Osteoporosis And Physiotherapy

                                                                                         

Osteoporosis is a health problem which spans the world, with a woman having a risk through her lifetime of getting an osteoporotic fracture of 30 to 40 percent. Men have a lower but still important risk of 13%. The development of osteoporosis is usually slow and without dramatic symptoms until an obvious symptom such as a fracture appears. It is now being recognised as a common condition and the value of early diagnosis and treatment is becoming widely accepted. Research into the risk factors, basic bone biology, drug treatment and physical management is ongoing.

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.

Being menopausal or past the menopause is the biggest risk factor for getting osteoporosis as the secretion of the hormones which maintained bone density through adult life are decreasing or stopping. Other factors which can increase the risk are age, osteoporosis in the family, low levels of calcium, smoking, drinking large amounts of alcohol, suffering from a hormone deficiency and being female. Osteoporosis should be suspected and investigated for if a woman is over 65, if there is a fracture with minimal trauma or force and if the woman is menopausal and has some of the other risk factors.

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.

Prevention of osteoporosis includes eating a balanced diet rich in calcium and vitamin D, weight bearing exercise such as walking and avoiding excessive alcohol and smoking. Hormone replacement therapy (HRT) is also preventative in post-menopausal women. Drug treatments include HRT, bisphoshonates, calcitonin, vitamin D and calcium supplementation and selective oestrogen receptor modulators. An anabolic agent is also used to add new bone to increase someones bone mass rather than just stem the decrease. As our bone mass is built when we are young, it is important to have a good diet and perform weight bearing exercises when our bones are being laid down.

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.

There is a close relationship between the level of bone density and exercise and exercise instruction is given by physiotherapists in group classes. Young people and children are guided to participate in exercise as this builds a good basis of bone density to start off their life well. The loss of bone density can be slowed down by exercise and jarring exercises are better than non weight bearing ones such as swimming. There is no age limit to beginning to improve bone density and physiotherapists take classes for the very elderly.

About the author:
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about Physiotherapy, back pain, orthopaedic conditions, neck pain, injury management and physiotherapists in Leicester. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.

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