Indeed. Make no bones about it! Osteoporosis affects over 55 per cent of people over 50 years, and is more prevalent than coronary heart disease, heart attack or diabetes, according to the US Surgeon General's Report in 2004. It is even more common than breast, uterine and ovarian cancer combined!
Osteoporosis more than likely affects someone you know. It is a systemic skeletal disorder that manifests itself as compromised bone strength, and predisposes the individual to increased fracture risk. In this condition, the bone becomes very fragile and can fracture with even the slightest of stresses, such as bending to pick up something on the floor, getting up from sitting or rolling in bed.
It occurs in one out of every two women and in one out of every four men in the USA and can be immediately life altering and life threatening because of the increased risk of falls and fracture.
The most common places for fractures include the vertebral bones and the hip, followed closely by the wrist, which is usually fractured by a fall on an outstretched hand. After the first vertebral fracture, the risk of sustaining a second vertebral fracture increases fivefold! One in five women will get a second fracture within one year of the first.
Osteoporosis is actually a pediatric condition that manifests itself in adulthood, as periods of peak bone growth are in utero and during adolescence. Therefore, prevention actually begins before birth with the mother and continues throughout the lifespan of the child. It is vital to encourage children in sport and a lifestyle of exercise. Risk factors include heredity (60-80%), low physical activity in youth, poor nutrition, hormonal status (post-menopausal women are at risk), Caucasian or Indian ethnicity, certain medications and lifestyle factors like caffeine intake and weight-bearing status.
There are many postural changes that occur in people who have the condition. With decreased bone strength, the individual actually loses height because of the compression and degeneration of the bones in the spine. People may lose as much as ten inches in height. The typical posture is one of a humped back, or kyphosis, with a forward head posture. This rounded posture can become so severe that the internal organs become affected due to the spatial changes. Together with the decreased bone strength, this abnormal posture increases the stresses on the weakened bone and can lead to compression fractures of the spine. However, only 20-30% of these fractures are symptomatic, so many people may be walking around with these fractures and not even know it!
Management of the individual with osteoporosis is multifactorial, and involves the expertise of physicians and physical therapists. Physicians monitor the changes in the bone density and prescribe appropriate medications to help prevent bone loss and to increase bone production. Physical therapists play a vital role in helping to improve function and prevent compression fractures and falls.
Alignment of the spine in the patient with osteoporosis is key, as good alignment helps to reduce the stresses on the spine, decreasing the risk of fracture and falls. Alignment can be improved by the prescription of specialised exercises that help to lengthen the compressed spine, and can also aid in pain management. Bracing with a specialised osteoporosis-specific brace that supports and protects the spine without weakening it is another part of comprehensive management for such patients.
Other types of exercises include weight-bearing activities like walking and simple, yet safe movements that involve random impact and odd forces. Bone responds to stresses placed upon it, so these exercises are important to stimulate bone growth. Balance challenges and education in safe and appropriate body mechanics are also vital in reducing the risk of falls and fractures during activities of daily living.
Owing to the flexed posture that is so commonly seen in patients with osteoporosis, lung function may be compromised and occasionally breathing deeply can be difficult. Diaphragmatic deep breathing exercises are highly recommended to help with alignment, rib cage expansion and mobility. Aquatic therapy can help improve breathing, balance and strength in a safe, pain-reduced environment. While the water provides limited weight-bearing stresses, the pull of the muscles on the bones during aquatic exercise provides stresses that stimulate bone growth. Patients who function at high levels may also benefit from specialised yoga and pilates. In fact, Tai Chi has been shown to significantly improve balance and strength in patients with osteoporosis in some research studies. There is even Ai Chi, which is Tai Chi in the aquatic environment! No matter the type of exercise, it is important to avoid bending and rotation of the spine as these can cause vertebral fractures.
Osteoporosis has been described as the world's ticking time bomb, but there is something you can do about it! Sticks and stones do not have to break our bones!
Carla Rauseo, DPT, CSCS is a doctor of physical therapy and certified strength and conditioning specialist at Total Rehabilitation Centre Ltd in El Socorro.
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