Osteoporosis

Osteoporosis is a condition characterized by a decrease in bone density, making bones more susceptible to fractures. Over 70% of those aged 80 and above are affected with this condition, and is 3 to 4 times more common in females than in males.

What is Osteoporosis?

Osteoporosis is a chronic, progressive disease of multifactorial etiology. It is often referred to as the 'silent ailment' due to the absence of pain during the gradual loss of bone mass. The true extent of the issue only becomes evident when a fracture occurs. Frequently, individuals may remain unaware of their osteoporosis until a minor incident, such as a small stumble or fall, leads to a fracture, highlighting the underlying problem. Osteoporotic fractures lead to a significant decrease in quality of life, with increased morbidity, mortality, and disability. Osteopenia is a medical term used to describe a condition where there is a decrease in the protein and mineral levels within bone tissue, although not to the same extent as seen in osteoporosis.

Decreased production of estrogen as seen in postmenopausal women is one of the primary types of osteoporosis. This population commonly lose about 1% of bone density per year after reaching its peak. On the other hand, age-related bone loss with advanced age is called senile osteoporosis. Low calcium intake or absorption greatly increases the risk of developing this condition. It might be worth noting that excessive consumption of cigarettes and alcohol reduces our body’s ability to absorb calcium. The human body is incredible, our bones respond to the load that is applied onto it. Those who have a sedentary lifestyle would typically have lower bone density compared to those who are physically active. 

A few more risk factors would include family history, smaller body frames, hormonal levels (thyroid problems, estrogen, etc.), and dietary factors. Long term use of oral or corticosteroids interferes with our bone-building process. Bad habits and lifestyle choices also puts us at a greater risk for developing osteoporosis.

How would I know if I have Osteoporosis?

If you or your general practitioner have concerns about potential bone density reduction, they might recommend consulting a specialist for a Dexa scan, which assesses your bone density. The results of this scan will provide a 'T score,' indicating whether your bone density is within the normal range, suggests osteopenia (lower bone density), or indicates osteoporosis (severe bone density reduction).


This 'T score' is a crucial factor in evaluating your fracture risk. It is quite rare that physical examination would reveal any changes from decreased bone density until it is advanced; some would present with loss of height, kyphosis or stooped posture; advanced clinical presentations may include lower back pain, decrease in height, decreased activity tolerance, and compression fractures of the spine or other bones. It is recommended that individuals without the associated risk factors be screened for osteoporosis at the age of 65.

Is Osteoporosis preventable?

Yes! With good nutrition, proper and regular exercise, and dietary management are all key factors to help us fight osteoporosis. Men and women of all different ages have varying nutritional needs. We shall look into the role of calcium and vitamin D. Wonderful sources of calcium include low-fat dairy, dark green leafy vegetables, soy products, and calcium-fortified meals or drinks. On the other hand, vitamin D improves the body’s ability to absorb calcium. As you know, you can get it from sunlight. Those with mobility issues and regularly use sunscreen might not be able to get enough vitamin D. Some consider taking supplements to support their dietary needs. Please remember to consult your healthcare professional for advice to truly get what we need.

Meanwhile, research has shown and supports the evidence that high intensity training in the prevention of bone density loss in women postmenopausal years. We will get to the exercises that we suggest in the next section of this post.

However, once an individual is diagnosed with osteoporosis, doctors may recommend taking medications. Medications for osteoporosis play a role in enhancing bone density. They can substantially decrease the occurrence of fractures. To illustrate, these medications can lead to a bone density increase of roughly 1-3% in the hip and 4-8% in the spine during the initial 3-4 years of treatment. Notably, these medications have the potential to decrease spinal fractures by about 30-70% and hip fractures by 30-50%. Encouragingly, a positive impact can often be observed as early as 6 to 12 months after initiating treatment.

How can Physiotherapy Help Osteoporosis?

Physiotherapy intervention for osteoporosis should include flexibility and strengthening exercises, postural exercises, dynamic balance, and weight bearing exercises. Along with paced walking, using resistance bands or weights is shown to improve bone density and strengthen targeted muscles. Tai Chi and Yoga are effective and fun exercises to improve postural control, stability, and drastically decrease an individual susceptibility to falls. Exercises such as chin tucks, scapular exercises, trunk mobility, and hip exercises are shown to improve overall posture. 

Physiotherapists can tailor-fit the exercises that you need as we base it on your current fitness level and goals. We make it fun and exciting as well towards achieving better health.

References:

  1. The Chartered Society of Physiotherapists: Osteoporosis Available: https://www.csp.org.uk/conditions/osteoporosis (accessed 23/08/23)
  2. Physiopedia: Osteoporosis Available: https://www.physio-pedia.com/Osteoporosis (accessed 23/08/23)
  3. World Health Organization. WHO scientific group on the assessment of osteoporosis at primary health care level. Summary meeting report 2004 May 5 (Vol. 5, pp. 5-7).
  4. Kanis JA. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994 Nov. 4(6):368-81.
  5. Paskins Z, Ong T, Armstrong DJ. Bringing osteoporosis up to date: time to address the identity crisis. Age & Aging. 2020.
  6. Joann L. Porter; Matthew Varacallo 19.12.2019 Osteoporosis Available from:https://www.ncbi.nlm.nih.gov/books/NBK441901/
  7. Cannataro R, Carbone L, Petro JL, Cione E, Vargas S, Angulo H, Forero DA, Odriozola-Martínez A, Kreider RB, Bonilla DA. Sarcopenia: Etiology, nutritional approaches, and miRNAs. International Journal of Molecular Sciences. 2021 Sep 8;22(18):9724.
  8. Mayo Clinic. Osteoporosis. http://www.mayoclinic.com/health/osteoporosis/DS00128 (accessed 24 August 2023)