OsteoporosisThe Role of Physical Therapists

Objectives•Discuss the rising prevalence of Osteoporosis•Describe what populations are at a

heightened risk•Expand on the relationship between the

disease and physical therapist•List goals that physical therapist should have

in treating this patient population•Provide an example of an exercise program •Demonstrates the positive effects physical

therapy can have

Prevalence is Rising

•In 2002, almost 44 million men and women of 50 years or older were diagnosed with either osteoporosis or osteopenia 1

▫This 44 million is 55% of the entire population of people of 50 years or older in the United States

•By 2020, an estimated 61 million will be affected by this disease 1

•Osteoporosis is responsible for an estimated 1.2 million bone fractures each year in the U.S. 2

Are you ready for this?• A study published out of Illinois in 2011

surveyed how comfortable physical therapists were in recognizing and treating osteoporosis

• The study found that most were able to identify the major risk factors and contraindicated exercises, but some were still prescribing exercises that could injure their patients

• Overall, the results indicated that physical therapists need further education in osteoporosis screening, interventions, and examinations 4

Skeletal status of persons aged 50 years and over: United States, 2005–2008

45%

46%

8%

Figure 1 3

Normal at femur neck or lumbar spineLow Bone Mass at femur neck or lumbar spineOsteoporosis at femur neck or lum-bar spine

Who is at risk?• Both men and women

▫ One in every two women and one in every four men of 50 years or older will have an osteoporosis-related fracture in their lifetime 4• Post-menopausal women lose

bone more quickly and are at highest risk 5

• Patients on long term doses of certain steroids, such as Prednisone 4

• People with family history 5

• People of Caucasian or Asian decent 5

• Small-boned women weighing less than 127 pounds

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How does this relate to Physical Therapy?• Physical Therapists in all areas are very likely to

see patients with either osteoporosis or osteopenia 6

• With their specialized skills, diverse practice areas, and various settings, physical therapists are the ideal members of the interdisciplinary team to aid individuals with, or at risk of, osteoporosis with management strategies 6

•  Patients that received physical therapy treatment apart from pharmacological treatment experienced a decreased risk of falls and fractures 7

The Goals of Treatment

1. Promote bone growth2. Prevent falls3. Prevent Fractures4. Rehabilitation of previous fractures5. Treat other underlying musculoskeletal

conditions that may be limiting the patient’s mobility and increasing their risk of falls or fractures 6

How?

•Individual exercise prescription•Mobility aids•Ergonomic devices•Protective equipment•Manual Therapy•Education 6

Individual Exercise Prescription

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•  Exercise should provide a new stimulus to promote bone formation while also remaining safe given the patient's history▫ Dynamic loading and intermittent

loading bone growth• Strength and balance training are

crucial for fall prevention• Resistance and agility training can help

to prevent the progression to osteoporosis in patients with low bone mass

• Weight bearing exercises are critical in patients with weakness in back and lower extremities 6

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Example Exercise Program 8

• Postural Exercises▫ Corner Stretch

Stand in corner with arms against wall (90˚Shoulder Abduction, 90˚ Elbow flexion) and one leg forward. Lean in towards corner.

2 sets on each side holding for 20-30 seconds

• Strengthening Exercise▫ Standing Hip Abduction

Steady self by holding onto chair/table and kick straightened leg out to side (~35˚ Hip Abduction) and back down.

2 sets of 10 repetitions Increase difficulty with either

ankle weight or theraband.

Example Exercise Program 8 (cont.)• Balance exercise

▫ Toe and heel raises Holding onto chair back as little

as possible, rise up onto toes, comes down slowly, and then roll back on heels

2 sets of ten repetitions• Functional Exercise

▫ Wall slides Stand with feet pointing

forward and shoulder width apart about one shoe’s length away from wall. Place back, head, and palms flat against the wall and slide down wall by bending knees (~45˚ knee flexion) and back up

2 sets of ten repetitions

Contraindications for Activity

•Patients known to have, or at high risk of having vertebral osteoporosis should avoid:▫Trunk flexing, side-bending, and spinal

rotation Such activities have been shown to cause

compression fractures •Patients who are post-menopausal should

also avoid flexion exercises because these exercises have been shown to cause increased vertebral compression fractures 4

Mobility Aids• Allow the patient to

maximize their mobility• The increase in mobility

permitted by the device allows for more bone formation by allowing the patient to become more active and bear more weight

• Examples of devices:▫ Cane▫ Walker▫ Orthotics▫ Braces 6

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Ergonomic Advice

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• Instruct patient on safe bending and lifting techniques

• Provide advice specific to activity patient would like to participate in

• Discuss proper body mechanics▫ Create an ergonomic

workspace▫ Use kneeling pads▫ Diagram example of

proper and improper body mechanics 6

Protective Equipment• Hip Protectors

▫ Placed on greater trochanter to shunt and distribute forces placed on the bone to the surrounding soft tissue

▫ Help to prevent future fractures

▫ Proper fit and placement is essential 6

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Manual Therapy

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• Increase the flexibility and mobility of patient

• Though it seems risky, especially when manipulating the spine, studies have shown that it is very unlikely that a properly trained physical therapists will produce new fractures 6

Education

•Explain the importance of the exercise program and the rationale behind the exercises▫Understanding the plan may help to

increase adherence•Educate on the meaning of bone mineral

density▫This could help to erase fear of exercise

and to visualize a goal•Tailor the education to the individual and

their interests, questions, and goals 6

Effects of Physical Therapy

•Improves the overall quality of life in patients with osteoporosis 9

▫Increases bone growth▫Prevents the recurrence of falls and

fractures▫Improves the balance and stability▫Educates patients on management and

prevention of worsening symptoms 6

In Conclusion,

•Physical Therapy can have multiple positive effects on a patient with osteoporosis or osteopenia

•The only way to increase the occasion of these benefits reaching the patient population is by ensuring physical therapists are properly educated and trained

Questions?

•Feel free to send questions, comments, or concerns to:▫Clark.che@husky.neu.edu

References1. Prevalence Report. National Osteoporosis Foundation. 2011. Available at:

http://www.nof.org/advocacy/resources/prevalencereport. Accessed on October 9, 2012. 2. Osteoporosis. Human Diseases and Conditions. Available at:

http://www.humanillnesses.com/original/Men-Os/Osteoporosis.html#b. Accessed on October 9, 2012.

3. Looker AC, Borrud LG, Dawson-Hughes B, Shepherd JA, Wright NC. Osteoporosis or low bone mass at the femur neck or lumbar spine in older adults: United States, 2005–2008. NCHS data brief no 93. Hyattsville, MD: National Center for Health Statistics. 2012.

4.  Peterson M, L., Bertram S, McCarthy S, Saathoff E. A survey of screening and practice patterns used for patients with osteoporosis in a sample of physical therapists from illinois. J GERIATR PHYS THER. 2011;34(1):28-34.

5. Frisco D. Who is at Risk for Osteoporosis. Spine-Health. Available at: http://www.spine-health.com/conditions/osteoporosis/who-risk-osteoporosis. Accessed on October 9, 2012

6.  Sran MM, Khan KM. The role of the physical therapist in the prevention and management of osteoporosis. J WOMENS HEALTH PHYS THER. 2005;29(3):53-57.

7. Ksiezopolska-Orlowska K. Changes in Bone Mechanical Strength in Response to Physical Therapy. PubMed.com. 2010. Available at: http://www.ncbi.nlm.nih.gov/pubmed/20864911. Accessed on October 9, 2012.

8. Prevention: Exercise Examples. National Osteoporosis Foundation. 2011. Available at: http://www.nof.org/aboutosteoporosis/prevention/excersiceexamples. Accessed on October 10, 2012.

9. Schröder G, Schober H, Kundt G, Knauerhase A. Effects of physical therapy on quality of life in osteoporosis patients - a randomized clinical trial. Health and Quality of Life Outcomes. 2012. Available at: http://www.hqlo.com/content/10/1/101/abstract. Accessed on October 10, 2012.