Physiotherapy Treatment for Osteoporosis
Assess, treat, and safely manage exercise and body movement
What is Osteoporosis?
Osteoporosis is a condition that results in gradual (or sometimes sudden) loss of bone density. This leads to a loss of bone strength and an increased risk of breaking a bone even with relatively low impact falls or movements. It has been called the “silent thief” because there are no obvious symptoms of bone loss until someone has already broken a bone. Osteoporosis is often referred to as a pediatric disease that has geriatric consequences. Most bone density is built before the age of 25, but the impact of low bone density is seen after the fourth decade when both women and men start to lose bone mass. The best defense against osteoporosis is to build strong bones when young, but there is also a lot that can be done to help prevent or decrease bone loss as we age.
Osteoporosis affects approximately 2 million Canadians, and although we may think of it as a disease that mostly affects older women, it impacts men as well. One in three women and one in five men will end up fracturing a bone because of low bone mass. In fact, approximately 80% of bone fractures that happen in Canadians over the age of 50 are due to low bone density. The most common osteoporotic fracture sites are the wrist, spine, shoulder, and hip. Of these areas, hip fractures are considered to be the most devastating, as they result in some of the highest risks of mortality and disability. Spinal compression fractures can also cause significant pain, deformity and increased health risks, including spinal kyphosis which can limit spinal mobility and the ability to breathe deeply. However, all osteoporotic fractures can have serious consequences in terms of self-esteem, confidence, independence, and mobility. The primary goal of most osteoporosis treatment and management strategies is the prevention of fractures.
Key to achieving this goal is to accurately diagnose bone density loss early, before a devastating fracture has occurred, and to implement management strategies including proper nutrition, safe exercise, and medication if it is needed. Right now, in Canada, less than 20% of women and less than 10% of men who have a fracture undergo testing for osteoporosis, which means that treatment is not always started as early as it could have been. Read on for more information about bone density testing, fracture risk assessment, management strategies for bone loss, and how a physiotherapist can be an important part of your healthcare team!
Stages of Osteoporosis
Osteopenia vs. Osteoporosis: Bone Density on a Spectrum
The most common type of bone density test is called dual-energy x-ray absorptiometry scan, or DEXA scan for short. Generally, the spine and one or both hips are scanned, and the results of the test are then compared to the average bone density of a young adult.
If your bone density is lower than the average young adult’s but not low enough to diagnose osteoporosis, then you will generally be diagnosed with osteopenia. With osteopenia the risk for a fracture is not as high, so the biggest goal is to slow down bone loss and prevent the development of osteoporosis, which has a much higher risk of fracture. If you have recently been told you have osteopenia, this is a really good time to get serious about finding out how to decrease or prevent further bone loss. If you have recently been told you have osteoporosis, it is also important to prevent further bone loss, but it is vital to learn about how to prevent falls and how to move safely when completing your daily activities as some of your bones may be weak enough to fracture with a relatively small amount of force.
Management Strategies for Maintaining Bone Density
Management strategies for preventing bone loss should be discussed with a healthcare provider, such as your physical therapist, nutritionist, and/or family doctor. The approach is individual and depends on your individual risk factors, goals, and preferences, so there is no one-size-fits-all strategy.
Nutrition, exercise, and medication are the three primary tools that individuals can use to prevent or decrease bone loss. For individuals with a low 10-year fracture risk and for younger individuals, making some nutrition and physical activity changes are the most common approaches to preventing or slowing down bone loss. For individuals with a moderate 10-year fracture risk, your doctor may or may not recommend the addition of certain medications that protect against bone loss depending on your individual risk profile. For individuals with a high 10-year fracture risk, there is good evidence for the use of medication to slow down further bone loss, but the decision is always up to you and your doctor and will depend on several factors.
Speak to your family doctor or a nutritionist if you have any questions about medication or nutrition for osteoporosis and read the next few sections to learn more about the benefits of exercise regardless of where you fall on the 10-year fracture risk scale.
What makes bones get stronger or weaker?
We often think of bone as a stable or static structure that never changes but the reality is that, just like every other part of our body, bone is a living tissue and is constantly being built up and broken down every single day. So, what makes that happen?
There are many different factors that play in to the overall ‘activity level’ of a particular bone – that is, whether it is building density, staying the same, or decreasing density. Age and hormone changes play a big role in the likelihood that a bone will naturally start to lose some density. Availability of the building blocks of bone, like Calcium, will also play a role, which is why Calcium and Vitamin D are some of the most recommended dietary supplements.
Another big factor that can affect bone build-up or loss is the amount of tension and demand that is placed on that bone regularly. Put quite simply, bones respond to increased tension or demand by increasing their density, and, conversely, to decreased tension or demand by decreasing their density. This is why exercise, and particularly weight-bearing exercise and strength training, plays such a big role in osteoporosis management, and this is where your physical therapist can be a vital resource in getting you started on the right path.
In Canada, two systems are used to calculate overall 10-year Fracture Risk, the CAROC and the FRAX, which both consider several factors such as age, sex, steroid use, BMI, and bone density testing results. Patients are then stratified into either Low, Moderate, or High 10-year fracture risk, and management strategies are different depending on the level of risk.
Every Canadian adult over 65 should have their bone density tested approximately every 10 years, and those who have evidence of bone loss or are considered at moderate or high risk of fractures should be tested more frequently. There are also several risk factors that could mean Canadians younger than 65 should have their bone density tested, so speak to your family doctor or physical therapist if you have any questions or concerns about your bone density or whether you should get tested.
Osteoporosis Canada, in partnership with an expert panel that included researchers and clinicians from Australia, Canada, Finland, and the USA, has developed a series of exercise recommendations for people with osteoporosis or spine fractures. These recommendations involve including strength, balance, flexibility, aerobic, and postural exercises into your weekly routine, and there are specific recommendations built in to avoid the risk of vertebral compression fractures. A physical therapist can help you decide on the right level of exercise for you, pick out exercises that feel good and that you feel confident doing, and help you understand how to combine all the different recommendations into a manageable weekly program.
The other big component of the Osteoporosis Canada exercise recommendations is the use of ‘Spine Sparing Strategies’ throughout all your day-to-day activities, including your household chores, sports, and hobbies of choice. Oftentimes it is during these day-to-day activities that a vertebral fracture can occur, and it is important to learn how to move throughout the day to avoid that risk. A diagnosis of osteopenia or osteoporosis does not necessarily mean you have to give up your favourite activity, like golfing, gardening, or yoga – it just means you need to learn how to do it safely! A physical therapist can help you do this by focusing in on the types of movements you should be modifying and teaching you how to move in new ways that are safer for your back but still let you participate in the activities you love.
Osteoporosis Treatment Options at Best Health
If you’d like to learn more about how to manage osteopenia or osteoporosis with exercise, or just how to move safely while doing your favourite activities, Kathryn McGuire, PT Resident, has taken special training through Osteoporosis Canada and is a certified Bone Fit™ trained professional. She can conduct an individual assessment, help you understand your overall fracture risk, and help teach you how to safely exercise and move your body through the day to avoid or prevent a fracture in the future.
Best Health Physiotherapy is also launching an Osteoporosis group exercise program later in 2021, so stay tuned for more details on that!
Osteoporosis Canada (osteoporosis.ca) has created several resources and videos for people with osteoporosis and is an excellent place to go if you are looking for more information!