Osteoporosis is a disease that causes weakening and thinning of the bones. People of all ages are affected. Women are at greater risk for getting the disease than men are. Fifty five percent of Americans who are 50 years old and older are affected by osteoporosis; twenty five percent of men and fifty percent of women end up fracturing a bone.
In the U.S., thin bones cause 1.5 million fractures each year. Just hip fractures cause 300,000 hospitalizations. It is very important that osteoporosis be diagnosed early on to ensure that steps are taken in order to lower the risk for sustaining a fracture.
Physical therapist assistants are able to help patients treat symptoms such as pain from osteoporosis. In this article we will share everything that a physical therapist assistant needs to know before they begin working with osteoporosis patients.
What is Osteoporosis?
Is a bone disease that is characterized by changes in bone structure, decreased bone strength and low-bone density (bone thickness) which can result in increased risk for fractures. The regular bone structure gets porous and thinned out, which leaves the bone with less ability to be able to withstand the regular forces that everyday living brings. Fractures from low bone density and osteoporosis can be quite serious. They can cause a lot of pain and greatly affect quality of life.
Bone is a type of living tissue. Usually one kind of cell adds bone and another removes bone in an ongoing and balanced process. Bones weaken in osteoporosis when there isn’t a sufficient amount of new bone formed or too much bone has been lost. This type of imbalance typically starts with women during the initial 5 years of their menopause. However, it can take place in children and men as well, often because of diseases affecting bone development like kidney disease, cystic fibrosis, spina bifida, rheumatoid arthritis, inflammatory bowel disease and Celiac disease. Some medicine, like steroids, might increase the risk of your developing osteoporosis. Other people who are susceptible include athletes who were underweight during their peak bone development time.
Many different factors can cause an individual to be at risk to develop the disease. Knowing what the risks are is very important so that you can get a diagnosis early on and be proactive with your treatment.
Osteoporosis Risk Factors
Non Controllable Risks
- Predisposing medical conditions
- Hormone levels
- Advanced age
- Small frame
- Female gender
- Low vitamin D levels
- Calcium-poor diet
- Low weight
- Poor health
- Drugs (eg heparin, steroids)
- Insufficient weight bearing exercise
- Excessive caffeine intake
- Inactive lifestyle
- Excessive alcohol intake
- Cigarette smoking
How Does Osteoporosis Feel?
Osteoporosis can be a disease that is “silent.” Until a fracture happens, there might not be any outward symptoms. If you are at least middle-aged, you might notice you getting a humpback or losing height, although this isn’t in and of itself an osteoporosis diagnosis. Fractures might take place in situations that wouldn’t take place in individuals that have healthy bones, like breaking a rib while opening a window, breaking a hip when falling or breaking an ankle from stepping off the curb. They are referred to as fragility fractures. For bone disease, they are one of the red flags. Spinal compression fractures, especially those that are in the thoracic spine (the area in between the lower back and neck) or upper back, are the most common types of fractures, with wrist and hip fractures following behind them.
How Is Osteoporosis Diagnosed?
If you have back pain or some other type of rehabilitation issues and are visiting a physical therapist, he or she will do a review of your hormonal, dietary, exercise, medication, family and medical history, perform a physical exam and determine what your risk factors are for osteoporosis. Your assessment might cause your therapist to recommend that further testing be done.
The best way to diagnose osteoporosis is through a painless and quick specialized x-ray which is called DXA. It measures bone density, and reports results using Z-scores and T-scores.
Your score on the T-score is compared to the score of a healthy 30-year-old adult. If your T-score is -1 or less, then you have a higher risk of getting a fracture.
Your bone mineral density on the Z-score is compared to individuals of the same age, weight and sex. It is used with individuals who have a bone mass that hasn’t peaked yet, along with men over the age of 50 and premenopausal women.
Other bone density measuring methods include CT scan, ultrasound and x-ray.
How A Physical Therapist Can Help
A specific program can be developed for you by your physical therapist that is based on what your individual needs are to help improve your bone health overall, help you with avoiding fractures and maintain your bone health. Your physical therapist might teach you the following:
- How to protect the health of your bones my learning how to adjust to your environment
- How to make improvements to your balance to less your risks for falling
- Proper posture
- Specific exercises for decreasing bone loss amount or building bone
PTs and PTAs will work with their patients to teach them how to improve their posture, perform therapy exercises, and improve the health of bone tissue.
Here is a good video on physical therapy for osteoporosis patients
Here is an in depth instructional video on physical therapy for osteoporosis
A healthy lifestyle is how you build and maintain healthy bones. You will be taught specific exercises by your physical therapist to meet your specific needs.
In terms of exercising to slow bone loss or build bone, the process is very similar and specific for individuals of all ages. Bones grow when it’s properly and sufficiently stressed, similar to how muscles grow when it is challenged by heavier than usual weight. There are two kinds of exercise that are ideal for bone health: resistance and weight-bearing.
The best thing to do is have a physical therapist give you a custom bone-building plan to ensure that you don’t either under- or over-exercise. Exercises are typically done 2 or 3 times per week as part of the overall fitness program of an individual.
After the physical therapist assesses the patient and puts together their treatment plan, the physical therapist assistant will begin working with the patient to implement the treatment plan. Periodic check ins on patient progress will ensure improvement over time by the physical therapist.
If working as a physical therapist assistant sounds interesting to you then you can learn more about the career and compare PTA programs at physical-therapy-assistant.org.
Weight-bearing exercises for osteoporosis
- Heel drops
- Racquet sports
Resistance Exercises for osteoporosis
- Gravity resistance (eg sustained yoga poses, push-ups)
- Water resistance
- Using exercise bands
- Weight lifting
If you have low-bone density or are diagnosed with osteoporosis, then your physical therapist can help you to:
- Avoid movements and exercises that might contribute to spinal fractures, including excessive hip or spinal twisting or any kind of crunch or sit-up.
- Improve your living and work environments as well as your posture.
- Improve your dynamic balance for avoiding falls.
- Building bone or reducing the amount of bone loss in areas that are most vulnerable to fracturing through exercising the arms, shoulders, spine and hips.
Conservative fracture treatment includes appropriate pain medication and bed rest. Your physical therapist can work with you on:
- Improving the alignment of your posture, strengthening your muscles and decreasing your risk for falls.
- Providing you with appropriate external devices, like bracing, for improving posture and promoting healing.
- Decreasing your pain through various pain-relieving modalities such as positioning.
If you still have pain for more than 6 weeks after sustaining a fracture, then you can discuss potential surgical options with your surgeon, primary care physician or physical therapist.
For adolescents and children, physical therapists can provide youth groups and families with education on the need for movement on a daily basis as well as proper posture and exercise. Children that have health problems like cerebral palsy, Crohn’s disease, diabetes and spina bifida have a higher risk of developing bone disease. They can especially benefit from a physical therapist’s guidance. Most bone is built during the adolescent years and peaks in one’s thirties.
If you are at least middle-aged, you might start noticing strength and postural balance changes. Your physical therapist can help you to:
- Improve your hip mobility and strength
- Improve the strength in your back muscles
- Improve your posture
- Improve your dynamic balance so that you can better avoid falls
- Optimize an exercise program for you for lessening bone loss or promoting bone growth
Can Osteoporosis Be Prevented?
Like nerve pain, bone pain can be debilitating, so it is worth learning how to prevent.
You can help to prevent osteoporosis by building an adequate level of bone density as a child, adolescent and young adult. In order to build strong bones, you need to intake an adequate amount of vitamin D and calcium and also exercise on a regular basis.
There are steps that can be taken to improve your bone health no matter what age you are. An active lifestyle which includes weight-bearing and resistance exercise is very important for maintaining healthy bones. Avoiding habits that might promote bone loss is also very important, such as not getting enough calcium as part of your diet, excessive alcohol consumption or smoking. Maintaining good posture and body mechanics also are important contributing factors to having good bone health. The genetic tendencies that we inherit is something we don’t have any control over. However, we can manage osteoporosis through appropriate exercise and proper diet and medication.
Leading a healthy overall lifestyle is the key to staying well, no matter what your potential health issues might be.
Are you a PT or PTA that has worked with osteoporosis patients? Tell us about your experience in the comments below! 🙂
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