Osteoporosis

Osteoporosis is a loss of bone mineral density and bone mass which can weaken bones and lead to fractures. Roughly 10 million people in the U.S. have osteoporosis while another 43 million are considered at increased risk. (1) Although anyone can develop osteoporosis it is most common in non-Hispanic white women and Asian women and for many it starts to develop 1-2 years before menopause. (2)

Many people with osteoporosis don’t know they have it until after they’ve broken a bone, with fractures of the hip, spine, and wrist being most common. These fractures often occur after a fall, but depending on the severity of the disease even bending, lifting, or coughing can cause a break. Signs of vertebral or spinal  fracture include severe back pain and posture changes such as an increased kyphosis or curve of the back. (2)

In addition to age and sex other factors that increase the risk of developing osteoporosis include (2):

• Body size: people with slighter builds 
• Hormones: decreased estrogen in women or decreased testosterone in men
• Family history of osteoporosis
• Medical conditions: eating disorders, rheumatoid arthritis, endocrine disorders, gastrointestinal disorders, and certain cancers
• Long-term medications: certain steroids, antiepileptic, proton pump inhibitors, SSRI (a type of medication for depression and anxiety), thiazolidinediones (a medication used in diabetes treatment), and cancer medications
• Diet: not getting enough Vitamin D and calcium
• Lifestyle: sedentary lifestyle, heavy alcohol use, and smoking

It is currently recommended to screen all women over the age of 65 for osteoporosis. The most common test to check bone mineral density is a specific type of x-ray called DXA (dual-energy x-ray absorptiometry).  If you are diagnosed with osteoporosis your doctor may prescribe medication but many of the strategies to manage osteoporosis involve diet, exercise, and lifestyle changes. (3)

When examining your diet you want to make sure you are getting enough calcium, Vitamin D, and protein and maintaining an overall calorie level appropriate for your age, height, and weight. Food sources of calcium include: dark leafy green vegetables, broccoli, low-fat dairy, salmon or sardines, and calcium fortified foods like orange juice or cereals. Vitamin-D can be found in fatty fish, fish oil, egg yolks, and fortified foods such as milk and cereals. (3)

In childhood and into adulthood strength training can increase bone density. In older adults the window for increasing bone mass has closed (3) but exercise still has an important role to play in keeping muscles strong and decreasing fall risk. 

Falls are common in older adults, with greater than 1 in 4 falling each year. (4) To decrease your risk of falling set yourself up for success at home by moving cords or loose rugs that could cause you to trip, making sure stairs have enough light and a handrail, wearing shoes or non-skid socks when walking on slick floors, and consider installing grab bars in the bathroom. 

You can also perform exercises at home to improve your balance with no special equipment such as:

• Tandem balance: standing in front of a countertop or sturdy furniture that you can use to steady yourself if needed position yourself with one foot directly in the front of the other. Try to maintain your balance for 30 seconds, only using your hands if you start to lose control. Practice with each foot in front.
• Single leg balance: once again stand in front of a countertop or sturdy furniture that you can use to steady yourself if needed and pick one foot up. Try not to use your hands or rest your lifted leg on your standing leg and try to maintain this position for 30 seconds. Practice on both legs.
• Tandem gait: find a clear path such as a hallway and walk a straight line trying to bring one foot directly in front of the other. You may need to start off with the feet more separated and work up to being able to touch the heel of one foot to the toe of the other as you step forward.
• Sit to stand: sit in the middle of a firm chair such as a dining chair and stand up trying not to use your hands, then sit slowly back down without plopping in the chair.

For an individualized balance and strengthening program schedule a physical therapy evaluation to help you stay safe and active.

1. https://health.gov/healthypeople/about/workgroups/osteoporosis-workgroup#:~:text=In%20the%20United%20States%2C%20an,at%20increased%20risk%20for%20osteoporosis. 
2. https://www.niams.nih.gov/health-topics/osteoporosis#:~:text=Osteoporosis%20is%20a%20bone%20disease,of%20fractures%20(broken%20bones). 
3. https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take 
4. https://health.gov/myhealthfinder/healthy-living/safety/lower-your-risk-falling