HEALTHWATCH
When the bone deteriorates
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A combination of physical activity and exercises goes a long way in preventing complications from osteoporosis. DR. KAARTHICK MANI
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Photo: AFP
A silent disease: Flexibility is the first casualty.
Osteoporosis (means “porous bones”) is a condition characterised by the decrease in the amount of normal bone mineral density. It results when the production of new bone mass is exceeded by the re-absorption of old bone. The National Oste
oporosis Foundation (NOF), U.S., states that 80 per cent of those affected by osteoporosis are women.
The reasons for the differential rates of porous bone in men and women secondary to demineralisation of bone are not understood.
One of the factors, oestrogen deficiency occurring with menopause leads to bone loss in women. Similarly, hypogonadism (decreased testosterone levels) is a well known cause for osteoporosis in the male.
The World Health Organisation (WHO) reports that the incidence of vertebral (spine) fractures caused by osteoporosis is greater in females than male and increases with age. Between the ages of 60-90 years, the incidence rises 20 fold in women and 10 fold in men.
The commonest sites of fractures are hip, spine (vertebra) and wrist due to low bone mass causing deterioration of bony structures. These fractures result while trying to carry grocery bags, bending to lift an object, rolling in the bed and other daily activities. Hence they are called as trivial fractures.
Symptom-free
Osteoporosis is a silent disease. People are symptom-free until their bones become weak due to the loss of bone density. Any trivial incidents like bending, bumping onto an object, rising from a chair or sustaining a fall may result in fracture of the spine, hip or wrist joints.
They often complain of severe low back pain if they have fractured their vertebral (spine) bone. Some may not complain of pain. This may lead to shortening of the spine and cause spinal deformities like kyphosis or stooped posture. This stooped posture if untreated may result in retention of bronchial secretions with poor respiration.
Eventually, the person may develop repeated episodes of pneumonia. Also, abdominal organs get compressed because of the postural changes causing symptoms like bloating and constipation.
Back pain resulting secondary to osteoporosis can be treated with pain relieving modalities like interferential therapy, heat/cold applications. Physical therapists can perform detailed postural evaluation.
Good posture may minimise the effects of the condition. Once the evaluation is completed, tailor-made exercises will be prescribed with the focus on postural re-education.
Patients may have poor sense of balance, which may be the predisposing factor for sustaining a fall from the bed or while walking, bumping into wall ,which in turn may result in an injury or a fracture. Balance training exercises will be another part of the treatment regimen for these patients.
A cross-sectional design study reported exercise to influence bone remodelling. Bone density was higher in athletes compared with sedentary person. Also, they found that athletes involved in weight-bearing activities had the highest bone mineral content.
Several other research studies found that exercises performed in weight-bearing (standing, walking) increases the amount of muscle mass and it is proportional to bone mineral content (stronger the muscle, stronger the bone).
Exercises
There are two types of exercises prescribed for clients diagnosed with osteoporosis. Weight bearing activities like walking, stair climbing, jogging, etc. and resistance exercises are performed with free weights or machine weights used in the gym.
Swimming is a non-weight bearing exercise, but considered as a part of exercise regimen for osteoporosis. Exercises are prescribed depending on the severity of condition.
Certain exercise machines like biceps, deltoid and triceps weight machine, abdominal sit-up, curl-up exercises, machine involving trunk rotation and forward bending should be avoided if the condition is severe.
A physician or a physical therapist will be the right person to discuss about exercises after the Bone Mineral Density (BMD) test using DXA (Dual X-ray Absorptiometry)scan are performed.
The use of vitamin supplements, leading a healthy lifestyle without smoking, and other medications for osteoporosis can be discussed with the physician.
The writer is an Orthopaedic Manual Therapy Specialist based in Chicago, the U.S.
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