Osteoporosis is a global public health problem. It is a metabolic bone disorder characterized by low bone mass and micro architectural deterioration leading to skeletal fragility and increased fracture risk.
Bone mineral density test is used to diagnose osteoporosis. Osteoporosis is defined as a T-score that is 25% lower than the average 30 year old or 2.5 standard deviations below the mean or a T-score lower than -2.5. Whereas osteopenia is defined as 10% to 25% below an average healthy 30 year old adult, or a T-score between –1.0 and –2.5 standard deviations below normal (WHO).
Modifiable Risk Factors
A Body Mass Index (BMI) of less than 19〖kg/m〗^2 is a risk factor for osteoporosis. Being underweight can lead to lower estrogen levels in girls and women, similar to after menopause, which may contribute to the development of osteoporosis. At the same time, frail people are at higher risk of fracture.
2. Inadequate Vitamin D intake
Do you spend less than 10 minutes per day outdoors (with part of your body exposed to sunlight), without taking vitamin D supplements? Vitamin D is made in the skin upon exposure to UVB rays from the sun. Vitamin D benefits bone health as it is necessary for the absorption of calcium.
3. Sedentary lifestyle
Is your daily level of physical activity less than 30 minutes per day (housework, gardening, walking, running etc.)? Lack of physical activity may result in bone and muscle loss.
4. Avoiding dairy foods
Calcium, the most important mineral for your bones, is contained mostly in dairy products. If you avoid, are allergic or intolerant to dairy products, without taking any calcium supplements, you have probably been calcium deficient and are at higher risk of osteoporosis.
5. Alcohol intake
Drinking too much alcohol impacts negatively on bone health and can also lead to frequent falls, which increases the risk of fractures.
Whether you are a current smoker, or have smoked in the past, you should be aware that smoking has a negative impact on bone health.
Non-modifiable Risk Factors
The risk of osteoporosis increases with ages especially for a woman aged 60 years or over, or a man aged 70 years or over.
2. Family history
If your parents had a hip fracture, you may be at higher risk of developing osteoporosis and having a fracture. If either of your parents had a stooped back or there is a strong family history of osteoporosis, this could also be a sign that you are at increased risk of developing osteoporosis.
3. Low Testosterone level
Have you ever suffered from impotence, lack of libido or other symptoms related to low testosterone levels? Testosterone in men plays a similar role to estrogen in women – lower levels of this hormone negatively affect bone health and may increase the risk of osteoporosis.
4. Early menopause
Did your menopause occur before the age of 45? Estrogen has a protective effect on bone. Once menopause begins your body produces lower levels of estrogen and the rate of bone loss increases rapidly.
5. Rheumatologic conditions
Conditions such as rheumathoid arthritis, ankylosing spondylitis may lead to osteoporosis.
6. Gastrointestinal disorders
Conditions such as ulcerative colitis, Crohn’s disease or coeliac disease lead to poor absorption of nutrients in food. Increased osteoporosis risk is due to malabsorption of calcium and other nutrients (and often low boy weight).
Role of Physiotherapy in Management and Prevention
A physiotherapist plays crucial role in encouraging active lifestyle and improving your physical activity level as bone mass density (BMD) is higher in physically active at all aged people compared to those who are sedentary.
1. Weight loading exercises
Studies have demonstrated the most bone gain is achieved by the weight bearing exercises. Weight bearing exercises like running, jogging, walking, dancing, climbing stairs are effective in increasing the bone mass. The muscle forces and gravity has an effect by producing stress on the joint and bones by which the osteoblast activity is stimulated.
2. Strength training
Studies have shown that bone mineral content increased due to an increase in the muscle strength, which is achieved by exercises and resistance training. The dynamic strength exercises and isometric activity can be incorporated in the functional training as it has a greater efficacy to improve the bone strength. It also improves balance and thus may prevent falls.
3. Exercises that improve coordination, balance and posture
Osteoporosis can lead to postural abnormalities like kyphosis deformity. Functional strengthening exercises, dynamic stabilization exercise for the trunk and extremities and postural re-education are particularly essential to normalize the mechanical forces.
1. International Osteoporosis Foundation.
2. Gabriella Posa, Erika Roka, Edit Sziver, Regina Finta, Levente Szilágyi, Krisztina Koncsek PT and Edit Nagy. 2017. Osteoporosis and the Role of Physical Therapy in the Different Domains. J Osteopor Phys Act 5(1): 1-4.
3. Kim Bennell, Karim Khan, Heather McKay. 2000. The Role of Physiotherapy in the Prevention and Treatment of Osteoporosis. Manual Therapy 5(4):198-213.
4. Vijay Samuel Raj V. 2016. Osteoporosis: Physiotherapy Role in Management and Prevention. Int J Physiother 3(3): 258-262.