Osteoporosis

The word ‘osteoporosis’ means ‘porous bone.’ It is a disease that causes bones to become weak and brittle — so brittle that a fall or even mild stresses such as bending over or coughing can cause a fracture. Osteoporosis increases the risk for sudden and unexpected bone fractures. It means that you have less bone mass and strength. The disease often develops without any symptoms or pain, and it is usually not discovered until the weakened bones cause painful fractures. Most of these are fractures of the hip, wrist and spine.

Bone is living tissue that is constantly being broken down and replaced. Osteoporosis occurs when the creation of new bone doesn't keep up with the loss of old bone.

Symptoms

There typically are no symptoms in the early stages of bone loss. But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include:

• Back pain, caused by a fractured or collapsed vertebra
• Loss of height over time
• A stooped posture
• A bone that breaks much more easily than expected

Causes

Your bones are constantly being renewed — new bone is formed and old bone is broken down. When you're young, your body creates new bone faster than it degrades old bone, so your bone mass grows. This process slows after the early twenties, and most people reach their peak bone mass by the age of thirty. Bone mass is lost faster than it is created as people age.

How likely you are to develop osteoporosis depends partly on how much bone mass you attained in your youth. Peak bone mass is partly inherited and varies also by ethnic group. The higher your peak bone mass, the more bone you have "in the bank" and the less likely you are to develop osteoporosis as you age.

Predisposing factors

 A number of factors can increase the likelihood that you'll develop osteoporosis — including your age, race, lifestyle choices, and medical conditions and treatments.

Unchangeable risks

Some risk factors for osteoporosis are out of your control, including:

• Your sex. Women are much more likely to develop osteoporosis than are men.
• Age. The older you get, the greater your risk of osteoporosis.
• Race. You're at greatest risk of osteoporosis if you're white or of Asian descent.
• Family history. Having a parent or sibling with osteoporosis puts you at greater risk, especially if your mother or father fractured a hip.
• Body frame size. Men and women who have small body frames tend to have a higher risk because they might have less bone mass to draw from as they age

Medical conditions

Some medical conditions and medications increase your risk. If you have or had any of the following conditions, some of which are related to irregular hormone levels, you and your healthcare provider might consider earlier screening for osteoporosis.

• Overactive thyroid, parathyroid, or adrenal glands.
• History of bariatric (weight loss) surgery or organ transplant.
• Hormone treatment for breast or prostate cancer or a history of missed periods.
• Celiac disease or inflammatory bowel disease.
• Blood diseases such as multiple myeloma.

Some medications cause side effects that may damage bone and lead to osteoporosis. These include steroids, treatments for breast cancer, and medications for treating seizures.

Dietary factors

Osteoporosis is more likely to occur in people who have:

• Low calcium intake. A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.
• Eating disorders. Severely restricting food intake and being underweight weakens bone in both men and women.
• Gastrointestinal surgery. Surgery to reduce the size of your stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. These surgeries include those to help you lose weight and for other gastrointestinal disorders.

Lifestyle

People who lead sedentary (inactive) lifestyles have a higher risk of osteoporosis.

Tobacco use: Smoking increases the risk of fractures.

Alcohol use: Having two drinks a day (or more) increases the risk of osteoporosis.

Diagnosis of Osteoporosis

Your healthcare provider can order a test to give you information about your bone health before problems begin. Bone mineral density (BMD) tests also known as dual-energy X-ray absorptiometry (DEXA or DXA) scans. These X-rays use very small amounts of radiation to determine how solid the bones of the spine, hip or wrist are. Regular X-rays will only show osteoporosis when the disease is very far along.

All women over the age of 65 should have a bone density test. The DEXA scan may be done earlier for women who have risk factors for osteoporosis. Men over age 70, or younger men with risk factors, should also consider getting a bone density test.

When should osteoporosis be treated with medication?

Women whose bone density test shows T-scores of -2.5 or lower, such as -3.3 or -3.8, should begin therapy to reduce their risk of fracture. Many women need treatment if they have osteopenia, which is bone weakness that is not as severe as osteoporosis. Your doctor might use the World Health Organization fracture risk assessment tool, or FRAX, to see if you qualify for treatment based on your risk factors and bone density results. People who have had a typical osteoporosis fracture, such as that of the wrist, spine or hip, should also be treated (sometimes even if the bone density results are normal).

Treatment

Treatment recommendations are often based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If your risk isn't high, treatment might not include medication and might focus instead on modifying risk factors for bone loss and falls.

Bisphosphonates

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates.

Physical Therapy Management

Physical therapy intervention for individuals with osteoporosis, or even osteopenia, should include:

1. Weight-bearing exercises

• Exercises such as walking or hopping, has been shown to maintain or improve bone density in this population
• Strengthening exercises, using weights or resistance bands, have also been shown to maintain or improve bone density at the location of the targeted muscle attachments
• Maintaining bone health in this population is extremely important, especially in the elderly as there is typically has a decline in bone mass with age

1. Flexibility and strengthening exercises

 These can help improve the individual's overall physical function and postural control.

1. Postural exercise

• These are crucial to prevent structural changes that often accompany osteoporosis, such as thoracic kyphosis
• Every osteoporosis program should include extension exercises; chin tucks, scapular retractions, thoracic extensions, and hip extensions
• Strengthening the extensor muscles will promote improved posture and improved balance
• Flexion exercises are contraindicated especially in patients with a risk of a spinal fracture. Anterior compressive forces to the vertebra can contribute to compression fractures. Flexion and twisting place a high compressive load on the vertebral bodies, these high levels should be avoided

1. Education - top tips easily given to clients

• Follow a healthy diet that includes enough calcium and Vitamin D
• Wear sensible, well-fitting shoes to avoid falls
• Avoid rugs and sloppy slippers – both can cause trips
• Have good lighting on stairs
• Get eyesight checked regularly
• Try to avoid heavy lifting – consider home delivery grocery shopping

1. Prescription of balancing exercises
2. Back pain

• Physiotherapists may treat patients with osteoporosis for back pain
• Agility training, resistance training, and stretching have all been shown to decrease back pain and its related disabilities in this population

General management

The condition has many risk factors and is best managed by an inter- professional team of healthcare workers.

Patient education is vital as many are unaware of the serious consequences of the disorder. Early prevention can help reduce the high morbidity.

Attending physiotherapy for exercise prescription and participation in a supervised exercise programme is recommended

Patients should be urged to modify their lifestyle and remain compliant with the medications prescribed

The patient should be urged to quit smoking and abstain from alcohol

The dietitian should educate the patient on a calcium-rich diet and the need to take vitamin D supplements

The pharmacist should assist the team by educating the patient about the benefits of bisphosphonates and their adverse effects

Women over the age of 65 should be urged to have a bone density scan