Are You Bone Strong?
Recommendations for preventing osteoporosis
Every year, more Americans are diagnosed with osteoporosis, a disease that causes bones to weaken and become more likely to break. You may not know that you have this "silent" disease until your bones are so weak that a sudden strain, bump or fall causes your wrist to break or your hip to fracture.
Osteoporosis is a bone disease characterized by low bone density that can increase fracture risk. Bone density is measured by dual-energy X-ray absorptiometry, also known as a DEXA scan. This is reported as a T-score with a score of -2.5, indicating osteoporosis. The body areas that are most affected are the hip, spine, and lower wrist or radius.
Risk factors for osteoporosis are divided into two types: modifiable and non-modifiable. Age, gender, ethnic background, family history of osteoporosis, history of falls and a history of a previous fracture are all nonmodifiable risk factors. Advancing age is a risk factor, especially for women in their seventies and men in their eighties. While both men and women do lose bone mass with age, women, in particular, lose bone mass more rapidly in the first five to 10 years after menopause because of the sudden decrease in estrogen. Hormonal status can also impact bone health, especially in young females who have started having a menstrual cycle but then stop with increased activity or changes in nutritional status.
Regarding ethnicity and sex, white and Asian women are both at greater risk for osteoporosis. A family history of osteoporosis or a low-trauma fracture can also impact risk. Height loss of more than 0.5 cm per year can also increase the risk for fractures. A history of falls increases the likelihood of a fracture. Previous fractures also increase the risk of a future fracture. Medical conditions such as diabetes mellitus, cardiovascular disease and cancer may impact bone density. Oftentimes, medications, such as corticosteroids, which are needed to treat different conditions, can impact bone health.
The good news is that several factors are considered modifiable, meaning under an individual's control. Lack of physical activity or being at risk for falls can be modified through increased activity or activities that help with fall prevention. Cigarette smoking can affect bone health, with cessation of smoking impacting overall health and bone health. It is never too late to stop smoking; your bones will thank you! Increased alcohol consumption with more than two glasses of wine per day can increase the risk of fracture. Low body mass can also be a modifiable risk factor and can contribute to frailty. Reduced calcium consumption and reduced Vitamin D also increased the risk for osteoporosis; however, this can be altered with dietary changes and 10 to 15 minutes in the sun. Additional Vitamin D supplementation may be necessary to be optimized.
One of the most important times to influence bone health is childhood and adolescence. During this time, bone is being developed and deposited, similar to putting money in the bank. Increased physical activity with running and jumping helps to form bone and create a larger balance as people begin to encounter non-modifiable risks such as aging. Exercise continues throughout the lifespan to positively benefit bone health and osteoporosis prevention.
There are specific activity recommendations for those with lower bone density or with established osteoporosis based on a newly published Clinical Practice Guideline. Weight-bearing exercises are recommended. Activity for static weight-bearing included singleleg standing. This should be performed in a safe environment with a counter to reach for as support or in a door facing. The low-force dynamic recommendations are for activities such as walking, Tai Chi and strength training in a weight-bearing position. Non-weight-bearing exercises with low-weight and higher repetitions did not have any specific recommendation for change in bone density. However, non-weight-bearing exercises with higher loads could possibly help to improve hip bone density. These modes could be combined to improve bone density and help increase strength.
Fall prevention should be a consideration for those at risk for osteoporosis and those with an established diagnosis. There are environmental factors to consider that can be adapted. Small pets, rugs and low light settings can become fall hazards. Removing carpets or making sure that rugs properly adhere to the floor can help decrease fall risk. Adding a nightlight can be helpful, especially for nighttime trips to the bathroom. Loss of balance is another consideration with falls. There are many reasons for losing balance – visual impairments, dizziness and altered sensation in the lower extremities. Physical therapy interventions can be focused on helping improve balance with a focus on fall prevention.
Primary care physicians and rheumatologists routinely screen for osteoporosis. If you have concerns about osteoporosis, there is a free website that can help you estimate your 10-year risk for osteoporosis fracture: https:// americanbonehealth.org/calculator/, which can help start the conversation with your provider. If you are already diagnosed with osteoporosis and have concerns about falls or need an exercise program, a local physical therapist can help. Optimal loading with strengthening and weight-bearing combined with addressing modifiable risk factors can help reduce the risk of osteoporotic fracture.
Amanda Mahoney, PT, DPT, is a board-certified specialist in orthopaedic physical therapy and is a clinical assistant professor of physical therapy -- School of Allied Health Professions at LSU Health Shreveport.