OSTEOPOROSIS
Osteoporosis is a common disease in Australia with 1.2 million people estimated to have osteoporosis and further 6.3 million with low bone density. This article will be explaining what osteoporosis is, reviewing common risk factors and diagnosis, as well as what you can do about it!
WHAT IS OSTEOPOROSIS?
Osteoporosis is an advanced stage bone thinning condition whereby the bone has become thin, weak and fragile, such that even a bump or minor accident may cause a broken bone.
Osteoporosis occurs when bones lose minerals, such as calcium, more quickly than the body can replace them, causing a loss of bone thickness (bone density or mass). This is through a process called “bone remodelling”. Throughout our lifetime, new bone cells are produced (bone formation), and old bone cells are gotten rid of (bone resorption). When the rate of bone resorption is increased with no increase in bone formation (due to loss of minerals), this will cause an overall change in structural integrity of our bones. Early onset of this is termed Osteopenia, which is where the bones have started to become weaker than normal, but not as advanced as Osteoporosis.
Any bone can be affected by osteoporosis, but the most common sites are the hip, spine, wrist, upper arm, forearm or ribs. Fractures in the spine due to osteoporosis can result in changes in posture and height loss. Osteoporosis usually has no symptoms until a fracture occurs, this is why osteoporosis is often called the 'silent disease'.
OSTEOPOROSIS RISK FACTORS
We all have certain ‘risk factors’ that make us more likely to develop osteoporosis. Women are at a greater risk of developing osteoporosis because of the rapid decline in oestrogen levels during menopause. When oestrogen levels decrease, bones lose calcium and other minerals at a much faster rate, leading to more ‘bone resorption’.
Men also lose bone as they age, however testosterone levels in men decline more gradually so their bone mass remains adequate till later in life.
Family History
Bone health can be strongly inherited so consider your family history of osteoporosis. It is important to note if anyone in your family (particularly parents or siblings) has ever been diagnosed with osteoporosis, broken a bone from a minor fall or rapidly lost height. These can indicate low bone density.
Your calcium and vitamin D levels
Low calcium intake - adults require 1,000 mg per day, which increases to 1,300 mg per day for women over 50 and men over 70.
Low vitamin D levels - this vitamin is needed for your body to absorb calcium, so ensure you get enough sun exposure.
Your doctor is the best person to advise you on this.
Lifestyle Factors
- Low levels of physical activity
- Smoking
- Excessive alcohol intake
- Weight: thin body build or excessive weight
DIAGNOSING OSTEOPOROSIS
Osteoporosis is classified based on your Bone Mineral Density (BMD). When you go for a bone mineral density scan, you will receive a T-score which represents the density of your bone comparative to healthy population of the same age. They will then classify your bone health into three categories:
- Osteoporosis: <-2.5
- Osteopenia: -1 to -2.5
- Normal bone: >-1
Before performing treatment for Osteoporosis you should consult your local General Practitioner, who may refer you on to a bone density scan. For this, DEXA scans are the gold standard. This will enable your treatment to be more specific to the level your bone density is at.
RECOMMENDED OSTEOPOROSIS TREATMENT
This depends on the health of your bones, whether it is considered in the Osteoporosis or Osteopenia range. Essentially, the less fragile it is, the more the bone can be loaded up in order to stimulate bone growth.
Here’s how it differs, and what is recommended:
Osteoporosis:
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Perform progressive resistance-based training (whether using body weight, therabands, or weights, that are progressively increased over time), 3-4 x/wk.
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Weight-bearing LOW impact activities: walking, yoga, mat pilates, Tai Chi.
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Balance exercises and falls prevention training
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Calcium and Vitamin D supplementation (your local GP should advise you on this)
Osteopenia:
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Perform progressive resistance-based training (whether using body weight, therabands, or weights, that are progressively increased over time), 3-4 x/wk.
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Weight-bearing MODERATE - HIGH impact activities (depending on the severity of the OPA): running/jogging, brisk walking, stair climbing, basketball/netball, impact aerobics, dancing/gymnastics, tennis, skipping.
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Balance exercises and falls prevention training
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Calcium and Vitamin D supplementation (again, your GP should advise you on this)
WHY IS PROGRESSIVE RESISTANCE-BASED TRAINING & WEIGHT-BEARING ACTIVITIES IMPORTANT?
This is something people commonly are unaware about, that a well designed resistance-based training program (strength training) is CRUCIAL for improving bone density. Essentially what happens, as our muscles lengthen and shorten to contract (e.g., going down and then up in a squat), this creates a pull on your tendons and ligaments (which both attach onto bones). This pull creates an internal stimulus that travels through the bone, which over time, encourages more bone formation.
Still have your doubts? Check out this amazing article written by the ABC on strength training to improve bone density!
As to why you should perform weight-bearing impact activities? Similarly to strength training, as our feet impact the ground during running, jumping, hopping, etc., this creates an external stimulus that goes through our body which then encourages new bone formation, thus improving bone density. Performing weight-bearing exercises in general will also have more carry-over effect to balance, stability and strength opposed to seated exercises.
WHO IS THE CORRECT HEALTH PROFESSIONAL TO SEE FOR OSTEOPOROSIS?
Well, a physiotherapist is the way to go! A physiotherapist will provide evidence-based exercise based rehabilitation for chronic conditions and disabilities such as osteoporosis/osteopenia, low back pain, etc. Physiotherapists are experts in building up specialised exercise programs for people based on their medical and injury history, goals, lifestyle and environmental factors (access to equipment, gym, etc), as well as assessing movement to ensure you exercise safely and effectively.
DO YOU NEED A REFERRAL TO SEE A PHYSIOTHERAPIST?
Short answer, no. You can book an appointment with a physio to start your treatment as soon as you want. However, it is more beneficial that you have prior to starting treatment a bone density scan, so that your physio can know exactly what stage you are at in order to make your program more specific to you. Your GP can refer you to this, and can also write you a medicare rebate referral plan which can be addressed to your physiotherapist.
WHAT HAPPENS IF YOU LEAVE IT...
As mentioned before, Osteoporosis is a deterioration of bone density. As our bones progressively become weaker, this means we are progressively more prone to fractures or breakages if we fall. As it is a condition more commonly found in elder adults, who likely have reduced balance, a fracture from a fall could lead to a deterioration of quality of life, as we become less mobile. This can also reduce the body’s ability to handle force in everyday life, meaning we are more susceptible to things like lower back, hip and wrist pain, if the underlying base of support (our bones) is weakened.
WANT TO GET STARTED TODAY?
Feel free to contact our friendly reception staff on 0294122222 or book online with our physiotherapis. We have clinics based in Chatswood, North Sydney, Sydney CBD (near Martin Place) and Mosman.