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Osteoporosis is something that can cause pain, heartache and severely limit your daily activities, especially if it becomes severe. The good news is that you can prevent it from becoming severe.
One good thing is that you can still receive chiropractic treatment despite having osteoporosis. We might have to modify the treatment, but there is always a chiropractic treatment method that will suit you.
Osteoporosis (porous bone) is a condition where the bones become weak and thin. It is characterised by low bone mass and structural deterioration of bone tissue, causing bone fragility and an increased likelihood of fracture.
Normal bone structure has the appearance of honeycomb - a thick outer shell and a strong inner mesh. The holes between the bony mesh become larger in osteoporosis meaning the bone structure is weakened and susceptible to breaking with the slightest knock or fall.
In men and women, the bones are continuously being broken down and rebuilt in a cycle that takes two to three months. From childhood into the 30s, an individual's bones absorb calcium, becoming strong and dense. As people age, however, the body starts to reabsorb calcium from the bones, leading to the loss of between 0.3 and 0.5% more bone than is rebuilt. This inequity causes the bone mass to shrink. The bones become fragile and prone to fractures even from everyday activities. These fractures often occur in the spine, hip or wrist.
How common is Osteoporosis?
In the UK, one in two women over the age of 50 will break a bone, predominantly due to osteoporosis. One in five men over 50 are also affected. It affects an estimated 75 million people in Europe, USA and Japan. In 2000, there was an estimated 9 million new osteoporosis fractures, 1.6 million being in the hip, 1.7 million in the forearm and 1.4 million in the vertebrae. Europe and the US accounted for 51% of these fractures. 30 - 50 % of women and 15 - 30 % of men will suffer a fracture related to osteoporosis in their lifetime. If there is a 10% loss of bone mass in the vertebrae, it will double the risk of vertebral fracture and a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture.
In females, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 risk of a diagnosis of breast cancer. In males, the estimated lifetime risk of experiencing an osteoporosis fracture over 50 years is 30%, similar to the lifetime risk of developing prostate cancer.
Unfortunately, if you have had a prior fracture due to osteoporosis, there is an 86% increased risk of another fracture. Also the great majority of individuals at high risk (80%) who have already had at least one osteoporosis fracture are neither identified nor treated. That is why osteoporosis screening is important.
Signs and Symptoms of Osteoporosis
Unfortunately, you cannot feel your bones getting weaker. Often, osteoporosis is diagnosed in patients when x-rays are taken indicating bone mass loss. Most people are unaware that they have osteoporosis until they fracture a bone. Osteoporosis sufferers can fracture a bone from a minor fall, or in serious cases, from a simple action such as a sneeze or even just spontaneously.
Vertebral fractures of the may initially present as back pain, loss of height or spinal deformity e.g. kyphosis, Dowager's hump or stooped posture. In many cases, a vertebral fracture can occur without causing pain and is found on x-rays as an incidental finding without the patient being aware of previous fractures.
Women can lose up to 20% of their bone mass in the first 5 - 7 years after menopause, making them more likely to develop osteoporosis. Without treatment, a person with osteoporosis is likely to have fractures, most often in the spine or hips (which support the body's weight) or in the wrists from bracing against a fall.
Fractures of the spine, vertebral fracture, can happen even without a fall or an injury and is found on x-rays as an incidental finding without the patient being aware of previous fractures. The bones of the spine become so weak that they start to compress. These fractures can cause back pain; loss of height; stooped posture; deformity; immobility; an increased number of recovery days in bed and even reduced lung function leading to pneumonia.
Vertebral fractures are associated with an increased risk of both further vertebral and non-vertebral fractures. It is estimated that only a third of vertebral fractures come to clinical attention and non-diagnosis of vertebral fractures is a worldwide problem.
The impact on quality of life can be huge as a result of loss of self-esteem, distorted body image and depression. Also, there can be a significant effect on normal daily living activities.
Hip fractures, the second most common type of fracture due to osteoporosis, usually result from a fall. Although most people do relatively well with modern surgical treatment, a hip fracture unfortunately often results in increased dependency or even death. It is common to get postoperative complications such as pneumonia or deep vein thrombosis (DVT) as a complication.
Osteoporosis Causes and Risk Factors
The strength of the bones depends on their size and density. Bone strength ultimately depends on how much calcium, phosphorus and other minerals they contain. Bone density loss can occur for a variety of reasons, including:
The chance of developing osteoporosis increases for those who:
Osteoporosis can be quickly and painlessly diagnosed with a bone density test. There are two types of bone density tests:
The National Osteoporosis Foundation recommends that women have a bone density test if they are not taking estrogen and if they:
Doctors don't generally recommend osteoporosis screening for men because the disease is far less common in men than in women.
Osteoporosis Medical Treatment
Although there is no cure for osteoporosis, it can be treated in a variety of ways. There is a range of drug treatments available for post-menopausal osteoporosis: Bisphosphonates , Alendronate (Fosamax & Fosovance), Risedronate (Actonel), Ibandronate (Bonviva), Raloxifene (Evista), Calcium and vitamin D, Calcitonin, Calcitriol (Rocatrol), and hormone replacement therapy (HRT).
HRT is not being used as much for osteoporosis treatment after menopause as there are more effective treatments. Some side-effects of HRT include an increased risk of blood clots, gallbladder and heart diseases, breast cancer and vaginal bleeding. The long-term benefits of HRT are, therefore, under intense scrutiny.
Studies have shown that depending on the drug and patient population, treatment decreases the risk of vertebral fracture by between 30 - 65 % and of non-vertebral fracture by 16 - 53 %.
Treatment of established osteoporosis is cost effective irrespective of age. Identifying and treating patients at risk of fracture but who have not yet had a fracture, will substantially reduce the long term burden of osteoporosis, reduce the risk of first fracture from 8% to 2% which can reduce the 5 year fracture incidence from approximately 34% to 10%.
Sunlight exposure can increase the BMD in vitamin D deficient bone and aid prevention of non-vertebral fractures.
A balanced diet rich in calcium, adequate vitamin D, regular weight-bearing exercise programme and fall prevention are important in maintaining strong and healthy bone.
Taking steps to prevent bone density loss is helpful no matter what your age or condition:
If you already have osteoporosis, you may also want to consider the following:
Chiropractors do not treat osteoporosis, but we are able to reduce some of the symptoms, particularly relating to spinal compression fractures and we offer important advice to help prevent further fractures and loss of bone density. We often identify compression fractures and osteoporosis on x-rays and we are able to advise patients to have further tests to establish the severity of the problem.
We can all be affected by osteoporosis, but its pretty difficult to know if you are affected until you have a test.
We know that the higher your bone density is at the age of 30, the better it tends to be in later years, so it is important to tell our children to eat well, exercise and look after themselves. We also know that if we do weight bearing exercise, eat well and have a good lifestyle in our later years we are less likely to suffer osteoporosis, so we need to tell our parents about it.
Remember, it is never too late to improve your bone density, so don't delay telling the people you love and care for what they should do.
Please let us know how we can help you get started. If you have any questions or if you want to make an appointment, please call us at (416) 633.3000.
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I have been a patient of Dr. Pisarek for a few years now. Every morning I have to say "thank you Dr. P.!". Your care and your treatment renew my energy... no more pains in my lower back, knee and foot. With your help I lost 20 pounds and I am keeping it off. I am really grateful to you and your wife Hilda for taking care of me. My retirement got a new meaning, thanks to you.