Osteoporosis is a worldwide problem, though mostly documented in countries with advanced healthcare systems, and affects many millions of people across all countries. Women have a higher lifetime risk of a fracture due to osteoporosis with about thirty to forty percent chance in their life, whilst men have a much smaller but still significant risk of 13%. Osteoporosis is a condition which occurs slowly and quietly with the sufferer mostly not aware there is anything amiss until it is too late and they have a problem. The assessment of risk and the preventative treatment of this condition are vital and very active areas in research and treatment.
With at least half of all fifty year old women affected by osteoporosis and almost ninety percent of those women over 75 years old, osteoporosis is a common condition. Fractures are the main symptom along with the pain and in the US there are a million and a half fractures yearly from this condition alone. The fractures have consequences of pain and disability if they are vertebral and with hip fractures (neck of femur) there is a five to twenty percent incidence of death from the side effects of the fracture and the treatment.
The greatest risk factor for getting osteoporosis is passing through the menopause, when the bone-protecting hormones stop being produced or are greatly reduced. The bone density of the person can then drop steeply unless they are diagnosed and treated. Other risk factors include being female, age, having a family history of osteoporosis, a hormone deficiency, having low calcium levels, drinking excessive alcohol and smoking cigarettes. If there is the menopause plus a number of risk factors, the woman is 65 years old or older or the person has had a fracture without significant trauma then they should be investigated for low bone density.
There are few signs and symptoms of osteoporosis until something goes wrong such as an acute spinal fracture whilst bending over or lifting a weight. Spinal fracture pain is very sharp and limiting so the patient has no doubt something has occurred. Lumbar and thoracic pain is common and the thoracic curve may be increased due to anterior compression fractures of the vertebral bodies, with a dowagers hump and a distinct loss of height from their normal adult level. Any fracture occurring in normal activity should be investigated for the cause. Osteoporosis may be a clear diagnosis with compression fractures and thin bones on x-ray but a DEXA scan can document the severity and the change with treatment.
Lifestyle factors helping to prevent osteoporosis include avoiding smoking or excess alcohol, exercising whilst weight bearing and eating a nutritious diet rich in calcium and vitamin D. If the woman has gone through the menopause then HRT can be preventative. Medications employed include selective oestrogen receptor modulators, calcium and vitamin D, HRT and bisphosphonates, with an anabolic drug used to increase bone mass, adding new bone rather than just preventing loss. We gain our maximum bone density when we are young so should eat a good diet at this time and participate in exercises to develop the maximum strength in our bones.
A recent development in the treatment of hyper acute spinal fractures with their very severe and disabling pain is vertebroplasty. In this procedure a radiologist introduces a needle under x-ray control into the front of the body of the vertebra which has collapsed and then injects a cement material which mechanically bolsters the area, with great relief of pain. Falls are particularly dangerous due to the high risk of fracture and exercise can improve balance, stability, co-ordination and muscle strength to reduce the risk. As this may be a long term condition it may be necessary to provide both practical and psychological help to enable patients to cope best with their condition.
There is a close relationship between the level of bone density and exercise and exercise instruction is given by physiotherapists in group classes. Young people and children are guided to participate in exercise as this builds a good basis of bone density to start off their life well. The loss of bone density can be slowed down by exercise and jarring exercises are better than non weight bearing ones such as swimming. There is no age limit to beginning to improve bone density and physiotherapists take classes for the very elderly.
Jonathan Blood Smyth, editor of the Physiotherapy Site, writes articles about
Physiotherapists, physiotherapy,
physiotherapists in Leeds, back pain, orthopaedic conditions, neck pain and injury management. Jonathan is a superintendant physiotherapist at an NHS hospital in the South-West of the UK.
