by Dr. Vimal Telang, with Foreword by Dr. Sandhya Kamath
Foreword
Osteoporosis is increasing in elderly persons in India, especially women (about 61 million people in the country have osteoporosis, with 80 per cent of them being women).
Osteoporosis often develops 10–20 years earlier in India than in Western countries, which can have a significant impact on the country’s health and economy. Osteoporosis is a disease that weakens the bones making them thinner and less dense than they should be. With advancing age, bones naturally lose some of their density and the ability to regrow (remodel) themselves. Fractures are the most common manifestation of osteoporosis. Even though osteoporosis doesn’t directly cause symptoms, a few changes in the body mean that the bones are losing strength or density. These warning signs of osteoporosis can include losing an inch or more in height, changes in the natural posture (stooping or bending forward more), shortness of breath (if disks in the spine are compressed enough to reduce the lung capacity), lower back pain (pain in your lumbar spine) etc.
Risk factors for osteoporosis include age, gender, family history, and nutritional deficiencies. Calcium and vitamin D are two key nutrients that impact bone health and protein deficiency.
India has high rates of vitamin D deficiency despite its abundant sunlight. Multiparity (multiple pregnancies in a woman), and increased abortions are common in our country. Early menopause and intake of certain medications (commonly corticosteroids) can lead to osteoporosis. Osteoporosis can be considered a lifestyle disease; chronic smokers and alcoholics are also prone to be affected. Osteoporosis is diagnosed by Bone Density Test which is a non-invasive one.
Physiotherapy for Osteoporosis
The bone tissue is constantly being absorbed and replaced throughout one’s lifespan. The bone mass decreases when the rate of absorption is more than the rate of production which typically occurs with advanced age. Bone density is a measure of the calcium and other minerals in our bones.
Osteoporosis means porous bones
Osteoporosis can be silently progressive with no prominent symptoms until complications like fractures occur if left untreated or unidentified.
Reduction in calcium levels affects muscle health too. Calcium is an essential component for a muscle to contract. The calcium helps muscles maintain a healthy tone. Your body needs calcium for muscles to move and nerves to carry messages between your brain and every part of your body. Reduction of the calcium in the bones makes the bones brittle, especially the spine vertebra. The square-shaped vertebral bodies become wedge-shaped due to bone collapse. This leads to malalignment of the spine, hence the postural changes of a bent spine and pain. This is further worsened by muscle weakness. Reduction of muscle strength and body alignment further causes loss of balance and falls, because of which he/she is more likely to sustain a fracture. Common sites of fracture are the hip, vertebra, shoulder, wrist, pubic bone, and
sometimes head injury as well. This may be life-altering or even life-threatening.
Strategies to improve bone density and reduce the likelihood of falls are important in the prevention of osteoporosis and its related after-effects. Physiotherapy plays an important part in treating this health problem.
A Physiotherapist:
- assesses joint range of motion
- determines areas of restriction and flexibility with the intent to establish good body mechanics and alignment of body parts, to increase the effect of muscle contraction on bone.
- A Physiotherapist will guide you on the exercises you should perform based on the assessment.
Weight-bearing and muscle contraction are important determinants of bone strength and are recommended for persons
with osteoporosis. Weight-bearing exercise means bearing the body weight through the bones while exercising.
Research gives high-quality evidence that:
a) Exercise has beneficial effects on BMD. Therefore, the more specific an exercise program can be in targeting the at-risk areas of the body, the stronger the bones will be and the risk of fracture will be reduced.
b) Strengthening the Spine muscles (erector spinae) reduces the incidence of compression fracture of the spine in persons with osteoporosis.
c) Weight-bearing and strengthening exercise are effective at reducing bone loss in the hip and lumbar spine in post-menopausal women. Similarly, upper body resistance exercise increases forearm bone mass.
d) In people with osteoporosis, repetitive forced spinal forward flexion exercises should be undertaken with care as this specific movement may be associated with an increased risk of new vertebral fractures.
e) Exercise interventions to reduce falls in people with osteoporosis and/or at high risk of falling, have been found to be safe.
The majority of non-vertebral fractures are preceded by a fall. Exercise can significantly reduce the risk of falls and, perhaps the risk of subsequent fractures, by maintaining or restoring muscle strength, coordination, balance, posture, improving confidence and reaction times.
Restoration of an optimal anatomical alignment can help relieve back pain and other symptoms plus it can help assure better weight-bearing forces through the bones and more specific muscle contraction on the bones, thereby positively affecting bone health and strength.
Instructions on Do’s and Don’ts while performing activities of Daily living keeping good body mechanics in mind to prevent work related injuries, need to be followed to prevent fracture risk.
Do's
Don'ts
Exercise programs include the use of exercise bands, gravity resistance exercises e.g., squats, single-leg heel raises, prone trunk extension with cushion to protect lowest ribs, push-ups, lunges, sustained standing positions in neutral spine position. Swimming is also a very good exercise for managing osteoporosis.
People with osteoporosis are afraid to perform strengthening exercises and other strenuous exercises. For any physiological system to improve its function load larger than normal must be exposed for strengthening. Bones must meet forces greater than those it sustains to improve strength on a day-to-day basis.
Osteoporosis is occurring in epidemic proportions in India and world over in children, young adults, the elderly, men and women, in people of all ethnicities, body types and lifestyles. According to the World Health Organization, there is a word-wide osteoporosis ticking time bomb.
Regular exercise, healthy Diet can prevent Osteoporosis for healthy, happy Ageing.
The author Dr. Vimal Telang (MSc. PT, P.G.C.R) is a Consultant Physiotherapist with 43 years of experience. She is the former Head of the Department of Physiotherapy at All India Institute of Physical Medicine and Rehabilitation, Mumbai. Her speciality area is Neuro-Physiotherapy and Community Physiotherapy. She has guided numerous post graduate research theses.
At present, she heads the PhysioCare Centre, the physiotherapy rehabilitation unit of GSBS Medical Trust.
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