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Therapist Q&A: Osteoporosis and Bone Health


Osteoporosis is a common condition, with 10 million Americans currently diagnosed and an additional 43 million at increased risk for developing it due to low bone density.  It is often referred to as a “silent disease” because many people don’t know they have low bone mass until they break a bone. Check out this Q&A with Innocent Rwakonda, PT, DPT, CFMP to learn more about this condition and how physical therapy can help.

What is osteoporosis?

Osteoporosis is a disease process that is based in stem cell and immunological dysfunctions. This process leads to bone loss which can ultimately result in fractures. There are actually 1.2 million osteoporosis related fractures per year, most commonly occurring in the spine, hips, wrists, and forearms.

How is osteoporosis diagnosed?

Diagnosis is typically done using a specialized X-ray called a DXA scan, which measures bone density. The results of the DXA scan are given in the following ranges:

  • Normal: greater than or equal to -1.0
  • Osteopenia : between –1.0 and –2.5
  • Osteoporosis: less than –2.5
  • Severe osteoporosis: less than –2.5 with fractures

An osteopenia diagnosis indicates low bone density and increased risk for developing osteoporosis.

What are the risk factors for osteoporosis?

There are many different risk factors for osteoporosis. Some are due to factors that are outside of our control, like aging, genetics and the onset of menopause. Conditions such as eating disorders, gastrointestinal diseases, autoimmune diseases, and cancers can also increase risk. Certain medications such as glucocorticoids, PPIs, SSRIs and antacids can contribute as well.
However, there are also several risk factors due to environment and lifestyle choices:

  • Tobacco use
  • Alcohol
  • Poor diet
  • Stress
  • Exposure to toxins such as heavy metals

Does osteoporosis always cause pain and/or a rounded back?

As the disease progresses, patients may experience pain from fractures or weakness of bones and muscles. As the spinal column or vertebrae continue to deteriorate and muscles get weaker, most people will end up with rounded back, and increased risk of fractures.

Is osteoarthritis related to osteoporosis?

Osteoarthritis is a joint disease characterized by loss of joint cartilage, which may also occur in the presence of osteoporosis but the two conditions are not related.

How does exercise affect bone health?

Exercise is a key component in maintaining bone health for all adults. Adolescence and young adulthood is a time of building bones. During adulthood, we should focus on bone conservation. Weight bearing exercises such as brisk walking, hiking, tennis or golf help to maintain bone mass in adulthood. Exercise in adulthood must focus on maintaining muscle mass for strength and coordination. As we age we lose about 5% muscle mass per decade after the age of 30 and this usually accelerates after 65, so muscle mass may be more important than increased bone mineral density.

Are these conditions reversible?

Unfortunately osteoporosis is not completely reversible, but there are some treatments that can slow (or in some cases counteract) bone loss. Your physician may prescribe medications such as bisphosphonates or SERMS. In addition to medications, a nutritional approach is often beneficial. Strategic nutrition can create an environment that builds muscle and strengthen bones. Patients are encouraged to choose a diet that is low in grains and refined carbs, provides adequate protein, and is high in:

  • Vegetables
  • Omega 3’s
  • Greens, greens, greens
  • Vitamin D
  • Calcium and minerals

What lifestyle changes can improve my bone health?

Improve physical activity/exercise regularly and avoid a sedentary life style at any age. Eat a healthy diet that includes sufficient protein, vegetables, and lots of greens.

How can physical therapy help?

Are you afraid to move? We can help! After completing a thorough assessment of your needs, problems or challenges, as well as your goals, your physical therapist will guide you on:

  • Exercises to focus on for your strength building program
  • Weight bearing activities/exercises
  • Improving your posture from head to toe
  • Improving the way you walk
  • Helping build or regain your balance with activities to prevent or reduce future falls

Specialized Doctors of Physical Therapy will also give you tips to improve nutritional intake as you start to exercise more and begin to feed your bones. Your bones are not just a frame for your body, they are an important organ, just like your kidneys, liver, pancreas etc. Like your other organs, your bones need proper nutrients, so feed your bones and move better!