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:
- Endocrine imbalances
- Not getting enough vitamin D and calcium in the diet
- Falling estrogen levels associated with menopause. Women who have reached menopause lose bone at a rate of one to three percent a year. While this slows down around the age of 60, it doesn't stop entirely. Older women may have lost between a third to a half of their bone mass, while men may lose between 20 and 35%.
The chance of developing osteoporosis increases for those who:
- Inactive lifestyle. Physical inactivity and a sedentary lifestyle as well as impaired neurological and muscular function (e.g. decreased muscle strength, impaired gait and balance) are risk factors for developing fractures. Exercising regularly can help ensure that your bones stay strong throughout your life.
- Are a woman. Twice as many women have bone fractures from osteoporosis as men. This happens because women are smaller and have less bone mass to begin with and because they tend to live longer. Menopause also causes bone loss to accelerate.
- Are a man with low levels of testosterone
- Have a family history of osteoporosis
- Are older
- Are slender and small framed. Studies have provided evidence that weight in infancy is a determinant of bone mass in adulthood.
- Smoke or use tobacco
- Take certain diuretics (furosemide [Lasix], bumetanide [Bumex], ethacrynic acid [Edecrin] and torsemide [Demadex]), which cause your body to excrete fluids. This can lead to a loss of calcium.
- Take corticosteroid drugs, such as prednisone, cortisone, prednisolone and dexamethasone on a long-term basis. These drugs are commonly used to treat asthma, rheumatoid arthritis and psoriasis. Prolonged use of corticosteroids is the most common cause of secondary osteoporosis. It has been estimated that 30 - 50 % of patients on long-term corticosteroid therapy will experience a fracture with an increased risk of hip fracture by 2 fold in females and 2.6 in males. If you need to take a steroid medication for long periods, your doctor may monitor your bone density and recommend other drugs to help prevent bone loss.
- Take the blood-thinning drug heparin, methotrexate, some antiseizure drugs and aluminum-contain antacids
- Are Caucasian or Southeast Asian. African Americans have the lowest risk of osteoporosis; Hispanics and Native Americans appear to have an intermediate risk.
- Have short-term exposure to estrogen. Risks are higher for women who began menstruating at a later than average age and who had an earlier than average menopause. Risks are also higher for women who have had their ovaries surgically removed before age 45 without receiving hormone replacement therapy (HRT).
- Have an overactive thyroid (hyperthyroidism) or take too much thyroid hormone medication to treat an under active thyroid (hypothyroidism)
- Have had certain medical conditions or procedures that decrease calcium absorption. These include stomach surgery, Crohn's disease, anorexia nervosa or Cushing's disease (a rare disorder in which the adrenal glands produce too much corticosteroid hormones).
- Drink too much alcohol on a regular basis, which interferes with your body's ability to absorb calcium. For men, alcoholism is one of the highest risk factors for osteoporosis.
- Are depressed. Recent studies show that women who experience depression have increased rates of bone loss.
- Diet: Low calcium intake, Low vitamin D intake, Excessive intake of protein, sodium (salt), alcohol and caffeine (tea and coffee)Diagnosis of Osteoporosis
Osteoporosis can be quickly and painlessly diagnosed with a bone density test. There are two types of bone density tests:
- Dual energy X-ray absorptiometry (DEXA), which is the standard tool for diagnosis of osteoporosis
- Heel ultrasound, which is simpler and easier to use but only accurate enough for screening purposes
The National Osteoporosis Foundation recommends that women have a bone density test if they are not taking estrogen and if they:
- Use medications that can cause osteoporosis
- Have insulin-dependent diabetes, liver disease, kidney disease or a family history of osteoporosis
- Had an early onset of menopause
- Are post menopausal, older than age 50 and have at least one risk factor for osteoporosis
- Are post menopausal, older than age 65 and have never had a bone density test
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:
- Maintaining a healthy diet and active lifestyle will help prevent osteoporosis.
- Get enough calcium and vitamin D. Pre menopausal women and post menopausal women on HRT should have at least 1,200 milligrams (mgs) of calcium and 400 international units (IU) of vitamin D every day. Post menopausal women not on HRT and those at risk of getting osteoporosis from taking steroids should get 1,500 mgs of calcium and 800 IU of vitamin D daily. Men under age 65 should consume 1,000 mgs of calcium every day and men over age 65, 1,500 mgs. Good sources of calcium include milk; low-fat plain yogurt; Swiss, cheddar and ricotta cheese; broccoli; canned salmon with the bones; orange juice and tofu. If you find it hard to get this much calcium from your diet, try calcium supplements.
- Exercise, which helps build strong bones and slow bone loss. It is helpful no matter when you begin, but it has the greatest benefits when you start young and do it throughout your life. Strength training lets you build the muscles and bones in your arms and upper spine. Weight-bearing exercise (walking, jogging, running, stair climbing, skipping rope, skiing and impact-producing sports) helps the bones in your legs, hips and lower spine.
- Click here for simple preventative exercises for osteoporosis...
- Don't smoke. Smoking speeds bone loss, perhaps by lowering how much estrogen a woman's body makes and by reducing the calcium absorbed by the intestine.
- Consider HRT. HRT is the best way to reduce a woman's risk of osteoporosis during and after menopause.
- Avoid drinking too much alcohol. Having more than two alcoholic drinks a day may cut bone formation and the body's ability to absorb calcium. There's no clear link between limited alcohol intake and osteoporosis.
- Limit caffeine.
If you already have osteoporosis, you may also want to consider the following:
- Maintain good posture. Keep your head held high, chin in, shoulders back, upper back flat and lower back arched to avoid stress on your spine. When you sit or drive, put a rolled towel in the small of your back. Don't lean over while reading or doing handwork. When lifting, bend at your knees, not your waist. Lift with your legs, keeping your upper back straight.
- Prevent falls. Wear low-heeled shoes with non slip soles, and check your house for electrical cords, throw rugs and slippery surfaces that might cause you to trip or fall.
- Manage pain. Discuss pain management with your doctor. Don't ignore chronic pain. Left untreated, it can limit your mobility and cause even more pain.
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.