone mass ends with the understanding that she will continue to work out at her community gym, and will follow up with her physician to monitor her bone-density levels in the future.