At Lilyfield Physio, we see many people who have been diagnosed with osteoporosis or osteopenia and are often diagnosed too late, after a fall and subsequent fracture. There is a lot to be aware of when it comes to osteoporosis and we hope to summarise the information to hopefully help everyone be better informed!
What is Osteoporosis?
Osteoporosis is a medical condition characterised by weakening of the bones, which leads to an increased risk of fractures (broken bones). Not to be confused with Osteoarthritis, which is a condition of the cartilage that lines the bones. For the most part, osteoporosis is not a cause of pain.
Osteoporosis is classified by a reduced bone density. This is important to identify as it leaves your bones more susceptible to fractures from falls or injuries.
Normally, bones undergo a constant process of breakdown and rebuilding. In osteoporosis, the creation of new bone tissue doesn’t keep up with the removal of old bone tissue. This imbalance results in bones becoming porous and brittle.
Osteoporosis is often considered a “silent” disease because it progresses without any noticeable symptoms until a fracture occurs. Common sites for fractures related to osteoporosis include the spine, hip, and wrist.
What is Osteopaenia?
Osteopenia is a condition characterized by lower than normal bone mineral density (BMD), but not to the extent seen in osteoporosis.
In osteopenia, bones are weaker than normal but not weak enough to be classified as osteoporosis. This means that individuals with osteopenia have a higher risk of fractures, but the risk is not as high as in those with osteoporosis.
Osteopenia is considered a precursor to osteoporosis. It’s a warning sign that bone mass is compromised and that steps should be taken to improve bone mass.
What is bone density?
Bone density refers to the amount of mineral matter (primarily calcium and phosphorus) packed into a certain volume of bone. It’s a measure of how strong your bones are. It is often measured and documented as “bone mineral density” (BMD).
Higher bone mineral density indicates stronger bones, which are less likely to fracture or break. Lower bone mineral density, on the other hand, indicates weaker bones that are more prone to fractures.
Bone mineral density is not distributed evenly throughout the skeleton. Some areas, like the hip and spine, tend to have higher bone mass, while others, like the ends of long bones, have lower bone mass. When doctors refer to low bone density, they’re often concerned about the density in the hip (femur) or lower (Lumbar) spine, as these areas are particularly vulnerable to fractures, particularly from a fall.
How is osteoporosis diagnosed?
Measuring bone mineral density is done through a painless and non-invasive test called dual-energy x-ray absorptiometry, or DEXA for short. It involves a low-level x-ray that scans specific bones, usually the hip and spine and forearm. The results are typically reported as a T-score, which is a comparison of your bone density to that of a healthy young adult.
T-score above -1: this is considered normal.
T-score between -1 and -2.5: You have low bone density (osteopenia)
T-score of -2.5 or lower: This indicates osteoporosis.
It’s important to note that while osteoporosis increases the risk of fractures, it does not mean you will definitely experience one. Many other factors, such as balance, muscle strength, and the presence of other medical conditions, also play a role.
When are bones at their strongest?
We generally reach peak bone mass during early adulthood, usually in a person’s mid-20s. During this time, bone growth is still occurring at a relatively high rate.
During childhood and adolescence, bones grow and mineralize, increasing in size and density. This process continues until around the mid-20s when peak bone growth/mass is typically reached.
Peak bone mass refers to the maximum amount of bone a person can achieve, and it serves as a reservoir for bone health throughout their lifetime.
After reaching peak bone mass, there is a gradual decline in bone density as part of the natural aging process. Unfortunately, this is a normal process and we cannot prevent this. However, maintaining a healthy lifestyle, including regular weight-bearing and high impact exercise, a balanced diet rich in calcium and vitamin D, and avoiding smoking and excessive alcohol consumption, can help slow down the rate of bone loss.
It’s important to note that while bones are strongest in early adulthood, they can still be strengthened and maintained through exercise and a healthy lifestyle at any age!
Risk factors for osteoporosis:
The risk factors for osteoporosis include:
Age: The risk of osteoporosis increases with age, especially in postmenopausal women and older adults.
Gender: Women are at a higher risk than men, particularly after menopause due to a drop in oestrogen levels.
Family History: If a close family member, especially a parent or sibling, has had osteoporosis or fractures, your risk may be higher.
Body Composition: Individuals with lower body weight or smaller frames have less bone mass to draw from as they age, which can increase their risk.
Hormonal changes:
Menopause: Oestrogen, a hormone that helps protect bones, decreases significantly during menopause, putting women at higher risk.
Low Testosterone: Low levels of testosterone in men can lead to bone loss.
Dietary factors:
Low Calcium Intake: A diet low in calcium can contribute to bone loss.
Low Vitamin D Levels: Vitamin D is crucial for calcium absorption in the body.
Lifestyle factors:
Lack of Exercise: Physical inactivity can lead to weaker bones. Particularly a lack of strengthening exercises and high impact exercises.
Smoking: Smoking is associated with lower bone density and an increased risk of fractures.
Excessive Alcohol Consumption: Heavy alcohol consumption can reduce bone density.
Certain medical conditions:
Rheumatoid Arthritis: Autoimmune disorders like rheumatoid arthritis can lead to bone loss.
Inflammatory Bowel Disease (e.g., Crohn’s Disease): These conditions can interfere with the absorption of nutrients necessary to support bone health.
Celiac Disease: This digestive disorder can lead to nutrient malabsorption, affecting bone health.
Certain medications:
Corticosteroids: Long-term use of medications like prednisone and cortisone can weaken bones.
Certain Cancer Treatments: Some treatments for cancer, particularly chemotherapy and hormonal therapies, can lead to bone loss.
Endocrine disorders:
Hyperthyroidism: Overactive thyroid function can lead to bone loss.
Cushing’s Syndrome: Excess production of cortisol can weaken bones.
Genetic factors: Some individuals may have a genetic predisposition to developing osteoporosis.
It’s important to note that while these factors can increase the risk of developing osteoporosis, they do not guarantee that someone will develop osteoporosis. Many cases of osteoporosis can be prevented or managed through lifestyle modifications and, in some cases, medication.
How is osteoporosis treated?
Management is often multifactorial and not necessarily the same for everyone. Osteoporosis management can often involve a team of physiotherapists, exercise physiologists, general practitioners, dieticians and sometimes specialists.
Treatment options to consider when managing osteoporosis includes.
Lifestyle modifications:
Balanced/Healthy Diet: Ensure you have a diet rich in calcium and vitamin D. Dairy products, leafy green vegetables, fortified foods, and supplements can be sources of these essential nutrients.
Quit Smoking: Smoking is associated with reduced bone density. If you smoke, consider quitting.
Limit Alcohol: Excessive alcohol can weaken bones. If you drink alcohol, do so in moderation.
Regular weight-bearing exercise:
Engage in weight-bearing exercises like walking, jogging, dancing, and weightlifting. These activities help stimulate bone growth and strengthen bones. In addition, exercises to improve your balance to prevent falls and resistance exercises to improve muscle mass are important.
Management with your general practitioner:
Medication: Medications may include bisphosphonates, hormone replacement therapy (HRT), selective oestrogen receptor modulators (SERMs), and other drugs.
Calcium and Vitamin D Supplements: If you have difficulty getting enough calcium and vitamin D through your diet, supplements may be recommended. These should be taken under the guidance of a healthcare provider.
Bone Density Monitoring: Regular DEXA scans can help track changes in bone mineral density over time. This information is crucial for assessing the effectiveness of treatments and making any necessary adjustments. Typically, a follow up scan where necessary is performed every 2 years.
Fracture prevention:
Taking steps to prevent a fall and broken bone is a critical aspect of managing osteoporosis. This includes fall prevention measures such as installing hand rails in your house and removal of trip hazards. In some cases, the use of assistive devices like canes or walkers could be beneficial.
Exercises that are weight-bearing and resistance-based are particularly beneficial for individuals with osteoporosis. These types of exercises help to stimulate bone growth and increase density. It is important that exercise is vigorous enough to place stress on the bones.
Examples of exercises that can facilitate bone growth include:
Weight-bearing aerobic exercises:
Jogging or Running (if appropriate): Higher-impact activities like jogging or running can be beneficial for creating healthy bone, but they may not be suitable for everyone. Consult with your healthcare provider before starting high-impact exercises.
Dancing: This is a fun way to incorporate weight-bearing activity and improve balance.
Stair Climbing: Climbing stairs provides resistance and weight-bearing benefits for the legs and hips.
Hiking: Walking on uneven terrain can help challenge and strengthen bones.
Jumping: controlled jumps or skipping can
Unfortunately walking, although it is considered weight bearing exercise, is not of high enough intensity to stimulate bone formation. However, walking particularly at a vigorous intensity is beneficial for many other reasons.
Resistance Exercises: These include activities that use weights, resistance bands, or body weight to build muscle strength and mass. Focus on exercises that target major muscle groups, such as squats, lunges, push-ups, and weightlifting.
Core-Strengthening Exercises: Strong core muscles can help support the spine and improve posture, which is important for those with osteoporosis.
Balance and flexibility exercises:
Yoga and Pilates: These exercises improve balance, flexibility, and posture, which can help prevent falls and fractures.
Tai Chi: This ancient Chinese practice really emphasises balance and stability to prevent possible falls.
Functional movements:
Functional movements mimic activities of daily living. They help improve strength and coordination in ways that are directly applicable to your everyday life. Examples include getting up from a chair, reaching for objects, and lifting.
Flexibility exercises:
Gentle stretching exercises can help improve flexibility and range of motion.
Why is it important to manage osteoporosis?
Osteoporosis can have serious consequences on a person’s health and quality of life. The most important factor to consider with osteoporosis is the risk of fractures (broken bone) which can manifest from direct trauma, like a fall, or can be from overactivity/overload resulting in a stress fracture.
As already mentioned, broken bones or fractures are not a guarantee if you have been diagnosed with osteoporosis, but we want to minimise the risk of one occurring.
From falls, the most common injuries seen are hip fracture, wrist fracture, and sometimes spinal fracture (although less common).
Hip fractures are of serious concern particularly as we age and are associated with a higher risk of mortality within a year of injury.
Spinal Compression Fractures can happen suddenly or over time. These fractures occur in the vertebrae of the spine, particularly of the middle back (thoracic spine). They can lead to a stooped posture (kyphosis) and loss of height, which may be why you are feeling more stooped over.
When to see a doctor?
There is no strict guideline on when to see a GP to diagnose osteoporosis. Early detection and intervention are crucial in managing and preventing osteoporosis. If you have any of the above risk factors or concerns, don’t hesitate to discuss them with your healthcare provider. They can assess your risk, perform necessary tests, and provide personalised recommendations to help protect your bone health.
At Lilyfield physio, our physiotherapists and exercise physiologists are skilled in helping you treat osteoporosis. We offer a wide range of options and run regular exercise classes (for example FitBones) designed to get your bones healthy again!
