Medical management: Osteoporosis medicines can increase bone density and while the increases may appear small this can have a very positive effect on reducing fracture rates.
Osteoporosis medicines are grouped into different 'classes' depending on their 'active ingredient'
1.Bisphosphonates - Tablets (daily, weekly or monthly)
2. Denosumab - 6 monthly injection: Denosumab (brand name: Prolia)
3. Selective oestrogen receptor modulators (SERMS)
Daily tablet: Raloxifene (brand name: Evista)
4. Hormone replacement therapy (HRT) - The active ingredient is the hormone oestrogen. Some HRT treatments also contain progestogen (combined HRT)
5. Teriparatide - Daily injection for 18 months (self-administered): Teriparatide (Brand name: Forteo).
Physical therapy management: Physical therapy intervention for individuals with osteoporosis, or even osteopenia, should include:
· flexibility exercise
· strengthening exercise
· postural exercise
· balance exercise
1. Weight-bearing exercises
· Exercises such as walking or hopping, has been shown to maintain or improve bone density in this population.
· Strengthening exercises, using weights or resistance bands, has also been shown to maintain or improve bone density at the location of the targeted muscle attachments.
· Maintaining bone health in this population is extremely important, especially in the elderly as there is typically has a decline in bone mass with age.
2. Flexibility and strengthening exercises
· These can help improve the individual's overall physical function and postural control. eg yoga
· Improving postural control is important to reduce the risk of falls
· Falls often result in fractures in frail individuals.
· Balance exercises are also important to incorporate to further reduce the risk of falls. eg Otago Progra
2. Postural exercises
· These are crucial to prevent structural changes that often accompany osteoporosis, such as thoracic kyphosis.
· Every osteoporosis program should include extension exercises; chin tucks, scapular retractions, thoracic extensions, and hip extensions.
· Strengthening the extensor muscles will promote improved posture and improved balance.
· Flexion exercises are CONTRAINDICATED. Anterior compressive forces to the vertebra can contribute to compression fractures.
3. Back pain
Physical therapist may treat patients with osteoporosis for back pain.
Agility training, resistance training, and stretching have all been shown to decrease back pain and its related disabilities in this population.
4. High intensity training - Research highly supports high intensity training in the prevention of bone loss for women in menopausal years and early stage post menopausal.
· High intensity training would include body-weight and resistive exercises at a high intensity, similar to circuit training. This type of training is often contraindicated for individuals with low bone mass.
The most important nutrients for people with osteoporosis are calcium and vitamin D.
· Calcium is a key building block for bones. Vitamin D helps the body to absorb calcium.
· Calcium and vitamin D can be from diet, supplements, or both. (It’s best to get these nutrients from food, rather than supplements).