Fighting Osteoporosis with Physical Therapy
Osteoporosis is a metabolic bone disease characterized by low bone density, thin, brittle bones, decreased bone strength, and changes in bone structure that increase the risk of a bone fracture. Physical therapy can play a crucial role in managing osteoporosis and helping you maintain and build bone density through a customized therapeutic exercise program. Exercise places beneficial stress on your bones by directly loading the bone and increasing muscle mass, which places mechanical stress on the skeleton and strengthens your bones. Numerous research studies have found that combining weight-bearing and strength training exercises are most effective for bone building and the management of osteoporosis.
What is Osteoporosis?
Osteoporosis is a metabolic bone disease that is characterized by low bone density (thin, brittle bones), decreased bone strength, and changes in bone structure, which increases the risk of bone fractures. Osteoporosis affects 12.3 million Americans with 55% of Americans aged 50 or older with the disease. Osteoporosis is a silent disease in which bones gradually become thinner and more brittle until an osteoporosis-related fracture occurs, known as a fragility fracture.
Fragility fractures are bone fractures that occur from low-trauma forces due to the thin brittle bones of those with osteoporosis, such as breaking your wrist or hip during everyday situations that would not normally cause a bone fracture. Fragility fractures can result in increased morbidity, mortality, hospitalizations, and reduced quality of life. One in three women and one in five men over age 50 will experience an osteoporosis-related fracture in their lifetime. The most common fractures are to the vertebrae of the lumbar spine, the hip, and the wrist.
Your bones are living dynamic tissue that are constantly rebuilding and breaking down, while storing important minerals such as calcium and phosphorous. Your bones are rebuilding and growing stronger up through your twenties and early thirties, building up stores of calcium for strong bones. However, after your mid-30s you begin to slowly lose bone mass.
Your muscles and nerves also require calcium and phosphorous to function optimally. If your diet does not supply enough calcium and phosphorus, your body will withdraw these minerals form your bones which can degrade your bone’s microarchitecture, causing the bones to become thinned out and porous. Combined with other lifestyle and environmental factors as well as the natural loss of bone mass as you age, you can develop osteoporosis when the body is unable to replace bone tissue at a rate that keeps pace with the bone tissue that is broken down.
This imbalance in the rebuilding and breaking down of bone tissue is accelerated in the first five years after a woman experiences menopause. During menopause, the hormone, estrogen, which provides a protective effect on bone health, naturally declines, which causes women to lose bone density faster and increases osteoporosis risk . Other risk factors that contribute to the development of osteoporosis are smoking, excessive caffeine intake, low calcium and Vitamin D intake, lack of physical activity and weight-bearing exercise, and a poor diet.
Having a smaller frame, advanced age, early menopause before age 45, going one year without a period in pre-menopausal years, and abnormal hormone levels can also predispose you to developing osteoporosis. Diseases such as celiac disease, inflammatory bowel disease, rheumatoid arthritis, spina bifida, cystic fibrosis, or kidney disease can also contribute to osteoporosis as can taking certain medications, like steroids.
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Physical Therapy Management of Osteoporosis
Physical therapy can play a crucial role in managing osteoporosis and helping you safely maintain and build bone density through a customized therapeutic exercise program. Physical therapy treatment can include posture and body alignment training, education on home environment modifications, targeted strength training, aerobic conditioning, and balance training. Exercise places beneficial stress on your bones by directly loading the bone and increasing muscle mass, which places mechanical stress on the skeleton. In response, your bones thicken and grow stronger.
Numerous research studies have found that combining weight-bearing and strength training exercises are most effective for bone building and the management of osteoporosis. Both types of exercise can increase balance, posture, agility, and strength, while building stronger, more resilient bones.
Weight-bearing exercises include walking, jogging, climbing stairs, or dancing. The muscle forces of aerobic exercise combined with gravity have the effect of producing stress on the joints and bones, stimulating osteoblast activity and bone building. Strength training involves using body weight, hand weights, resistance bands, or weight machines to increase muscle mass. The force produced by muscle contraction when strength training combined with the ground reaction forces during weight-bearing load the skeletal system and strengthen bones.
Therapeutic exercise can also minimize fall risk and the risk of a fragility fracture. A recent meta-analysis of randomized control trials reviewed the effect of a moderate-intensity multicomponent exercise program that included aerobic, balance, and strength training on the number of falls. Researchers found that individuals had a 22% lower risk for falls and a 26% lower risk of injurious falls after completing the program.
A 2022 study evaluated the effect of three types of exercise interventions on bone mass density in 39 postmenopausal women to prevent the onset or progression of osteoporosis. Group 1 engaged in high-impact training, Group 2 did high impact training combined with calcium and vitamin D intake, and Group 3 walked at an intense pace and supplemented calcium and vitamin D.
All participants saw improvements; however, the Group 2 participants (high impact training combined with calcium and vitamin D intake) saw the largest improvements in bone mineral density with a baseline improvement over 20% in their T-scores (which measures bone mineral density). Group 2 also had the lowest percentage of fracture events following the intervention. High-impact training should only be done under careful supervision by a physical therapist.
If you have osteoporosis or are concerned that you may be at risk for the condition, work with a physical therapist who will guide you through a safe, effective exercise program to restore healthy movement and function and rebuild bone strength.
