What is osteoporosis?

Osteoporosis is a disease of the bones. It is also is called a “silent” disease. You may have bone loss for many years without any symptoms until you break a bone. Broken bones from osteoporosis cause serious health problems and disability, it can make it harder to do daily tasks on your own, such as walking. It mostly affects older women but prevention starts when you are younger. No matter your age, you can take steps to build bone mass and prevent bone loss.

What is bone loss?

Bone loss is the amount of minerals, such as calcium, that your body absorbs (takes) from your bones.

Some of the most common reasons include

• You do not get enough calcium from food. Your body uses calcium to build healthy bones and teeth and stores calcium in your bones. Your body also uses calcium to send messages through your nervous system, help your muscles contract, and regulate your heart’s rhythm. But your body does not make calcium. You have to get all the calcium your body needs from the foods you eat and drink (or from supplements). If you don’t get enough calcium each day, your body will take the calcium it needs from your bones.
• You are past menopause. As you get older, your bones don’t make new bone fast enough to keep up with your body’s needs. The calcium taken from your bones causes you to lose bone density. Bone loss also speeds up after menopause and can lead to weak, brittle bones.

Who can get osteoporosis?

Worldwide, it is estimated that 1 in 3 women above the age of 50 will experience osteoporotic fractures, as well as 1 in 5 men.^[1] India with a population of 1.2 billion people is the second most populated country in the world with approximately 10% of population (more than 100 million) over 50 years of age.^[2] In 2013, sources estimate that 50 million people in India are either osteoporotic (T-score lower than-2.5) or have low bone mass (T-score between-1.0 and-2.5).^[3] Osteoporosis affects more women than men. Osteoporosis is most common in older women. But younger women can get osteoporosis. And girls and women of all ages need to take steps to protect their bones.

Are some women more at risk for osteoporosis?

Yes. Your risk for osteoporosis is higher if you:

• Are past menopause.
•  Have a small, thin body (weigh less than 127 pounds)
• Have a family history of osteoporosis
• Do not get enough calcium and vitamin D. Calcium and vitamin D work together to build and maintain strong bones.
• Do not get enough physical activity. Women of all ages need to get regular weight-bearing physical activity, such as walking, dancing, or playing tennis, to help build and maintain bone density.
• Have not gotten your menstrual period for three months in a row (called amenorrhea). If you have amenorrhea and you are not pregnant, breastfeeding, or taking a medicine that stops your periods, talk to your doctor or nurse. Not getting your period means your ovaries may have stopped making estrogen.
• Have an eating disorder.
• Smoke. Women who smoke have lower bone density and often go through menopause earlier than nonsmokers. Studies also suggest that smoking raises your risk for broken bones, and this risk goes up the longer you smoke and the more cigarettes you smoke.^[4]
• Have a health problem that raises your risk of getting osteoporosis. These include diabetes, premature ovarian failure,  celiac disease and inflammatory bowel disease, and depression.
• Take certain medicines to treat long-term health problems, such as arthritis, asthma, lupus, or thyroid disease.
• Drink too much alcohol. For women, experts recommend no more than one alcoholic drink a day if you choose to drink alcohol.^[5] Long-term, heavy drinking can cause many health problems, including bone loss, heart disease, and stroke.

There are many factors that can cause a person to be at risk for developing osteoporosis. It is important to know your risks so that you can be diagnosed and proactive in your treatment.

What are the symptoms?

There may be no outward symptoms asit’s a “silent disease” until a fracture occurs. If you are middle-aged or older, you may notice a loss of height or the appearance of a humpback. You may also begin to experience pain between your shoulder blades or above the crest of the pelvis.

People with low bone density may experience fractures in everyday situations that would not occur in persons with healthy bones, such as breaking a hip or a wrist with a fall from a standing height, breaking a rib when opening a window or when receiving a hug, or breaking an ankle after stepping off a curb. These are called fragility fractures and are a red flag for bone disease. Spinal compression fractures, particularly those in the upper back or thoracic spine (area between the neck and the lower back), are the most common fractures, followed by hip and wrist fractures.

How Is It Diagnosed?

If you are seeing a physical therapist for back pain or other rehabilitation issues, the therapist will review your medical, family, medication, exercise, dietary, and hormonal history, conduct a complete physical examination, and determine your risk factors for osteoporosis. The assessment may lead the physical therapist to recommend further testing.

Osteoporosis is best diagnosed through a quick and painless specialized X-ray called the DXA, which measures bone density. The results are reported using T-scores and Z-scores.

• The T-score compares your score to that of healthy 30-year-old adults. If you have a T-score of -1 or less, you have a greater risk of having a fracture.
• If the T-score is -2.5 or less you will receive the diagnosis of osteoporosis.
• The Z-score compares your bone mineral density to those of the same sex, weight, and age. It is used for those whose bone mass has not yet peaked, premenopausal women, and men older than 50.

Other methods of measuring bone density include X-ray, ultrasound, and CT scan.

Do I need to be tested for osteoporosis?

Your doctor may suggest a bone density test for osteoporosis if.

• You are 65 or older
• You are younger than 65 and have risk factors for osteoporosis. Bone density testing is recommended for older women whose risk of breaking a bone is the same or greater than that of a 65‑year‑old white woman with no risk factors other than age. Ask your doctor or nurse whether you need a bone density test before age 65.

Can This Injury or Condition Be Prevented?

Osteoporosis can be prevented by building adequate bone density through childhood, adolescence, and early adulthood. Building strong bones requires an adequate intake of calcium and vitamin D, and regular exercise.

There are steps to take to improve bone health at any age. An active lifestyle that includes resistance and weight-bearing exercise is important to maintain healthy bone. It is also important to avoid habits that promote bone loss, such as smoking, excessive alcohol consumption, and an inadequate intake of calcium in your diet. Maintaining good body mechanics and posture also contribute to good bone health. We have no control over the genetic tendencies we have inherited, but we can choose to manage osteoporosis through proper medication, diet, and appropriate exercise.

As with any health issue, an overall healthy lifestyle is important for staying well.

How Can Physiotherapy Help?

Your physical therapist can develop a tailormade program based on your individual needs to help improve your overall bone health, keep your bones healthy, and help you avoid fracture. The exercise component for bone building or slowing bone loss is very specific and similar for all ages. Bone grows when it is sufficiently and properly stressed, just as muscle grows when challenged by more than usual weight. Two types of exercise are optimal for bone health: weight-bearing and resistance.

It is best for a physical therapist to provide your individual bone-building prescription to ensure that you are neither over exercising nor under exercising. Typically, exercises are performed 2 to 3 times a week as part of an overall fitness program.

If you are diagnosed with osteoporosis or low bone density, your physical therapist will work with you to:

• Build bone or lessen the amount of bone loss at areas most vulnerable to fracture through exercise—hip, spine, shoulder, arms.
• Improve your dynamic balance to avoid falls.
• Improve your posture.
• Adjust your work and living environments to limit risk.
• Help you avoid exercises and movements that may contribute to spinal fracture, including any type of sit-up or crunch, and excessive spinal or hip twisting.

Children and adolescents. Physical therapists can educate families and youth groups on proper exercise and posture and about the need to move daily to build bone strength and prevent bone loss. Children with health issues such as spina bifida, diabetes and cerebral palsy are at a greater risk for bone disease and can particularly benefit from the guidance of a physical therapist. Proper physical conditioning is crucial for children and adolescents: the majority of bone is built during adolescence and peaks by the third decade of life.

Healthy bone is built and maintained through a healthy lifestyle. Your physical therapist will teach you specific exercises to meet your particular needs.

Sowhat is Aquatic Exercise and Can It help improve osteoporosis?

Aquatic exercise is “vertical exercise in the water with the participant submerged to chest or shoulder depth”.^[6]

The Benefits of Aquatic Exercise:

• Decreased stress on weight-bearing joints due to the buoyancy of the water
• Increased mobility due to diminished gravitational pull
• The ability to use varying levels of resistance for strengthening
• Increased sensory stimulation in brain ⁴

Usually, weight-bearing exercise is recommended for increasing bone density. In weight-bearing exercises, you are supporting your own body weight through your feet and legs against gravity. They increase bone density by having the muscle pull on the bone through impact on the ground and from carrying your body weight. The National Osteoporosis Society mentions that swimming is not weight-bearing. And that it does not affect bone density.^[7] That’s because there’s less gravity in an aquatic environment.

Aquatic exercise is not usually recommended for individuals with osteoporosis because there’s less gravity. But it is recommended for individuals with more severe osteoporosis to improve function and balance. That’s because of the extra benefits from the support and comfort of the water.

Balance is important in reducing the risk of falling and thus the risk of fracture. A 2008 study compared aquatic versus land exercise on balance and quality of life in women with osteoporosis. The study found significant improvements in women’s balance in both land and water exercise. So if you have difficulty exercising on land (or simply don’t enjoy it) aquatic exercise may be a good alternative for you!

Another study from 2008 examined if aquatic exercise can improve bone density. They found that the exercise group was able to maintain and slightly improve their bone density compared to the control group^.[8] They were doing three hours of aquatic exercise for seven months.

So, not only can water exercises increase balance and posture, but they can also increase bone density. Not as much as running or other weight-bearing exercises, but still very significant!

Not a lot of clinical studies have been done to measure the bone-building effect of water exercises, but the ones that have been done show positive results. Many people report decreased back pain and improved back strength and posture too.

Do you have difficulty doing regular weight-bearing exercises or just want to try something new? Joining an aquatic exercise class for seniors can be terrific fun!

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