Osteopenia is the early stage of Osteoporosis. Having osteopenia places a person at risk of developing Osteoporosis. A diagnosis of osteopenia is a warning that you must start taking care of your bones and that prevention methods need to be put in place.
Osteoporosis means porous bones. It is a silent disease that is usually not diagnosed until a fracture/s (broken bone/s) occurs.
Bone is a living tissue that is constantly being removed and replaced. Bones need normal sex hormones, calcium, vitamin D, adequate calories, proteins and weight bearing/strengthening exercise to keep them healthy.
As we get older, more bone is naturally lost than is replaced, but people with Osteoporosis lose more bone than people who do not have the disease. This causes bones to become fragile and therefore they break easily e.g. through a minor bump or fall. A broken bone as a result of a trip or fall from a standing position is not normal at any age.
Osteoporosis can affect the whole skeleton, but the most common areas to break are the wrist, spine and hip. The disease affects all age groups and both sexes – it is not just a female or old person’s disease.
At present it is estimated that 300,000 people in Ireland have Osteoporosis. One in 4 men and 1 in 2 women over 50 will develop a fracture due to Osteoporosis in their lifetime. The disease can affect even children.
If you have one fragility (low trauma) fracture, this doubles your risk of another fracture due to Osteoporosis. However, it can be prevented in most cases, and is a treatable disease in the majority of people.

Diagnosis

A bone density scan, called a Dual Energy X-ray Absorptiometry (DXA or DEXA scan), is used to measure the density of your bones. This test is currently the most accurate and reliable means of assessing the strength of your bones and your risk of breaking a bone. It is a simple, painless procedure that uses very low doses of radiation (10% of a regular chest X-Ray). You will be asked to lie down on a table for 10-15 minutes whilst an x-ray arm passes over you to take an image of your spine and hips. A bone density scan can diagnose Osteoporosis, assess your risk of breaking a bone and monitor the effects of treatment. Early diagnosis is essential for the best results and is highly recommended if you are at risk (see signs and symptoms below)

Signs of Osteoporosis

  • Usually the first sign of Osteoporosis is a fragility (low trauma) fracture e.g. a broken bone due to a trip and fall from a standing position or less. Anyone who breaks a bone from a trip and fall or less: even if it was on cement or ice should be screened for Osteoporosis.
  • Unexplained broken bones: People with severe undiagnosed Osteoporosis can cough, sneeze, stand up from a chair, roll over in bed and break bones. Anyone with unexplained broken bones should be screened for Osteoporosis.

It is a lot cheaper to have a DXA scan to see if you have undiagnosed, than wait to see if you break more bones.

Symptoms of Osteoporosis

  • Sudden, severe episodes of upper, middle or low back pain.Anyone who has undiagnosed back pain, Osteoporosis should be ruled out, especially if the person has lost height or their posture has changed.
  • Loss of height (greater than 2cm) . It should not be considered normal at any age to loose height. It is a red flag if a person has lost height, especially if they have back pain or their posture has changed.
  • Posture change: Development of a hump on the back and / or a change in body shape, for example, the rib cage may rest on pelvic rim or a pot belly develops. A hump developing on a person’s back should not be considered “Normal Aging”. If it is from undiagnosed Osteoporosis, the bones in the spine are collapsing, the hump develops because there is not enough bone in the spine to keep the person upright. If treatment is not initiated, research shows that every 6-12 months another bone (vertebrae in spine) will collapse. The hump causes the persons centre of gravity to be off, therefore placing the person at a high risk of losing their balance and possibly fracturing their hip. The rib cage can end up resting on the pelvis, because the spine has lost bone support to hold it upright. A Pot belly can then occur as there is no place for the stomach contents to go, other than outwards. This can cause severe pain and/or difficulty in breathing and swallowing, in severe undiagnosed Osteoporosis patients.

Most people have no pain till a fracture occurs but a small percentage of people can have back or hip pain, prior to a fracture.
It is essential that you speak with your doctor or an Osteoporosis specialist if you experience any of these signs or symptoms.

Physiotherapy: Exercise & Osteoporosis

Exercise can play an important part in helping to reduce your risk of osteopenia / Osteoporosis and it is also an important aspect of treatment.

If you have been diagnosed with either, we recommend that you be assessed by a chartered physiotherapist. A physiotherapist can assess what exercises are safe and appropriate for you to do at home and what ones you should avoid, such as regular sit-ups, kickboxing or any stretch that puts additional stress on your vertebrae. If you are participating in a class (see below) or attending a gym, a physiotherapist can also advise you in this regard.
Bone is scaffolding which supports the body against the force of gravity. Bones resist the pull of our muscles to allow movement. As bone is a living tissue, it reacts to appropriate weight-bearing exercise by growing stronger. This is how you support the weight of your own body.
The safe and sensible way to begin an exercise programme is to take your time and listen to your body. The type of exercise you do depends on your risk of fracture, your age, your medical history and your DXA scan results.
Walking is a weight-bearing exercise appropriate for the older client, however it is important to change your pace intermittently. Some activities can be done in many places, and can be included in a busy daily routine. Stair climbing is good for your spine and hip but should only be done by those who are steady on their feet and using a rail. Ten times up and down an average flight of stairs (10-12 steps) is a third of your daily weight-bearing requirements.
Examples of weight bearing activities for the younger individual include tennis, hockey, football, basketball, running, jogging, team sports and dancing. Intermittent jogging is great for people who find running or jogging too strenuous. Walk for a few minutes and then jog for 30-60 seconds. This helps to increase bone density (strength) in the spine and hips but you should be medically cleared by your doctor.
Please remember that over-exercising is very harmful for your bones. In general, we recommend 30 minutes weight-bearing exercise a day, both for your bones and overall health. This can be broken up into 3-5 minutes at a time, 3 sets of 10 minutes or 30 minutes continuously. Children should be encouraged to do 60 minutes of moderate-high impact exercise daily (30 minutes weight-bearing and 30 minutes for overall general health). This is especially important prior to puberty as bone strength can be significantly increased to reduce the risk of Osteoporosis in later life.

Advice regarding Exercise for Adults with Osteopenia

Speak to your doctor and a Chartered Physiotherapist to find out what activities are appropriate for you. A chartered physiotherapist with a special interest in bone health will take into account your DXA scan results, your medical history, your risk of fracture and the areas most affected before prescribing an appropriate exercise programme.
Start slowly and gradually build up the amount and the intensity until you have reached the target prescribed by your physiotherapist. Never increase the speed and intensity at the same time, and add only one new exercise in the each session. This way if you experience a problem with an exercise you can identify which one it is.
Some exercises can specifically benefit your area of bone loss, e.g. the spine or hip. Exercise to promote good posture and balance are also recommended. Pilates may be beneficial, ideally in small classes and preferably run by a chartered physiotherapist (please see below for information on the gentle exercise class running here in our clinic).
STOP your exercise programme if you experience pain and have the area of pain reassessed. If pain persists, it could be a sign of an over-use injury, which means you should stop exercising until the injury heals. If you are feeling unwell, exercise is not recommended.
If you experience stiffness after exercising, this is your body saying that you have done too much, too soon. A slow walk could help to loosen up your muscles.
Exercise must be taken regularly to have any benefit. Little and often is the best strategy. Regular exercise must be a permanent lifestyle decision because if you stop, it’s beneficial effects gradually wear off. Muscles adapt to extra use within weeks but bones take several months.
Note that your exercise programme should be reassessed at intervals.

Advice regarding Exercise for Adults with Osteoporosis

Have an assessment with a Chartered Physiotherapist who will work with you to design an individualized programme of weight-bearing and muscle-strengthening exercises specifically for your needs.
Although it is important to avoid stresses that may cause fractures, avoiding all exercise and activities will only serve to diminish your bone health.
In general, avoid the following:

  • Excessive forward bending of your back e.g. regular sit-ups and touching your toes with your legs straight
  • Exercises that involve bending and twisting of your spine at the same time
  • High impact exercise as this increases your risk of developing or aggravating a back, hip, knee or ankle problem as well as the Osteoporosis itself

Remember that Osteoporosis affects people of all ages. An exercise programme for a 20, 45 and 70 year old will all differ.

Fall Prevention

If you have sustained a fracture as a result of a fall, then advice may be given by your physiotherapist on how to reduce your risk of further falls. A large amount of falls can be prevented, e.g. by wearing good walking shoes in your home instead of slippers. Removing throw rugs from your home and getting regular eye exams can also help.

Basic Rules for Exercising

Clothes: Wear runners and comfortable clothing.
Environment: Make sure you have enough space to move and that you will not get too hot or too cold.
Warm Up: Start slowly, doing gentle exercise like marching on the spot. Do safe stretching exercises before you begin your main exercise and cool down and stretch after the activity to reduce your risk of injury. Always stretch slowly and never bounce as this can cause an injury. Ideally you should hold the stretch for 30 seconds.
Type of Exercise: Try to pick an activity that you know you like, so you will not dread having to do it. Varying your activities reduces your risk of getting bored and will stimulate more bone growth.
Progression of your activity: Gradually build up the intensity and the amount of time.

Weight training for women and men

Resistance training using weights and gym machines has been shown to promote bone health by increasing your muscle strength and bone density. This consists of lifting heavy (but we recommend moderate if you have Osteoporosis) weights in a slow, controlled manner.
You should always warm up first and alternately work the arms and legs. Begin with two leg exercises followed by one upper body exercise. Begin lifting the weights slowly and take ten seconds in between each lift. Breathe in as you lift and breathe out as you lower the weight.
To avoid an injury, begin with weights that are 25 % of the maximum you can lift. As you slowly and steadily progress, increase the weights to 85% of your maximum; this should be done over 3-4 months. In young healthy individuals, begin with 50% of your maximum, increasing to 85% over 3-4 months.
If you weight train regularly, it is best to take a days rest in between training days.
Getting advice from a chartered physiotherapist should help you avoid an injury. You need to be especially careful with weight training if you have back pain combined with Osteoporosis risk factors. Remember that strenuous weight training can cause a serious injury if you have undiagnosed Osteoporosis.

Class Details

Carrick on Shannon Physiotherapy and Sports Injury Clinic run a physiotherapist – led gentle exercise class every Wednesday from 12PM – 1.00PM, with the aim of promoting safe, effective exercise in a supervised environment. Please contact us to here at 071 9671533 to book your place or for further information.