Physiotherapy And Treatment For Osteoporosis

Osteoporosis is a worldwide problem, though mostly documented in countries with advanced healthcare systems, and affects many millions of people across all countries. Women have a higher lifetime risk of a fracture due to osteoporosis with about thirty to forty percent chance in their life, whilst men have a much smaller but still significant risk of 13%. Osteoporosis is a condition which occurs slowly and quietly with the sufferer mostly not aware there is anything amiss until it is too late and they have a problem. The assessment of risk and the preventative treatment of this condition are vital and very active areas in research and treatment.

Osteoporosis is a common condition, with half of all women above fifty years old affected and nearly 90 percent of women over 75 years. It is a very common cause of fractures, with 1.5 million fractures from osteoporosis in the United States per year alone. Fracture of the neck of femur, generally referred to as hip fractures, are common and 5-20% of sufferers die in the ensuing months of the complications. Osteoporosis also has very high health costs from fractures and from the disability resulting, especially the pain and restriction from vertebral fractures.

The single greatest risk factor for getting osteoporosis is for a woman to have reached or passed the menopause, due to the reduction or abolition of the secretion of hormones which were protective of the bone density during younger adult life. Additional risk factors are smoking, drinking a lot of alcohol, hormone lack, being female, age, low calcium concentrations and a family history of the condition. Doctors are likely to investigate whether osteoporosis is present if there is a fracture without enough force to fracture normally, if there are other risk factors plus the menopause and if the person is over 65 years old.

When something dramatic happens the patient becomes aware that they have osteoporosis, such as a sudden fracture of the thoracic spine when lifting. The pain is very severe and disabling, making it quite clear that something serious has occurred. Thoracic and lumbar pain is common and the thoracic curve may be greatly increased by spinal compression fractures with an increased neck hump and a clear height loss. If a person has a fracture on normal activity without trauma then the cause should always be investigated as this is very abnormal. Thoracic fractures and reduced bone density on x-ray may make the diagnosis obvious but a bone density scan can indicate how severe the problem is and chart improvement.

Osteoporosis prevention encompasses lifestyle change, eating a diet rich in vitamin D and calcium, avoiding smoking and excessive alcohol and engaging in weight bearing exercise. HRT (hormone replacement therapy) is used to prevent this condition in women who are past the menopause. Drugs include bisphosphonates, HRT, selective oestrogen receptor modulators and calcium and vitamin D supplements. The development of new bone rather than stopping the loss might be achievable with an anabolic drug. When we are young we lay the groundwork for our bone mass so should be encouraged to eat well and engage in weightbearing exercises to ensure a good bone density.

A recent development in the treatment of hyper acute spinal fractures with their very severe and disabling pain is vertebroplasty. In this procedure a radiologist introduces a needle under x-ray control into the front of the body of the vertebra which has collapsed and then injects a cement material which mechanically bolsters the area, with great relief of pain. Falls are particularly dangerous due to the high risk of fracture and exercise can improve balance, stability, co-ordination and muscle strength to reduce the risk. As this may be a long term condition it may be necessary to provide both practical and psychological help to enable patients to cope best with their condition.

Bone mass and exercise are closely related and physiotherapists take exercise classes in clinics to encourage patients to exercise regularly. Younger people should be encouraged to exercise to build their initial bone mass. Exercises with impact affect the bones more strongly so walking or jogging is good rather than swimming. Improvement can occur with anyone of any age as long as they are guided by a skilled physiotherapist.