What is Osteoporosis?

Osteoporosis is a disease that is characterized by low bone mass, deterioration of bone tissue, and disruption of bone microarchitecture that can lead to compromised bone strength and an increased risk of fractures.

Two main features of osteoporosis are compromised bone density and compromised bone quality. Bone density is expressed as grams of mineral per square centimeter. Bone density is measured by dual x-ray absorptiometry (DXA). Bone quality refers to the structural (geometry and architecture of trabeculae) and material (mineralization, damage accumulation through microfractures) properties. Currently there is no method to assess bone quality in a clinical setting, however there are risk factors which are known to increase an individual’s likelihood of suffering from low bone quality.

Osteoporosis can affect individuals of almost any age but is most prevalent among Canadians that are 50 years of age or older. The annual incidence of osteoporotic fractures is approximately 140,000 with at least 1 in 3 women and 1 in 5 men that will break a bone due to this disease in their lifetime.

What are Risk Factors for Osteoporosis?

• Age: bone loss occurs at an increased rate in post-menopausal women and in men over the age of 65

• Sex: While osteoporosis affects both men and women, lowered estrogen after menopause in women increases the risk of osteoporosis. One in three women and one in five men will break a bone due to osteoporosis.

• Race: Caucasians are associated with higher risk

• Age of menopause: With menopause, the body produces much less of the sex hormone estrogen, which leads to increased rate of bone loss. Early menopause means that the protective effects of estrogen are lost sooner in life.

• BMI: Low Body Mass Index (BMI) or excessive thinness can increase risk of OP

• Menstruation: Disruption of menstrual cycles due to low estrogen levels (i.e. athletic amenorrhea) for a prolonged period of time, prior to menopause, at any age may have a negative impact on bone health

• History of fracture: Individuals with a history of fragility fractures or who have a parent who has had a hip fracture are at higher risk of developing osteoporosis and having a fracture.

• Calcium: If the body is not getting enough calcium through diet, it begins taking calcium from bones to serve all the other functions it is needed for.

• Vitamin D: Vitamin D helps build stronger bones by increasing the absorption of calcium.

• Alcohol intake: Increased risk of osteoporosis for those who regularly consume 3 or more alcoholic drinks per day. Increased alcohol intake also contributes to increased risk for falls and is often associated with poor nutrition.

• Smoking: First and second-hand smoke both have a negative impact on bone health

• Comorbid conditions: Rheumatoid arthritis, Type I Diabetes, Crohn’s Disease, chronic obstructive pulmonary disease, celiac Disease, hyperthyroidism, liver disease, kidney disease increase the risk of secondary osteoporosis

• Medication use: Long-term use of certain medications (i.e. glucocorticoids) can increase bone loss and as a result increase the risk of fracture. Some medications increase the risk of falls resulting in broken bones.

Signs and Symptoms for Osteoporosis:

Osteoporosis is a silent disease until someone experiences a fracture at any major skeletal site such as vertebrae of the spine, proximal femur (hip), distal forearm (wrist), or shoulder. This may happen in adults over 50 years with or without trauma, and should suggest that the diagnosis of osteoporosis needs further urgent assessment involving diagnosis and treatment.

Although patients with decreased BMD values usually have no specific abnormal physical findings, a thorough physical examination may detect signs and symptoms that include:

• Kyphosis (increased curvature of the spine

• Protruding abdomen

• Height loss is prevalent in patients with vertebral compression fractures

• Reduced grip strength

• Reduced gait speed

• Fragility/stress fractures caused by falls from standing height or less or performing daily chores without any trauma or fall

• Multiple vertebral fractures

• Acute or chronic back pain

How is Osteoporosis Diagnosed?

The diagnosis of osteoporosis is established by the measurement of bone mineral density (BMD) or by the occurrence of a fragility fracture of the hip or vertebra, and/or if laboratory testing revealed no secondary causes of osteoporosis. Bone mineral density measurements of the hip and spine (total hip, femoral neck, or total lumbar spine) are used to establish or confirm the diagnosis of osteoporosis, predict future fracture risk, and monitor patients. The results of a bone mineral density scan (DXA scan) are reported as a T-score which represents how many standard deviations a patient is away from a sex-matched healthy control. As defined by the World Health Organization (WHO), osteoporosis is present when bone mineral density is 2.5 SD or more below the average value for young healthy women (a T-score of < −2.5 standard deviations). Severe or established osteoporosis denotes osteoporosis that has been defined a t-score at or below -2.5 standard deviations plus the presence of one or more documented fragility fractures. An Intermediate category, osteopenia describes low bone mass indicated by a T-score that lies between −1 and −2.5 standard deviations.

Management of Osteoporosis Pain:

As the mechanisms underlying osteoporosis are irreversible, treatments focus on slowing down the process of bone resorption and protecting the remaining structural integrity of the bone, with a goal of avoiding fracture. Early detection and treatment are pivotal in the favourable prognosis of individuals with osteoporosis. Just as it’s important to recognize the risk factors leading to a diagnosis of osteoporosis for early detection, it is just as important, once diagnosed, to recognize and address factors that contribute to unfavourable consequences of the disease. Physiotherapy plays a huge role in the prevention and management of osteoporosis. Early treatment is imperative as a preventative measure to stop the deterioration of the bones as soon as possible, and therefore risk of fracture.

The main goals of physiotherapy treatment for osteoporosis are

1. To prevent fractures by improving bone strength and reducing the risk of falling and injury;

2. To relieve symptoms of fractures and skeletal deformity, and;

3. To maintain normal physical function.

For assessment and support of osteoporosis, book an appointment at our Main Street physiotherapy clinic. Our Vancouver physiotherapists will provide advice and direction to assist with symptom management and reducing the risk of falling and injury.

Original Article by Rachel Rubin-Sarganis

Photo by Jon Butterworth