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  • Writer's pictureRobin R Varghese, PT.

"Breaking the Silence": The power of Physical therapy in the management of Osteoporosis.

  • Osteoporosis is defined as low bone mineral density caused by altered bone microstructure, ultimately predisposing patients to low-impact, fragility fractures. (1)

  • Osteoporosis is a “silent” disease as there are no symptoms until one ends up with a fracture.

  • Osteoporosis is the major cause of fractures in postmenopausal women and in older men. (2)

  • In 2004, the WHO operationally defined osteoporosis based upon the bone mineral density (BMD) assessment of the patient. Thus the current osteoporosis definition is a “BMD that lies 2.5 standard deviations or more below the average value for young healthy women (a T-score of <-2.5 SD)(3)

To know more about T-score, click here


  • Types of Osteoporosis

Primary osteoporosis has no known definite cause, but there are many contributing factors associated with the disorder

Secondary osteoporosis is caused by prolonged use of medications or secondary to another disease or condition which inhibits the absorption of calcium or impedes the body's ability to produce bone..

These include prolonged negative calcium balance, impaired gonadal and adrenal function, estrogen deficiency, or sedentary lifestyle

Subtypes are: Endocrinal, Gastrointestinal, Rheumatological and connective tissue related (3)

osteoporosis is related to the aging process in conjunction with decreasing sex hormones.(1)

​The subtypes are: Post menopausal, Senile and Idiopathic.(3)

What causes Osteoporosis?

Osteoporosis is caused by an imbalance of bone resorption and bone remodeling, leading to decreased skeletal mass. In most individuals, bone mass peaks in the third decade, after which bone resorption exceeds bone formation. Failure to reach a normal peak bone mass or acceleration of bone loss can lead to osteoporosis.(1)

Is Osteoporosis Dangerous?

Bones affected by osteoporosis may become so fragile that fractures occur spontaneously or as the result of:

· Minor falls, such as a fall from standing height that would not normally cause a break in a healthy bone.

· Normal stresses such as bending, lifting, or even coughing.(2)


How can Physical Therapy be of help?

  • Health care providers and Physiotherapist have a specific role in osteoporosis through exercise prescription, education and strategies to maximize function, reduce the risk of falls and manage pain.

  • There are various treatment protocols involved in the treatment and prevention of osteoporosis, among which exercises have an impact on the bone mineral density.

  • Studies have presented the importance of exercises in improving bone mass apart from improving function and reducing the risk of fractures.

  • Type and intensity of exercises vary with age and it is important to understand the benefits and adverse effects.

  • Physiotherapists play a very important role in managing osteoporosis through assessment, exercise prescription, therapeutic modalities, special techniques and education.

  • Appropriate goals are established through proper assessment of signs and symptoms, involving the risk factors and functional status of the patient. 

  • The main aim is to maximize peak bone mass during the phases of childhood to adolescence and in adult and elderly is to increase and conserve bone mass, reduce the risks, reduce pain and improve mobility, balance and posture. Intervention of exercise has established that physical activity and exercises can reverse or prevent the loss of bone. 

  • These are achieved through appropriate planning and implementing structured physiotherapy training programes for the population. (4)

  • Evidence shows that physical therapy has an effect on the early stages of osteoporosis and may also help prevent further bone weakening.

  • Physical therapy may improve a person’s outlook by helping to prevent further bone weakening and reducing the risk of falls.

Physical therapy has several potential benefits for osteoporosis. These include:

  • reducing pain

  • improving balance

  • reducing the risk of falls

  • preventing bone loss

  • strengthening muscles

  • adjusting stooped posture

  • improving quality of life

Types of exercises

According to a 2018 review of studies, resistance training and weight-bearing aerobic exercises are the two types of exercise most beneficial to people with osteoporosis.

Resistance Training includes:

  • Balance exercises

  • Weightlifting

  • Gravity resistance exercises

  • Exercise bands

Weight-bearing aerobic exercises

These exercises can help improve balance and posture and increase strength and mobility.

Examples of weight-bearing aerobic exercises a physical therapist might suggest for a person with osteoporosis include:

  • Stomping and heel drops

  • Jogging

  • Racquet sports challenges bones to become stronger.(5)




Researches

  • Physical exercise is considered an effective means to stimulate bone osteogenesis in osteoporotic patients. Walking alone did not appear to improve bone mass; however it is able to limit its progressive loss. In fact, in order for the weight-bearing exercises to be effective, they must reach the mechanical intensity useful to determine an important ground reaction force. For exercise to be effective a joint reaction force superior to common daily activity with sensitive muscle strengthening must be determined. These exercises appear extremely site-specific, able to increase muscle mass and BMD only in the stimulated body regions. (6)

  • If a person does not receive treatment in the early stages of osteoporosis, they may experience injuries that can cause fractures and chronic pain. Without timely treatment, osteoporosis can lead to disability and a loss of independence.(5)

  • A person with osteoporosis should avoid exercises that twist or overexert the spine, such as sit-ups or golf, and activities with a high risk of falling and injury, such as horseback riding, contact sports, and snowboarding.(1)


At Valley Healing Hands, We provide the best Physical Therapy treatment for Osteoporosis. Depending on the severity and underlying cause of the condition, and based on the assessment, our physical therapist who are highly qualified will plan an individualized treatment routine, customized to your specific needs. Our patients are highly satisfied with out services. You can learn about what they have to say about us here and get connected to us here. Our patients love us and you too will!!!



References

4)https://www.researchgate.net/publication/303827346_Osteoporosis_Physiotherapy_Role_in_Management_and_Prevention



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