OSTEOPOROSIS

http://www.physio-pedia.com/Osteoporosis
Clinical Signs and Symptoms [4]
Goodman. Snyder. Differential Diagnosis for Physical Therapists; Screening for Referral. 4th. St.Louis:
Saunders, 2007.

Back pain: Episodic, acute low thoracic/high lumbar pain

Compression fracture of the spine

Bone fractures

Decrease in height

Kyphosis

Dowagers hump

Decreased activity tolerance

Early satiety

Etiology/Causes
Bone tissue is constantly being absorbed and replaced throughout ones life span. Bone mass
decreases when the rate of absorption increases the rate or production; typically occurring with
advanced age. Peak bone mass is met at the average age of 20. Those who develop less bone
mass prior to this time, have a high chance of developing osteoporosis.[9]
Primary osteoporosis has no known definite cause, but there are many contributing factors
associated with the disorder. These include prolonged negative calcium balance, impaired
gonadal and adrenal function, estrogen deficiency, or sedentary lifestyle. Postmenopausal
osteoporosis is associated with increased bone loss due to decrease production of estrogen.[2]
Women commonly lose 1% per year after peak bone density has been met, for up to 8 years post
menopause.[10] Senile osteoporosis is an age-related bone loss that often accompanies advanced
aging.[2]
Secondary osteoporosis is caused by prolonged use of medications or secondary to another
disease or condition which inhibits the absorption of calcium or impedes the body's ability to
produce bone.[2]

Low calcium intake or absorption can greatly increase one's risk for developing osteoporosis.
Life long calcium intake is crucial in building up bone stock prior to peak levels of bone mass, as
well as maintain bone mass after the age of 20. Excessive alcohol consumption can decrease the
body's ability to absorb calcium.[11]
Bone produces in response to the load applied to it. Physically active individuals typically have
higher bone density, than those who have a sedentary lifestyle.[11]
Hormone levels, either too little or too much, can impede on the body's ability to produce and
maintain adequate bone mass. Dysfunction with sex glands, thyroid, parathyroid, or adrenal
glands is often associated with osteoporosis. [11]

Risk Factors[2]

Age 50 years and older

Female gender

Caucasian and Asian

Menopause (especially early or surgically induced)

Family history of osteoporosis or fragility fractures

Northern European ancestry

Long periods of inactivity or immobilization

Depression

Alcohol (>3 drinks/day)

Tobacco

Caffeine (>4 cups/ day)

Amenorrhea (abnormal absence of menses)

Thin body build

Other risk factors - Long term use of long-acting benzodiazepines, anticonvulsants or

corticosteroids, low testosterone levels in men and anorexia or poor dietary intake

Medical Management (current best evidence)

According to Kurt Kennel, M.D., an endocrinology specialist from the Mayo Clinic, the most
common medications used to manage osteoporosis are biphosphonates, such as Fosamax,
Boniva, Actonel, Atelvia, Reclast, and Zometa. It is also a common practice to use hormones,
like estrogen, to help treat and prevent osteoporosis. Some women do not elect to use these
hormones due to the increased risk of heart attacks and certain types of cancers. The choice of
which drug is right for you is generally based on preference, convenience, and adhering to
dosing schedule.[13]
The length of time that a medicine should be used is variable. Most current research shows that
biphosphonate medications should be taken up to 5 years for it to be safe and effective. There
haven't been enough long-term studies to prove the efficiency of the medications after 5 years of
treatment. One thing is known that if you have been taking biphosphonate drugs you can still
have positive effects after you stop taking the medications due to building up the medicine in
your bone. Due to this effect of the medications, some doctors have patients take a break from
the medications after 5 years if they believe they are at a low-risk for fractures.[13]
Medical management helps reduce the risk of fractures but does not eliminate it. If you
experience a fracture while taking medications to help treat your osteoporosis you may need to
switch to a more aggressive bone-building therapy, such as Forteo (a parathyroid hormone), or a
new osteoporosis drug like Prolia or Xgeva. These drugs produce similar or better results than
biphosphonates but just work in a different way.[13]
Medical management isn't the only way to treat osteoporosis. It is also important to include daily
exercise, good nutrition (including the adequate amount of calcium and vitamin D), quit
smoking, and limit your alcohol intake.[13]

Physical Therapy Management (current best evidence)

Physical therapy intervention for individuals with osteoporosis, or even osteopenia, should
include:

weight-bearing

flexibility exercise

strengthening exercise

postural exercise

balance exercise

Weight-bearing exercises

Exercises such as walking or hopping, has been shown to maintain or improve bone density in
this population. Strengthening exercises, using weights or resistance bands, has also be shown to
maintain or improve bone density at the location of the targeted muscle attachments. Maintaining
bone health in this population is extremely important, especially in the elderly as there is
typically has a decline in bone mass with age.[14]
Flexibility and strengthening exercises

These can help improve the individuals overall physical function and postural control. Improving
postural control is important to reduce the risk for falls. Falls often result in fractures in frail
individuals. Balance exercises are also important to incorporate to further reduce the risk of falls.
[15]

Postural exercises

These are crucial to prevent structural changes that often accompany osteoporosis, such as
thoracic kyphosis. Every osteoporosis program should include extension exercises; chin tucks,
scapular retractions, thoracic extensions, and hip extensions. Strengthening the extensor muscles
will promote improved posture and improved balance. Flexion exercises are
CONTRAINDICATED. Anterior compressive forces to the vertebra can contribute to
compression fractures.[2]

Back pain

Physical therapist may treat patients with osteoporosis for back pain. Agility training, resistance
training, and stretching have all been shown to decrease back pain and its related disabilities in
this population.[16]
High intensity

Research highly supports high intensity training in the prevention of bone lost for women in
menopausal years and early stage post menopausal. High intensity training would include bodyweight and resistive exercises at a high intensity, similar to circuit training. [17] Most of these
studies have been performed on individuals who have NOT been diagnosed with osteoporosis.
This type of training is often contraindicated for individuals with low bone mass.
A Cochrane review has been completed to determine the best exercise for prevention and
treatment of osteoporosis. The population was healthy post menopausal females, age 45- 70.
Duration of the intervention was at the least ten months, several lasting over a year. The majority
of the studies has a frequency of 2- 3 days per week. The results were that combination of

exercise promotes greatest improvements in bone mass at the spine, wards triangle, and the
femoral trochanter. Dynamic weight-bearing, high force exercise results with greatest
improvements at the femoral neck and moderate results at the femoral trochanter. Dynamic
weight-bearing, low force exercise had moderate positive effects at the spine. Non-weightbearing, high force exercise were shown to have moderate effects at the femoral neck.[18]

References
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