What You Need To Know About OSTEOPOROSISA Physical Therapist’s PerspectiveAmerican Physical Therapy Association1What You NeedTo Know AboutOsteoporosisOsteoporosis literally means “porous bones” —bones that were once strong have become fragile.This insidious disease is sometimes called “the silentthief” because there are no symptoms. Yet it works lit-tle by little over a period of decades to rob your bonesof calcium—a mineral that keeps them strong. Olderwomen are the main victims of osteoporosis, as theysuffer nearly 1.5 million fractures to the hips, fore-arms, and vertebrae each year. Because bonesbecome thin and brittle, recovering from these frac-tures can be a long and complex process, with possi-ble life-threatening complications.Osteoporosis and low bone mass affects an estimated28 million women and men age 50 and over. Eightypercent of the osteoporosis cases are women, yet asignificant number of men also suffer from the disease.In addition to the toll it exacts in human suffering,osteoporosis costs our economy $13.8 billion eachyear in health care expenses and lost productivity.©1997 APTA All rights reserved.This brochure is not intended as a substitute forprofessional health care.The good news is that you can often prevent osteo-porosis if you begin weight-bearing exercise, such aswalking, running, gardening, or aerobics, and eat acalcium-rich diet from an early age. And if you alreadyhave osteoporosis—or you're at high risk for develop-ing it—physical therapy can help make the differencein keeping you active and mobile. In this booklet you will find out:• How the bones and spine are affected by osteoporosis;• How to assess your personal risk factors;• Why exercise, good posture, good diet, hormones, and lifestyle are important;• The role of hormone therapy and drugs in treating osteoporosis;• How young people can build a personal “bone bank”;• How physical therapy can help people living with osteoporosis.Understanding The Bones AndCurvature Of The SpineBones are living tissue that constantly renewsand destroys itself. An individual’s bone tis-sue reaches its peak mass in the late teensor early 20s, although some bones may continuegrowing past age 30. Between the ages of 30 and 50,bones gradually start to lose mass and strength fasterthan the body can replenish it. For post-menopausalwomen, the problem is accelerated by diminishinglevels of estrogen, a hormone that plays a pivotal rolein regulating bone loss. The bones gradually becomethinner and more prone to fracture. According to theNational Osteoporosis Foundation, one out of everytwo women and one out of every eight men over age50 has an osteoporosis-related fracture. Kyphosis—a forward curvature of the spine—is acommon symptom of osteoporosis. It is caused by compression fractures to the vertebrae (the individual bones which form the “backbone”) due to loss ofbone mass. As a result of compression fractures, theindividual vertebrae take on a flattened or wedgeshape in the front and the upper spine settles into anexaggerated C-shaped curve. These fractures arenot necessarily painful, and may go undiagnosed. Ifpain is present, the patient may mistakenly attribute itto muscle strain or a “bad back.”It is normal for elderly people to lose 1-11/2” in heightdue to degenerative causes such as osteoarthritisand the natural compression of the discs between thevertebrae. (Osteoarthritis, sometimes confused withosteoporosis, is an inflammation of the joints due toaging, wear and tear, or injury.) Osteoporosis cancause a more severe loss of height because ofchange in shape of the vertebrae due to fracture.23With osteoporosis, the spine is subject to compression frac-tures that cause the vertebrae to collapse. This may lead to forward curvature of the spine (as seen in the figure on theright).Are You At Risk For Osteoporosis?While we don’t yet know all the causes ofosteoporosis, there are many factors thatcan help predict who is at risk. Respond“yes” or “no” to the statements below to get an idea ofwhere you stand:___My older relatives have a history of broken bones.___I’m “petite” or thin.___I drink heavily.___I smoke.___I consume a lot of caffeine and/or salt.___I’ve been losing weight.___My spine curves forward more than in the past.___I have recently fractured my hip, wrist, or spine.___I’m not sure if I get enough calcium in my diet.___I don’t like dairy products.___I didn’t like dairy products as a child.___I don’t exercise very much.___My muscles are weak or sagging.___I take thyroid medication, anti-convulsive medication, or cortisone-like drugs.For women:___My ovaries have been removed.___I’ve reached menopause.___I had an early menopause.___I’ve never been pregnant.___Before menopause, I had long periods of amenor-rhea (absence of menstrual cycle).A “yes” to any of these statements suggests that youmay be at risk. More than one “yes” answer increasesthe likelihood that you will experience an osteoporo-sis-related fracture. In either case, it would be wise toconsult your physician about taking a bone densitytest to measure the strength and thickness of yourbones. There are actually several different tests forbone density, and all of them are painless and safe.In many cases you won’t even have to change intoan examining robe.The results of the test will assist your doctor in deter-mining the degree of bone loss (if any). This informa-tion is helpful in deciding upon a course of medicaltreatment or physical therapy. Although treatment forosteoporosis may begin before you are tested, it isrecommended that you have a bone-density test assoon as possible.Preventing And Treating OsteoporosisExercise. Weight-bearing exercise and strengthtraining are essential in the prevention andtreatment of osteoporosis. When it comes tomaintaining strong bones, “use it or lose it” is theorder of the day. Strength training also improvesstrength and balance, which help prevent falls thatlead to fracture. Exercise makes our bones strongand resilient, while inactivity leads to diminished bonemass and weakness. It’s important to remember,though, that exercise—walking, jogging, stair-climb-ing, weight-lifting, aerobics, tennis, dancing, or someother form of weight-bearing or resistance exercise—must be done regularly to bring long-term benefits.The U.S. Surgeon General recommends at least 30minutes of moderate exercise each day. A physical