The Osteoporosis Program
provides preventative strategies for those at risk and continuous
rehabilitation for people with a diagnosis of osteoporosis with
or without fractures.
What
is Osteoporosis?
Osteoporosis, means "porous bone". It
is a disease where the bones become porous and fragile. In osteoporosis
loss of bone density results in fractures from minimal or no trauma.
A fragility fracture (indicating osteoporosis) is one that occurs
from a fall from a standing height or from coughing, lifting or
twisting.
Is it painful?
Osteoporosis
is often called the silent disease because it does not cause pain
until it is advanced and results in a fracture. Spinal fractures
are often silent (not painful) or misinterpreted as a muscle strain
or “slipped disc”.
What are the
signs and symptoms?
Often there are
no symptoms until the first fracture occurs. The most common problems
are back pain, postural deformities and fractures of the hip,
spine and wrist. Spinal fractures can often be mistaken for a
pulled muscle or disc problem.
Up to 60% of spinal
fractures are painless so the person may not even be aware that
they have a fracture and are at risk for more fractures. Spinal
fractures are often discovered unexpectedly on an x-ray that was
taken for an unrelated reason such as a chest x-ray for pneumonia.
Other signs include a gradual (more than 2 inches, historically)
or sudden loss of height and a curved spine/stooped posture (Dowager’s
hump).
What caused it?
Osteoporosis has many different causes. Click on the Bone Health
Check Up tab to learn more.
What
are you feeling?
Because osteoporosis
is often ‘silent’ most people feel ‘fragile’
and become fearful of activity. Because of all the information
and mis-information in the media people become afraid to drink
coffee, are anxious about whether their diet has enough calcium,
and confused about what they should and shouldn’t eat or
drink.
What can you
do?
Seeing a physiotherapist
is the first step to successful management of your condition.
Treatment strategies include manual therapy, pain management,
safe exercise programs, counselling for safe participation in
sports and recreational activities, postural re-education, and
fall prevention.
What is physiotherapy for osteoporosis?
Many people think that
physiotherapy is just exercise and that if they have pain or a
recent fracture they are not ready for physiotherapy. But, physiotherapy
is more than just exercise!
The physiotherapy program
at The Downtown Clinic will help you with better control of your
pain , activity modification, and fracture prevention.
When you are ready you will do strengthening, stretching, balance,
and postural retraining exercises.
Where
Can I get Help? The
physiotherapy staff at The Downtown Clinic have been helping people
with osteoporosis for many years. They are experienced in being
able to assist you to get back to your activities safely and without
pain.
After an initial physiotherapy
and counselling assessment, your physiotherapist will take the
time to review pertinent findings with you. S/he will interpret
reports from x-rays and bone density tests, make treatment recommendations,
answer your questions and concerns about diet, medical management,
exercise, and fracture prevention- all the while ensuring that
you are involved in the process.
Consults with other
health care services may then be recommended such as: occupational
therapist, pharmacist, registered dietician, psychologist, physiatrist,
osteoporosis physician, registered massage therapist or fitness
personnel depending on your personal needs.
The physiotherapist
will also maintain a close working relationship with your family
doctor, ensuring that appropriate medical investigations and assessments
are carried out when necessary.
What
Does Osteoporosis Management really mean? Learning
to identify and modify your personal risk factors for fracture.
Leaning how to protect
your bones 24/7: applying the principles of posture, safe body
mechanics and strength during all your functional activities,
is also important.
Learning how to exercise
safely to maximize your function, reduce pain, prevent falls and
reduce your risk for fracture.
Learning how to participate
in your favourite sports or recreational activities safely. Feeling
confident you can do the things that are important to you without
fear of fracturing.
Maintaining contact
with your primary physician for follow-up bone density testing,
medication review, and symptom management.
Pain control: Your
physiotherapist will recommend thermal (hot/cold) and electrotherapeutic
modalities for you to use to reduce your pain (especially if you
have a fracture)
Trying different pillows and supports will help you with positioning
so that you can sleep, sit, and work as comfortably as possible
while you are healing.
Becoming stronger,
standing taller, and lasting longer. Your individualized exercise
program will help you become your physical best.
When Am I
going to be able to do all the things I did before I was diagnosed
with osteoporosis? When
your fracture has healed you will take the next step and begin
exercises that will improve your range of motion, strength, balance
and endurance.
Functional exercises will ensure that you are training the muscles
that you need to do the activities you used to do.
Discussion with your therapist about how to modify your activities
will ensure that you will always do them safely.
As you continue to
make improvement, you will be seen by your physiotherapist less
often.
But your therapist will constantly re-assess and review your progress-
and your concerns. She will ensure that you have both the tools
(exercise program, home devices) and contact with any health or
fitness personnel that you need (registered massage therapist,
personal trainer) to assist you in moving forward.
The philosophy of The
Downtown Clinic is to ensure that you ‘are able to maintain
your well-being throughout your life’.
You are always able to make an appointment with your physiotherapist-
any time you wish.
Some people find that
regular or occasional visits with their physiotherapist allow
them to maintain this ‘well-being’.
Remember you do not
need a medical referral to see a physiotherapist!
Osteoporosis
in Men
The incidence of osteoporosis (OP) in men is much
higher than previously thought. In Canada 1 in 8 men and 1 in
4 women have osteoporosis. As more evidence is revealed it is
becoming obvious that men suffer significant problems related
to bone loss and OP.
In the Canadian Multicentre
Osteoporosis Study (CaMOS) of men and women over age 50, 21.5%
of men and 23.5% of women had spinal fractures. This result was
surprising because it was thought that spinal fractures occurred
mostly in women.
Hip
fractures are a severe consequence of osteoporosis and can be
physically and mentally devastating. They cause loss of independence
and often result in institutionalization in long-term care facilities.
27% of all hip fractures occur in men. Compared with women, men
suffer greater health problems and mortality after a hip fracture.
In men OP can be due
to hypogonadism (reduced testosterone), steroid medication (ie:
prednisone) for diseases such as arthritis, or excessive alcohol
consumption. The most common secondary cause of osteoporosis in
men is steroid medication. The use of oral steroid medication
such as prednisone in doses as low as 7.5 mg per day for three
months or more can be detrimental to the skeleton and indicates
the need for an osteoporosis assessment. Inhaled steroids for
lung problems are not associated with a high incidence of bone
loss unless at very high doses over a long period of time.
Other conditions associated
with an increased risk of fracture or osteoporosis include primary
hyperparathyroidism, hypogonadism, gastrectomy, rheumatoid arthritis,
chronic lung disease, hyperthyroidism, and cancer. Other than
glucocorticoids, medications associated with bone loss include
anticonvulsants, and LHRH analogs which are used in the management
of prostate cancer.
According to the current
guidelines, a Bone Mineral Density (BMD) assessment should be
obtained in all men and women over the age of 65. In younger men,
BMD assessment is indicated in the presence of at least 1 major
or 2 minor risk factors. Ask your doctor if you are concerned
about whether you need a BMD measurement.
As with women, an established
vertebral fracture is an important risk factor for future fractures.
Age is also strongly associated with an increased risk of fracture
and maternal history of hip fracture significantly increases the
risk of osteoporosis in men.
Men at risk for osteoporosis
should be identified and appropriate therapy with a bisphosphonate
is recommended to reduce morbidity and mortality associated with
fractures.
Treatment
Ask
your doctor about appropriate therapy for you. Make sure you are
getting enough calcium and vitamin D. Elemental calcium intake
of 1500 mg daily from diet and supplements as well as 800-1000
IU of Vitamin D are recommended for both senior men and women.
Get enough exercise to prevent bone loss due to being sedentary.
Daily walking programs are essential for maintenance of skeletal
mineralization and fall prevention.
Bisphonates such as
“Fossamax” have been shown to be effective in the
management of male osteoporosis. Testosterone therapy improves
spine BMD and may be most effective for men with symptoms of hypogonadism
in whom testosterone will provide additional extraskeletal benefits.
Nasal calcitonin has not been well studied in men but it is beneficial
in managing the pain of an acute vertebral compression fracture.
Subcutaneous teriparatide (rhPTH 1-34) has recently been approved
in Canada and the US for the management of osteoporosis in both
men and women. Significant improvements in BMD were observed in
both men and women.
Osteoporosis
Check-up List for Men
Risk Factors:
Determine your risk factors to determine your fracture risk. Key
risk factors include:
Age
Low BMD
Previous vertebral
compression fractures
Previous history
of fragility fracture after age 40
Family history
of osteoporotic fracture (in particular maternal hip fracture
history)
Systemic glucocorticoid
therapy (> 3 months duration) or therapy with LHRH analogs
Review your medications with your doctor on a
regular basis. Are you taking any medicine that would cause you
to lose bone? Are you already being treated for osteoporosis?
Are you taking vitamin supplements, calcium, or herbal supplements.
Dietary scan. Do a 3 day scan of your diet. Are
you getting enough Calcium? See a dietician if you are not sure.
Elemental calcium intake of 1500 mg daily from diet and supplements
as well as 800-1000 IU of Vitamin D are recommended for both senior
men and women.
Have you had a BMD test or x-rays? Were the results
explained to you so that you understood what they mean? At The
Downtown Clinic your physiotherapist can help interpret test results
and take the time to answer your questions. When you go to your
doctor or physiotherapist with questions make sure you write out
a list and take it with you. And write the answers down to help
you remember when you leave.
Postural assessment, muscle imbalance testing.
Postural deformities and back pain occur over a long period of
time. If you check yourself yearly you have a better chance of
catching problems before they cause pain or permanent damage.
At The Downtown Clinic your physiotherapist can develop a safe
and effective exercise program to correct muscle imbalances, postural
dysfunction, strength, and endurance.
Exercise and Lifestyle: Check your exercise habits
on a yearly basis. Are you as active as you want to be? If not,
what is preventing you from doing so? Re-evaluate your priorities.
If you have pain or injuries, The Downtown Clinic physiotherapists
can help with the problem and get you back on track to where you
want to be.
Social Support: Do you have the right social
support to allow you to succeed? If not seek out friends or others
who value your goals and who will encourage you and give you the
support you need.
Medical Therapy for Osteoporosis: If you are
on therapy for osteoporosis, follow-up with doctor to monitor
your response to therapy. If you were prescribed a drug therapy
but never filled the prescription or decided to stop make sure
you tell your doctor what your concerns are. There are many alternate
therapies available.
Sports and other physical activities. If you
used to do a sport and have stopped because you have low bone
density, osteoporosis and/or fractures, your Downtown Clinic physiotherapist
can help you return to your previous sports or activities with
modifications where needed to ensure reduced fracture risk. Your
physiotherapist can go with you to the bowling alley or golf course
for example to assess your functional performance, suggest safety
modifications, and help with determining appropriate sport/activity
specific conditioning exercises. Daily walking or running programs
are excellent for maintenance of skeletal mineralization and fall
prevention.
WHAT
TO DO IF YOU HAVE A FRACTURE
SPINAL FRACTURES
In
up to 60% of all spinal fractures, there is no associated pain
at the time of the fracture and the person only finds out about
the fracture after being x-rayed. In other cases, a spinal fracture
is accompanied by sudden, severe, sharp back pain. It can feel
like a muscle spasm. Some describe it as a pulled muscle, while
others hear a tearing or popping sound as they lift a heavy object.
In many cases a person does not feel pain when the fracture occurs
and does not know something is wrong until they wake the following
morning.
In the past a spinal
fracture meant being confined to a hospital bed for weeks. Today,
most people are not admitted to hospital and are cared for at
home. Moving in bed, getting in and out of bed and changing positions
are usually very painful and the acute (sharp) pain can last for
two to twelve weeks.
It is important to
stay as mobile as possible. If you stop moving for too long a
time, your muscles stiffen up and become weaker which may affect
your independence later on.
Keeping mobile will also help you minimize loss of strength in
your muscles. So get up to go to the bathroom and move around
the house.
At first, standing up for more than a few minutes or sitting will
not be possible.
You will also probably need assistance to prepare your meals and
to bathe for at least the first week.
You may also need help with more demanding activities such as
laundry, housework and getting groceries.
It’s also time to call on your family and your friends!!!
(remember you would do it for them as well)
During this time, it is important that you see your doctor regularly
for ---during this 12 week period-.
So be sure to arrange for someone to accompany you for these appointments.
Physiotherapy
can help with pain relief. Some of the strategies include the
following:
1.
POSITIONING:
Using pillows under your knees, shoulders, head and arms when
lying on your back can relieve stress on the spine and reduce
muscle spasm.
When lying on your side, a pillow or rolled towel under your waist
will prevent the spine from curving and causing pain.
A pillow between your knees and ankles will prevent twisting of
the spine and improve comfort, while pillows in front and behind
you provide support and allow you to better relax.
2. ACTIVITY
MODIFICATION:
Short-term bed rest, use of appropriate aids, strategies to conserve
energy and getting the appropriate help at home will allow you
the time you need to heal.
Consider using a four wheeled walker, raised toilet seat, commode,
reacher, book holder and bath seat.
3. ICE:
A soft ice pack or ice massage (stroking the area of pain with
ice) works as a local nerve block and provides temporary relief
during the acute pain stage.
Ice can be applied to the points of burning and numbness every
hour.
4. HEAT:
After the first few days, heat can provide soothing pain relief,
especially if there is muscle spasm.
Moist heat is usually best but microwavable hot packs and heating
pads also work well.
Be careful not to burn yourself by lying on an electric heating
pad for too long.
Never fall asleep on a heating pad which has been left on.
Hot packs that will gradually cool off or those with an automatic
shut off are safest.
5. MASSAGE
& MYOFASCIAL RELEASE:
Gentle massage or myofascial release (technique performed by a
physiotherapist or registered massage therapist) can relieve pain
and muscle spasm. If you are generally have a massage, contact
your massage therapist and inform them about the new ‘problem’.
6. ULTRASOUND:
Your physiotherapist may use therapeutic ultrasound to help relieve
pain, reduce localized swelling and promote healing. Ultrasound
machines are portable and can also be used in your home by your
home care physiotherapist.
7. ELECTRICAL
MODALITIES :
Your physiotherapist may suggest the use of electrical modalities
to help reduce pain and restore functional movement. Transcutaneous
Electrical Nerve Stimulation (TENS), Codetron and Interferential
Current (IFC) are battery-powered electrical units that transmit
small electrical signals through electrodes placed on the skin
where the pain is located. The electrical signals block the pain.
These units are portable and can be rented for home use. (see
Electric Modalities at the End of the Web page on Physiotherapy
for more information)
8.
EXERCISE:
Deep breathing exercises will help with relaxation.
Other exercises including isometric (muscle contraction) can help
reduce muscle spasm and support the back, helping you stay mobile,
while also reducing stiffness, and pain when moving in bed
9. HELPFUL
AIDS & SERVICES:
For the first 2-4 weeks certain types of medical equipment can
make life easier ,allowing you to manage at home successfully
while you heal.
The use of a rollator walker with four wheels, a raised toilet
seat with arms on it, a bath seat, and a commode (portable toilet
chair) placed in your bedroom will make access easy.
If your bedroom is not on the same level as the kitchen you may
want to set up a bed on the main floor.
Beds, walkers and other equipment are available for rental at
medical supply companies.
There are also many health professionals and resources available
to help you: Family Doctor (Pain medication, home care referral,
referral to an Osteoporosis Clinic. Physiotherapist: Pain control, selecting walking
aids, education and exercises to reduce muscle spasms and stabilize
the spine. Occupational Therapist: Assistance with activities
of daily living (safest way to perform activities under the circumstances)
and equipment: walker, bath seat, raised toilet seat, electric
bed, commode and dressing aids. Nurse: Pain control, education, co-ordination
of other required resources. Home Support Worker: Meal preparation, bathing/dressing,
changing beds, laundry, housework. Other Services: Groceries, meals and prescription
delivery services
HIP FRACTURES The
most common cause of a hip fractures is falling. Hip fractures
are usually accompanied by sudden, severe pain and difficulty
moving and bearing weight on the injured leg. People with a suspected
hip fracture should go to the hospital emergency department. Fractures
are confirmed by x-ray and the person is normally admitted to
hospital. Surgery, if required, would be done within the first
24 to 48 hours. The fracture may be repaired or the hip may be
replaced.
Movement is important
as soon as possible during recovery and people are encouraged
to walk using a walker on the first or second day following surgery.
Length of hospital stay varies, and people are usually sent home
to recuperate after 3-4 days with help from home care services.
You will be seen in
the hospital by the physiotherapist and will be sent home with
an exercise program to do 2-3 times per day. You will also be
provided with helpful recommendations. The home care physiotherapist
will also progress your exercises and help you get back to your
previous levels of activity.
It is also important
to remember that if you have broken your hip, it is almost guaranteed
that you have osteoporosis and are at high risk of a second hip
fracture. After you recover from the fracture, you need to follow
up with your doctor about learning strategies to improve your
bone mass. Your doctor may prescribe a bone building medicine
and order a Bone Mineral Density Test to monitor your bone mass.
You should also make sure you are getting enough calcium and Vitamin
D as studies in nursing homes have shown that hip fractures drop
by 50 per cent when residents receive calcium and Vitamin D supplements.
A good exercise program
to help your bones and improve your balance to reduce your fall
and fracture risk is very important. At The Downtown Clinic we
will work with you to ensure you have an exercise program that
is safe, effective and feasible to continue over the long term.
WRIST FRACTURES
A wrist fracture, also known as a Colles fracture, usually results
from a person falling on an outstretched arm. Wrist fractures
are most common in women aged 50 to 70. The usual treatment for
this fracture is casting for six weeks. After the cast is removed,
both wrist strength and range of motion are greatly reduced. Physiotherapy
can help you with daily strengthening and range of motion exercises
are necessary to regain your mobility and function. Ice and active
movement can also help the swelling after the cast is removed.
RIB FRACTURES
Rib fractures are also fairly common. During such fractures, deep
breathing, coughing, bowel movements, changing position and moving
in bed are all painful. Rib fractures are usually treated conservatively
with pain medication, lots of rest and modifying activities. Rib
fractures usually take six weeks to heal with the acute pain lasting
anywhere from two to six weeks. Your physiotherapist can help
you with breathing and relaxation exercises to improve comfort,
mobility and function. As will all osteoporotic fractures, you
are at increased risk for further fracture and it is very important
to start a good exercise program to help your bones and improve
your balance to reduce your fall and fracture risk. The physiotherapists
at The Downtown Clinic will ensure you have an exercise program
that is safe, effective and feasible to continue over the long
term.
For Further
Information, contact Osteoporosis Canada at www.osteoporosis.ca
(1-800) 463-6842 or (1-416) 696-2817
To
register for the e-newsletters from the Canadian Osteoporosis
Patient Network,
contact COPN at copn@osteoporosis.ca
Good
Posture Is More Than Just Looking Good!
The Importance
of Good Posture
One
of the most important benefits for people with osteoporosis is
reducing fracture risk. Any time the spine curves forward a force
called a ‘flexion moment’ is placed upon the spine.
This force increases compression on the vertebrae thereby increasing
the risk of spinal fracture. By reducing the compression forces
on the spine you can reduce your fracture risk. This can be achieved
by reducing forward curving of the spine and maintaining good
posture especially when doing activities that place a load on
the spine such as lifting and carrying. Tightening your abdominal
muscles can reduce the compression on the spine by 20%. So, just
as your mother told you, straighten your back, pull your shoulders
back, and pull your tummy in!
Sitting Posture
Paying close attention
to how you sit is also very important. When you sit, muscles that
support your lower back easily get tired. With muscle fatigue
the hollow in your lower back, is lost and you end up slouching.
At the same time, muscles that support your head and neck also
tire, and the inward curve in your neck is lost as you poke your
head and neck forward. And once the slouched posture of your lower
back takes over, it is next to impossible to maintain or regain
a good posture in your head, neck or upper spine.
Unfortunately, we have
many poor habits in our daily lives involving poor postures such
as sitting forward on the edge of a chair, hunched over, with
head poked forward, while reading a book, lying on a couch or
bed while leaning on one elbow (creating imbalances and a sideward
curve of our spines), holding arms out, unsupported, while typing
for many hours a day at work. All of these activities lead to
the same results — headaches, sore necks, backs and shoulders,
and additional pressures on our spines — which, over the
long term, can result in significant muscle imbalances and serious
physical problems.
Always ensure you have
lower back support while sitting. A lower back roll, cylinder-shaped
piece of foam, small pillow, folded towel/jacket or a Nada chair
can be used in any chair, sofa, car or theatre seat.
Healthy Hints
Smart
Travel Tips:
• Be prepared
to bring your own back support
• Give your body regular stretch breaks
• Keep a back roll or small pillow in your car
• Try an adjustable full back support
• Make sure your feet are supported, many seats are higher
than a regular chair
Deskwork
Make sure your desk or computer chair has adequate support for
your lower back, and if it does not, be sure to add additional
support. Try also to keep your feet flat on the floor or a footrest
as much as possible. When typing, keep your shoulders relaxed
and your arms at your side with your elbows bent at a 90-degree
angle. Hold your forearms and wrists parallel to the floor. Sit
about one arm’s length from the screen, and position your
monitor level with your eyes so that you can keep your head and
neck relaxed and upright without straining.
Healthy Hints
User-friendly deskwork:
• Stretch your arms, hands, neck and back every 60 minutes,
or more often, if you feel strain
• Walk around every hour if possible
• Always hold the telephone receiver in your hand and not
tucked between your head and shoulder
• If you use the phone often, try a hands-free headset or
speaker phone
• If you are a smoker, use your smoke breaks to also do
your stretches
• If you are a non-smoker, take a stretch break while the
smokers take their smoke break
PowerFlower
WebDesign
What
is Osteoporosis?
What
are you feeling?
The
physiotherapy staff at The Downtown Clinic have been helping people
with osteoporosis for many years. They are experienced in being
able to assist you to get back to your activities safely and without
pain.
Learning
to identify and modify your personal risk factors for fracture.
When
your fracture has healed you will take the next step and begin
exercises that will improve your range of motion, strength, balance
and endurance. 
Hip
fractures are a severe consequence of osteoporosis and can be
physically and mentally devastating. They cause loss of independence
and often result in institutionalization in long-term care facilities.
27% of all hip fractures occur in men. Compared with women, men
suffer greater health problems and mortality after a hip fracture.
Ask
your doctor about appropriate therapy for you. Make sure you are
getting enough calcium and vitamin D. Elemental calcium intake
of 1500 mg daily from diet and supplements as well as 800-1000
IU of Vitamin D are recommended for both senior men and women.
Get enough exercise to prevent bone loss due to being sedentary.
Daily walking programs are essential for maintenance of skeletal
mineralization and fall prevention.
Review your medications with your doctor on a
regular basis. Are you taking any medicine that would cause you
to lose bone? Are you already being treated for osteoporosis?
Are you taking vitamin supplements, calcium, or herbal supplements.
In
up to 60% of all spinal fractures, there is no associated pain
at the time of the fracture and the person only finds out about
the fracture after being x-rayed. In other cases, a spinal fracture
is accompanied by sudden, severe, sharp back pain. It can feel
like a muscle spasm. Some describe it as a pulled muscle, while
others hear a tearing or popping sound as they lift a heavy object.
In many cases a person does not feel pain when the fracture occurs
and does not know something is wrong until they wake the following
morning. 
1.
POSITIONING: 
The
most common cause of a hip fractures is falling. Hip fractures
are usually accompanied by sudden, severe pain and difficulty
moving and bearing weight on the injured leg. People with a suspected
hip fracture should go to the hospital emergency department. Fractures
are confirmed by x-ray and the person is normally admitted to
hospital. Surgery, if required, would be done within the first
24 to 48 hours. The fracture may be repaired or the hip may be
replaced.
One
of the most important benefits for people with osteoporosis is
reducing fracture risk. Any time the spine curves forward a force
called a ‘flexion moment’ is placed upon the spine.
This force increases compression on the vertebrae thereby increasing
the risk of spinal fracture. By reducing the compression forces
on the spine you can reduce your fracture risk. This can be achieved
by reducing forward curving of the spine and maintaining good
posture especially when doing activities that place a load on
the spine such as lifting and carrying. Tightening your abdominal
muscles can reduce the compression on the spine by 20%. So, just
as your mother told you, straighten your back, pull your shoulders
back, and pull your tummy in! 
Smart
Travel Tips: