What is Osteoporosis?
Osteoporosis is something many people experience. It is a natural aging process that after the age of 35, our bones begin to lose density. Post-menopausal women’s bones lose density at a higher rate due to hormonal changes. We all lose bone density as we age; however, our bones are a living tissue that regenerates itself. A healthy bone under a microscope looks like a honeycomb when the regeneration process slows down the honeycomb spaces become larger. For those who suffer from osteoporosis, the bone under a microscope looks like a sponge; the spaces become much larger.
For some, the regeneration of bone is significantly affected. Those who suffer from osteoporosis lose a significant amount of bone density to the point where the bone becomes porous. During this process, the bone gets weak which can lead to fractures. This disease affects the quality of life as the bones become weak and unable to withstand typical forces generated by daily activities.
Women are at higher risk of developing osteoporosis; however, anyone can suffer from this disease. Children, men, and even women who use medications like steroids may have an increased risk of osteoporosis. Also, other underlying medical conditions may increase the risk of osteoporosis. A few of these medical conditions are:
- Breast cancer
- Celiac disease
- Cystic fibrosis
- Eating disorder (low weight)
- Irritable bowel syndrome
- Kidney disease
- Prostate cancer
- Rheumatoid arthritis
- Spina bifida
Osteoporosis is a common disease among the elderly. In fact, about 54 million Americans suffer from this disease and cause about 2 million bone fractures per year. About 1 in every two women and every 1 in 4 men suffer from this disease. It is a costly disease both financially and emotionally.
Those who suffer from osteoporosis are at higher risk of developing depression as they become less active and fearful of performing activities. Also, within one year of a hip fracture, approximately 20% of the elderly will die due to complicating factors.
Direct costs soar a billion dollars in direct for medical care needed with a bone fracture. There is also indirect costs which may include lost work days, home modification expenses and the loss of living independently.
There is another condition called osteopenia. This condition includes low bone density, but not low enough to be considered osteoporosis. The risk factors for osteopenia are the same as osteoporosis. There no symptoms of osteopenia, unless it develops into an osteoporotic fracture.
What causes osteoporosis?
There are controllable and uncontrollable risk factors for developing osteoporosis. The controllable factors include:
- Cigarette smoking
- Excessive alcohol consumption
- Low vitamin D intake
- Poor diet (low calcium)
The risk factors we cannot control include our age, gender, genetic makeup, and hormone changes.
Symptoms of Osteoporosis
There are a few warning signs to osteoporosis; however, symptoms are silent until a fracture occurs. A few warning symptoms may include loss of height, back pain, or the formation of a hunchback. Having these symptoms do not necessarily mean an individual has osteoporosis, but they certainly can be an indicator.
If a fracture occurs, the symptoms will vary depending on the severity. For example, a simple fracture, where the bone is stable, and a crack may exist, will have symptoms of pain, swelling, and possibly some discoloration to the area.
A complex fracture is a more complicated fracture that has the potential to cause damage to surrounding tissue. With this type of fracture, there will be pain, swelling, a deformity, possibly bleeding, and possibly loss of sensation (nerve injury). The type of symptoms will vary depending on the fracture.
How is osteoporosis diagnosed?
Since almost 55% of the elderly population suffer from osteoporosis, doctors today monitor aging adults’ health for warning signs. Bloodwork checks for calcium and vitamin D levels are typically done during annual physical check-ups. Also, there is newer technology such as DXA (Dual-energy X-Ray) that uses very low radiation levels to check for bone density.
DXA checks bone density in the arm, hips, and spine which are commonly affected areas of osteoporosis. The DXA provides a “T score” result based on the standard deviation of a normal adult’s bone density. If someone is a -1.5 to -2.5 they are diagnosed with osteopenia. Any “T score” > -2.5 is diagnosed as osteoporosis.
A “Z score” is given by the DXA for those whose bone density is not peaked, premenopausal women, and men over the age of 50, which the test provides the result of the mineral density of the bones.
DXA “T score” is provided for those with the following risk factors:
- Over the age of 65
- Postmenopausal women with a fracture
- Underlying medical condition that is a known risk factor
Physicians perform a DXA on those individuals who are willing to seek treatment if they are diagnosed with osteopenia or osteoporosis. It is not recommended for those who are not willing to make lifestyle changes or take medications to manage the condition.
Also, a DXA is not a diagnostic tool used for fractures. If you suspect a fracture, your physician may use an X-Ray or MRI (magnetic resonance imaging) to determine the presence of a fracture or if there is other tissue damage.
Treatment of Osteoporosis
Early diagnosis and intervention are important for reducing the future risk of fractures. As of today, there is no cure for osteoporosis, but there are steps you can take today to manage this condition.
Staying active is important as well as working with your health care provider such as your physician and physical therapist (PT). Your physician will monitor the condition, provide possible medications to manage the condition, and will treat any fractures that may occur.
Your PT will work with you on the appropriate exercises and levels an individual should be engaged and participating. For example, performing weight-bearing activities 3 times per week is very important. These activities include dancing, walking, jogging, etc. Your PT will work with you on the best activity levels for you.
Not only are weight bearing activities important, but so too are resistant type exercises. These include light levels of weight lifting, use of exercise bands, and balance activities like yoga. Again, your PT will guide you through which activities are right for you. Your PT will guide you through keeping active at safe levels. Too much or too little will alter the risks associated with a fracture.
If a fracture does occur, seek medical attention from your physician. He or she will work with you on the best options for healing whether it be a conservative approach with the use of a cast or brace, or with surgical intervention.
Regardless of the treatment for the fracture, once healed, PT is recommended to help with a safe return to activities. The goal is to keep the individual independent through strengthening and balancing activities as well as through education on activity modifications.
For some individuals, a lifestyle change or two may be needed. Cessation of smoking, curtailing consumption of alcohol, diet changes, and activities levels all have an impact on the progression of osteoporosis.
A physician may also work with you on supplements and medications to help manage the condition. Such supplements may include calcium and vitamin D. Your physician will guide you through the levels and types of supplements needed in conjunction with your diet.
Any recommended or prescribed medications should be thoroughly discussed with your physician. Often, medications have side effects so understanding and weighing the pros and cons of medications should be thoroughly assessed.
For the elderly, home assessments may be indicated. An occupational therapist (OT) can visit an individual in his or her home and go through safety hazards within the home. Removing all risks for tripping and modifying activities to safe levels is important to maintaining independence. Thing such as lighting, pets, and throw rugs will be addressed.
Proper lighting, especially at night with the walkway from the bedroom to the bathroom is critical for safety. Addressing pets. We all love our furry friends but making sure their toys and beds are out of walkways. Also, teaching individuals to slow down and look around them as they walk about the house. Tripping over pets is a common risk factor for falls.
Throw rugs or area rugs not securely fastened down are trip hazards. Ensuring throw rugs are removed along with area rugs is important. Moving furniture to open up walkways is important too, just as removing clutter. The goal of the home assessment is to keep the individual in their home and independent.
Early intervention to osteoporosis is extremely important in reducing the risk of future fractures. The sooner you address your symptoms, the more likely conservative care will work for you. As a consumer of health care, you have a choice in finding the right provider for you. Do your homework and search for a health care provider, like a physical or occupational therapist, with excellent outcomes, great customer reviews, and can provide you the care you need for a reasonable cost.
Most states have direct access to a physical therapist, meaning you can go directly to a physical therapist without a physician order. To determine if your state has direct access, please visit the American Physical Therapy Association’s website Physical Therapy Direct Access By State.
Most OTs work directly with physicians, family members, and social workers (when involved) to help maintain safety and independence. If your physician prescribes a home assessment, you have a choice in selecting the OT to work with you.
To get started with conservative care today, you can find a highly qualified PT or OT in your area. There are many qualified PTs and OTs, so to find one near you, please click on Find A Clinic. This link will help you find a PT and OT that has top national rankings for treating conditions such as osteoporosis.