The Story

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Osteoporosis Canada

Maggie is a 50-year-old woman who works in a factory, enjoys swimming, skiing and walking her dog.
One day she was cleaning out the garage, moving boxes and equipment and also lifting heavy objects overhead.
She developed severe back pain the next day.
Maggie went to her doctor and was told she had a muscular strain. She was prescribed anti-inflammatory medication, was told to rest, and stay off work for a few days. Maggie did as she was told- rested, did some stretching exercises and spent some time in the hot tub. However, her condition became worse.

A visit to Darien at The Downtown Clinic suggested that Maggie speak to her family doctor about having low back x-rays. Given that Maggie was also post-menopausal and her mother had had a hip fracture, it was also suggested that she have a bone density test.Results of the low back x-rays showed mild lumbar degenerative disc disease with some ‘osteophyte’ formation at the lumbar 3-5 levels as well as 2 spinal fractures at lumbar levels 1 and 2 (L1 and 2). The bone density test revealed severe osteoporosis.

Maggie’s story is not uncommon.
She was unaware that she had any problems with her bones; she exercised regularly and took calcium supplements. She had an injury that looked like a simple muscle strain, but because of her low bone density actually resulted in spinal fractures.

Darien and Maggie discussed the implications of the test results. Maggie did have some physical findings consistent with her age – degenerative disc disease (joint narrowing with osteophytes (extra bone growth at the edges of the spinal bones). But she also had loss of bone density -- that was more than it should be for a woman her age (osteoporosis) and a reduction in the height of the L1 and 2 vertebrae resulting from wedge shaped crushing fractures.

Consultation with Maggie’s family physician put her on a drug to help build her bone density and prevent further fractures. Maggie increased her calcium supplements and started taking Vitamin D. (Post menopausal women need 1500 mg calcium and 800 U.I. Vitamin D daily).

Physiotherapy management included general discussion about modification of her ‘risk factors for osteoporosis’ in order to help prevent further bone loss, the importance of improving her ‘posture’, and maintaining ‘good body mechanics’ especially during daily activities to reduce fracture risk.

Darien also worked with Maggie to develop a weight-bearing (strength training) exercise routine (to protect her bones, strengthen her muscles and prevent falls).
Since Maggie already enjoyed swimming it was also suggested that Maggie attend deep-water exercise classes to relieve some of the discomfort in the low back (no bouncing on the joints)

Maggie is now exercising regularly again - because she feels better! She also feels confident that her new program will strengthen her bones and is safe for her to do given her low bone mass and high fracture risk. Her exercise schedule alternates between a stretching and strengthening program, weight-bearing, cardio- fitness and aquatic exercises.

Maggie was afraid she would have to give up skiing, a sport she has done since she was young and which she really enjoys. Her ski holidays with her family are very important to her.

Darien and Maggie discussed the risks and benefits of skiing. Because she has been skiing for a long time, Maggie has the skill, coordination and strength to do it safely. But she also understands that if she falls she is at higher risk for fracture than a skier with normal bones.
The risk of stopping her sport was also discussed.
Maggie would be giving up an activity that helps to keep her muscles and bones strong and improves balance and coordination.

Armed with this information, Maggie is able to make safe choices and still not give up the activity she loves.
She can decide not to ski in risky weather, when she is tired or sore, or to give up the double black diamond runs with big moguls.

Maggie is taking important steps to maximize her bone strength. She is exercising safely and taking medicine to build her bones. Another bone density test in about a year to check on the status of her bones. Should bone density measurements not improve, other medical management may be suggested by her physician.