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Osteoporosis

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Introduction

People are often unaware that they have fragile bones until the time of a first fracture. Broken wrists, hips and spinal bones are the most common fractures in people with Osteoporosis and it is more widespread in older age, although younger people can sometimes be affected. Osteoporosis is not a painful condition. One in two women and one in five men over the age of 50 in the UK will fracture a bone, mainly as a result of Osteoporosis.

 

The cause of the disease is still not fully understood. As we get older, our bone tissue cannot regenerate as well as it did when we were younger. Due to this process, the development of Osteoporosis leads to our bones becoming less dense, making them more fragile.

Signs & Symptoms

Often the first sign of Osteoporosis is when someone breaks a bone after a relatively minor fall. It can also cause back pain and occasionally breathing problems due to lack of space under the ribs.

Causes & Risk Factors

  • Long term use of steroids hinders the production of bone by reducing the amount of calcium in our bodies.
  • Reduced Oestrogen levels for women due to an early menopause or having a hysterectomy with both ovaries removed.
  • Weight bearing exercise encourages bone development therefore lack of exercise puts you at greater risk of developing Osteoporosis.
  • Poor diet with lack of calcium and vitamin D or if you are significantly underweight & malnourished.
  • Smoking reduces a women’s ability to produce Oestrogen and a man’s ability to produce testosterone which can both lead to bone weakness.
  • Alcohol abuse – more than 4 units of alcohol /day.
  • Family history of the condition can also be pertinent.
  • Recent history of a fracture following minor bump or fall.
  • If you already have inflammatory conditions such as Rheumatoid Arthritis, Crohn’s disease or COPD.

Assessment & Diagnosis

Your Physio will ask for a history of your symptoms followed by performing a clinical examination so that they can understand your limitations, establish a working diagnosis and help you decide on the best treatment option. Your Physiotherapist will work closely with you to set individualised treatment goals for you to aim at and will regularly re-assess you to measure your progress and make any necessary modifications in your treatment. If Osteoporosis is suspected, you can chat to your doctor or your Physio may recommend having a DEXA scan performed. This scan involves lying on a couch fully clothed while your bones are X-rayed, giving an insight in to the structure of your bones.

Self-Management

If Osteoporosis is confirmed as the diagnosis, your Physio can educate you on the condition and suggest methods that will help you manage your symptoms and mitigate its progression. Some of the common lifestyle changes are outlined below:

 

Diet

The body contains 1kg of calcium, 99 percent of which is stored in our bones. While it is important to eat plenty of calcium to help build or maintain healthy bones, other vitamins and minerals are also important. Food sources containing high levels of calcium include milk, cheese, yoghurt and certain types of fish (Whitebait). Also green leafy vegetables, watercress, beans, chick peas and some nuts, seeds and dried fruit are good sources of calcium.

 

Things To Avoid

  • Drinking lots of fizzy drinks – phosphate, in the form of phosphoric acid, is used to improve the flavour in a lot of fizzy drinks and too much can cause the body to use calcium to balance levels.
  • Drinking too much caffeine – again, a high consumption of caffeine could affect the balance of calcium in the body.
  • Letting your weight drop too low – being overweight is not good for general health but being underweight increases the risk of broken bones when you fall.

 

Stop Smoking

Smoking has a toxic effect on bone by stopping cells from doing their work.

 

Reduce Alcohol Intake

Drinking too much alcohol is damaging to our skeleton and increases your risk of fracture and please do remember that too much alcohol can affect your balance and increase the risk of falling.

 

Vitamin D is also important as it allows the body to absorb calcium. This is found in  some foods particularly oily fish. It is also produced by the body when the skin is exposed to sunlight. You may need to take a supplement of Vitamin D, which your doctor will advise you on.

Physiotherapy

The skeleton grows stronger if you regularly perform weight bearing exercise. This includes any kind of physical activity where you are supporting the weight of your own body, for example jogging, aerobics, tennis, dancing and brisk walking. Click here for a useful link to exercises.

 

Your Physiotherapist will design a bespoke home exercise programme for you, aimed at developing your bone strength and increasing your strength which will help you stay functional and active. Regular re-assessment will check for progression and will present opportunities for exercise plan adjustments to me made.

Other Considerations

Drug-based therapy can also play a key role in managing osteoporosis. The most common medications are outlined below and your Physio will recommend discussing this with your GP.

 

Biphosphonates 

These are the most commonly prescribed drugs used to treat Osteoporosis. These drugs have been shown to reduce the risk of broken bones. Most are available in tablet form – daily, weekly or monthly – they are non-hormonal and act by slowing down the rate of bone loss.

 

Ibandronate and Zoledronic Acid are also bisphosphonates, but do not have the same side effects on the gullet.

 

Denosumab (Prolia)

It helps stop the development of the bone removing cells before they damage the bone, therefore increasing the strength of the bone. This is given via a subcutaneous injection every 6 months.

 

Calcium& Vitamin D

There are a number of calcium and vitamin D supplements to help prevent broken bones. Side effects can include irritation of the gullet and these drugs may not be suitable for people with stomach/bowel trouble or kidney problem.

Resources

National Osteoporosis Foundation:  www.nof.org

 

Royal Osteoporosis Society: https://theros.org.uk/

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