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What is Osteoporosis?

Osteoporosis is a bone disease characterized by low-bone density (thickness of the bone), decreased bone strength, and a change in the bone structure, which can lead to an increased risk of fracture. The normal bone structure becomes thinned out and porous, lessening the ability of the bone to withstand the typical forces that are applied in everyday living. Fractures from osteoporosis and low-bone density can be serious, causing pain and affecting your quality of life.

Bone is living tissue. Normally, one type of cell removes bone and another type of cell adds bone in a balanced, ongoing process. In osteoporosis, bones weaken when not enough new bone is formed and/or too much bone is lost. This imbalance commonly begins in women during the first 5 years of menopause. However, it can also occur in men and in children, often due to diseases that affect bone development, such as Celiac disease, inflammatory bowel disease, rheumatoid arthritis, spina bifida, cystic fibrosis, or kidney disease. Some medicines, such as steroids, may increase your risk for developing osteoporosis. Athletes who are underweight during the time of peak bone development are also susceptible.

There are many factors that can cause a person to be at risk for developing the disease. It is important to know your risks so that you can be diagnosed and proactive in your treatment.

Risk Factors for Osteoporosis

Noncontrollable Risks

Female gender
Small frame
Advanced age
Hormone levels
Predisposing medical conditions

Controllable Risks

Cigarette smoking
Excessive alcohol intake
Inactive lifestyle
Excessive caffeine intake
Lack of weight-bearing exercise
Drugs (eg, steroids, heparin)
Poor health
Low weight
Calcium-poor diet
Low vitamin D levels

How Does it Feel?

Osteoporosis is a disease that can be “silent,” and there may be no outward symptoms until a fracture occurs. If you are middle-aged or older, you may notice a loss of height or the appearance of a humpback, although this is not a diagnosis for osteoporosis in and of itself. Fractures may occur in situations that would not occur in persons with healthy bones, such as breaking an ankle after stepping off a curb, breaking a hip with a fall, or breaking a rib when opening a window. These are called fragility fractures and are a red flag for bone disease. Spinal compression fractures, particularly those in the upper back or thoracic spine (area between the neck and the lower back), are the most common fractures, followed by hip and wrist fractures.
How Is It Diagnosed?
If you are seeing a physical therapist for back pain or other rehabilitation issues, he or she will review your medical, family, medication, exercise, dietary, and hormonal history, conduct a complete physical examination, and determine your risk factors for osteoporosis. The assessment may lead the therapist to recommend further testing.

Osteoporosis is best diagnosed through a quick and painless specialized x-ray called the DXA, which measures bone density. The results are reported using T-scores and Z-scores.

The T-score compares your score to that of healthy 30-year-old adults. If you have a T-score of -1 or less, you have a greater risk of having a fracture.
The Z-score compares your bone mineral density to those of the same sex, weight, and age. It is used for those whose bone mass has not yet peaked, premenopausal women, and men older than 50.
Other methods of measuring bone density include x-ray, ultrasound, and CT scan.
How Can a Physical Therapist Help?
Your physical therapist can develop a specific program based on your individual needs to help improve your overall bone health, keep your bones healthy, and help you avoid fracture. Your physical therapist may teach you:

Specific exercises to build bone or decrease the amount of bone loss
Proper posture
How to improve your balance so as to reduce your risk of falling
How to adjust your environment to protect your bone health
Healthy bone is built and maintained through a healthy lifestyle. Your physical therapist will teach specific exercises to meet your particular needs.

The exercise component for bone building or slowing bone loss is very specific and similar for all ages. Bone grows when it is sufficiently and properly stressed, just as muscle grows when challenged by more than usual weight. Two types of exercise are optimal for bone health, weight-bearing and resistance.

It is best for a physical therapist to provide your individual bone-building prescription to ensure that you are neither over- or under-exercising. Typically, exercises are performed 2 to 3 times a week as part of an overall fitness program.

Weight-bearing exercises
Racquet sports
Heel drops

Resistance exercises
Weight lifting
Use of exercise bands
Water resistance
Gravity resistance (eg,push-ups, sustained yoga poses)

If you are diagnosed with osteoporosis or low-bone density, your physical therapist will work with you to:

Build bone or lessen the amount of bone loss at areas most vulnerable to fracture through exercise—hip, spine, shoulder, arms
Improve your dynamic balance to avoid falls
Improve your posture and your work and living environments
Help you avoid exercises and movements that may contribute to spinal fracture, including any type of sit-up or crunch, and excessive spinal or hip twisting
Conservative treatment of a fracture includes bed rest and appropriate pain medication. Your physical therapist will work with you to:

Decrease your pain through positioning and other pain-relieving modalities
Provide appropriate external devices, such as bracing, to promote healing and improve posture
Decrease your risk of a fall, strengthen your muscles, and improve your postural alignment
If your pain lasts longer than 6 weeks following a fracture, you can discuss surgical options with the physical therapist, primary care physician, and surgeon.

For children and adolescents, physical therapists can educate families and youth groups on proper exercise, posture, and the need to move daily. Children with health issues such as spina bifida, diabetes, Crohn’s disease, and cerebral palsy are at a greater risk for bone disease and can particularly benefit from the guidance of a physical therapist. The majority of bone is built during adolescence and peaks by the third decade of life.

If you are middle-aged and older, youmay begin to notice postural, balance, and strength changes. Your physical therapist will work with you to:

Optimize your exercise program to promote bone growth or lessen bone loss
Improve your dynamic balance to avoid falls
Improve your posture
Improve the strength of your back muscles
Improve your hip strength and mobility

Can this Injury or Condition be Prevented?

Osteoporosis can be prevented by building adequate bone density through childhood, adolescence, and early adulthood. Building strong bones requires an adequate intake of calcium and vitamin D, and regular exercise.

There are steps to take to improve bone health at any age. An active lifestyle that includes resistance and weight-bearing exercise is important to maintain healthy bone. It is also important to avoid habits that promote bone loss, such as smoking, excessive alcohol consumption, and an inadequate intake of calcium in your diet. Maintaining good body mechanics and posture also contribute to good bone health. We have no control over the genetic tendencies we have inherited, but we can choose to manage osteoporosis through proper medication, diet, and appropriate exercise

As with any health issue, an overall healthy lifestyle is important for staying well.

Real Life Experiences

Anna is 69 years old and has a history of breast and ovarian cancer. She has had a total knee replacement due to arthritis. She walks with a cane because of chronic knee and ankle pain, and she has experienced a loss of balance. She has a very rounded upper back, and low back pain. She is seeking the help of a physical therapist.

Anna’s physical therapist performs an assessment that includes a medical review for other health issues and osteoporosis risk factors. He evaluates her range of motion and strength, testing her arms, legs, and trunk, especially her upper back. He tests the flexibility of her spine and her balance, walking ability, and risk of falling. Anna’s walking style is uneven and she leans heavily on her cane. A DXA scan reveals that Anna has lost bone density in her spine and both hips. An x-ray shows that she has painless compression fractures of her spine. Her physical therapist diagnoses osteoporosis of the spine, and he photographs her posture for future comparison.

Anna first works with her physical therapist to improve her posture and knee function through flexibility and strengthening exercises, so she can walk more normally while working on her balance to lower her fall risk. He teaches her safe trunk movement to avoid spinal fracture. Anna agrees to wear a dynamic trunk brace 2 hours a day to help make her posture more upright. She practices weight-bearing exercises with considerations for her arthritis, and she is also given resistive strengthening exercises for her spine and hip. Anna’s physical therapist designs a gentle home exercise program for her as well.

By her last visit, the flexibility and strength of Anna’s trunk and legs and her tolerance of physical activity has improved. The quality of her walking and dynamic balance is measurably improved, and her risk of falling has decreased. Anna feels more confident about managing her condition, and she looks forward to new life experiences.

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