Many people think of osteoporosis primarily as a disease of elderly women, yet it affects men and younger people as well. In the United States, 10 million women and men currently have osteoporosis, and 18 million more have low bone density, a condition that places them at an increased risk for developing osteoporosis, the American Physical Therapy Association (APTA) says.

Sometimes referred to as "the silent thief" because it is a disease without symptoms, osteoporosis is a condition in which once-strong bones become brittle, fragile and more likely to break. Warning signs of osteoporosis in both men and women are a loss of height, a change in posture and sudden back pain.

If osteoporosis is present, a physical therapist can design an exercise program that can help increase bone density with proper strengthening and weight-bearing exercises, lessen stress on bones through improved balance, posture and body mechanics, and identify potential hazards in the home or workplace environment that could lead to fractures in those with osteoporosis.

"Throughout our lives, our bones are in a constant state of change, continuously absorbing calcium from or giving up calcium to our blood," says physical therapist Karen Red, PT, director of the Women's Care program at the Mechanicsburg office of First Choice Rehab. "There are many factors that regulate this process, and elderly women are not the only people who need to attend to their bone health. Physical therapists can recommend ways to strengthen bone density and maintain a balanced diet rich in calcium and vitamin D."

Not Just for the Elderly

Younger Americans are also at risk for developing osteoporosis. Young women who experience early menopause, or pre-menopausal women who have undergone a total hysterectomy are at risk for low bone density. Adolescents who have an eating disorder or who dabble with crash dieting are at increased risk for developing the disease. Also, diets low in calcium, smoking and excessive alcohol consumption are risk factors for everyone, regardless of age or sex.

The foundation for strong bones is laid during childhood and adolescence. "Children need to build up their bones while they are young, like a bank account," says Red. When we're young, our bodies deposit much more calcium into our bones than they withdraw, until we reach our peak bone mass in our late teens or early twenties. Around age 30, the pattern reverses and the body removes more calcium than it deposits.  Regular exercise and a good diet with enough calcium should stock this "bone bank." The U.S Surgeon General recommends at least 30 minutes of moderate exercise each day. "More than ever before, we need to encourage our children to get plenty of physical exercise," says Red, "and the sooner, the better."

Treatment

Unfortunately, osteoporosis is often undiagnosed until after a fracture has occurred. While any bone can be affected by osteoporosis, the bones in the hip, spine and wrist are most at risk.

Proper rehabilitation after a fracture is critical, especially with hip fractures and compression fractures of the spine. "A physical therapist understands the musculoskeletal system and can design an intervention plan that includes exercises to reduce pain from fractures and targeted weight-bearing exercises to strengthen bones and help prevent future fractures," says Red.

Exercises to build bone density must be directed at the muscles supporting or attached to the affected bone. For a spine fracture that leads to a rounding of the spine, exercises focus on strengthening the key muscles along the back of the vertebrae. "A physical therapist will focus on exercises that make the muscles pull against the bones in the weak areas, while helping the patient maintain proper body mechanics. This kind of resistive force is what builds bone density," says Red.

These muscles support upright posture and minimize the stress on the front of the vertebrae. Other exercises focus on dynamic (or moving) balance to prevent falls. These exercises will typically strengthen the lower legs and muscles surrounding the ankle, so that a patient can walk on uneven or moving surfaces without falling.

Patients must also avoid those activities that will place stress on weakened bones. "Although a lot of my patients don't like to hear it, golf is definitely not advisable for someone with bone weakness in the spine. There is too much twisting," says Red. "I also counsel patients to avoid biking, bowling and rowing machines. It is too easy to hunch over in these activities. And while swimming is great for people with joint problems, it unfortunately cannot help those with osteoporosis, who need weight-bearing exercise." Red recommends "water walking" using the resistive force of the water, regular walking, walking on a graded treadmill, and stairclimbing.

By Karen Red, PT