October is National Physical Therapy Month! So, don’t forget to give your physical therapist or physical therapist assistant a hug today. One topic that is constantly resurfacing for physical therapists is osteoporosis. This week’s column will review the definition, cause and prevention. Next week, I will present the 10 best exercises to prevent osteoporosis.

Definition of Osteoporosis:

Osteoporosis means porous bone "osteo" meaning bone and "porosis" meaning porous. It is a disease in which bone loses mass or density, which leads to structural deterioration. Over time, this fragile bone is not strong enough to withstand the forces of gravity and changes may occur in the shape of the bone. In the spine, vertebrae which are normally shaped like square blocks, deteriorate and change shape to resemble a codfish. Then, the spine as a whole, changes shape and develops a forward curve called kyphosis. Kyphosis can cause a “hunch back” appearance. The deteriorated bone is more susceptible to fractures, especially in the spine, hip and wrist.

Prevalence of Osteoporosis:

Osteoporosis is a very common problem. According to the National Osteoporosis Foundation, 55% of people over 50 years of age have osteoporosis. 80% of those with osteoporosis are women. One in two women and one in four men over age 50 will have a fracture related to osteoporosis in their lifetime. It accounts for 1.5 million fractures per year at an annual cost of more than 18 billion dollars.

Osteoporosis Symptoms & Risk Factors:

Bone loss silently occurs without symptoms. If not tested, most people are unaware of bone loss until severe deformity, loss of height or fracture is noted. However, several risk factors should encourage regular testing:

• History of fracture over age 50
• Low bone mass
• History of fracture or osteoporosis in immediate family
• Female
• Thin and small frame
• Over 70 years of age
• Estrogen deficiency – with menopause especially if early or surgical onset
• Loss of menstrual period
• Anorexia
• Low calcium intake - presently and as youth
• Vitamin D deficiency
• Medications: corticosteroids, chemotherapy, and anticonvulsant drugs
• Low testosterone levels in men
• Inactive lifestyle
• Cigarette smoker
• Excessive us of alcohol
• Caucasians & Asians greater risk than African Americans and Hispanic Americans

Osteoporosis Testing:

Osteoporosis can be detected early by a painless and quick test called a Bone Mineral Density (BMD) test. Medicare and most other health insurers pay for the test every two years. If you are concerned and have several risk factors talk to your family physician about a BMD test.

Prevent & Treat Osteoporosis:

While there is no cure for osteoporosis, being proactive can prevent, retard or stop the progression of this disease:

• Well - Balanced Diet – rich in calcium and vitamin D
  • Calcium Rich: milk, leafy green vegetables, soybeans, yogurt and cheese
  • Vitamin D: produced in skin via exposure to sun: also in fortified milk
• Healthy Lifestyle – avoid smoking and excessive alcohol use
• Weight –Bearing Exercise – such as walking, biking, hiking, and cross-country skiing for the lower body (3-5 times per week 30-45 minutes) Wall or table push-  ups and chest-press, biceps/triceps (light/moderate weight 10-15 times 3/week) for the upper body. (See specific details next week in Part II).
• Start Early – the best prevention for osteoporosis begins in childhood with a healthy diet and lifestyle with exercise as above.
• Continue Good Habits for Life – to maintain bone health but as you age talk to your doctor about calcium supplements with vitamin D. An adult under 50 years old requires 1000mg of calcium and 20 IUs of vitamin D. 1 cup of vitamin D fortified milk contains 302mg of calcium and 50 IUs of vitamin D.
• Get Tested – talk to your family physician about Bone Mineral Density Test
• Medication – in some cases medications are important to maintain healthy bone. Talk to your doctor about the most appropriate option for you. Currently the following medications are approved by the FDA for the prevention and/or treatment of osteoporosis:
  • Biophosphonates – FosamaxR , BonivaR, ActonelR  , MiacalcinR
  • Estrogen/Hormone Therapy – ClimaraR, Ortho-EstR, VivelleR
  • Selective Estrogen Receptor Modulators (SERMS) – EvistaR

NEXT MONDAY – Read “10 Best Exercises to Prevent Osteoporosis” by Dr. Paul J. Mackarey in the “Health & Exercise Forum!”

This article is not intended as a substitute for medical treatment. If you have questions related to your medical condition, please contact your family physician. For further inquires related to this topic email: drpmackarey@msn.com

Paul J. Mackarey PT, DHSc, OCS is a Doctor in Health Sciences specializing in orthopaedic and sports physical therapy. Dr. Mackarey is in private practice and is an affiliated faculty member at the University of  Scranton, PT Dept.