Osteoporosis

Osteoporosis is a disease characterised by low bone mineral density, micro bone surface deterioration with a consequent increase in bone fragility and susceptibility to fracture. Diagnosis is confirmed by measures of bone density (B.D) via a DEXA (dual-energy x-ray absorptiometry) scan. Osteoporosis is confirmed when B.D is 2.5 standard deviations bellow “young normal adult”.

Causes

Primary osteoporosis is caused by a disruption in the cycle of bone turnover. This includes:


  • Post-menopausal osteoporosis (type 1)

  • Age related osteoporosis (type 2)

  • Secondary osteoporosis is commonly caused from endocrine (hormonal) deficiencies that lead to the bones being affected. These include:

  • Hyperthyroidism

  • Chronic liver disease

  • Hypophosphatasia

Signs & Symptoms

  • There is often a long latent period before clinical symptoms or complications develop

  • The earliest symptom of osteoporosis is often an episode of acute dull ache type pain – similar to that of osteoarthritis

Differential Diagnosis

  • Osteomalacia

  • Osteoarthritis

PROmotion Assessment and outcome measures

  • Subjective examination including a family history check of osteoporosis and a thorough check of when the pain occurs, how it occurs and importantly – where it occurs.

  • Assessment of hip flexors, extensors, abductors, knee extensors and plantar flexor muscles.

  • Flexibility testing of muscles surrounding affected joint/s

  • Balance testing – BESS test, stalk stand

  • Cardiovascular ability testing

How to Manage

  • Education & advice surrounding correct loading of the joints and how to avoid overloading.

  • Correct postural re-training

  • Advice and training in breathing mechanics

  • Specific strengthening and loading of joints and surrounding musculature

  • Specific cardiovascular training

References

  1. Myers, J., Nieman, D. C., & American College of Sports Medicine. (2010). ACSM's resources for clinical exercise physiology: Musculoskeletal, neuromuscular, neoplastic, immunologic, and hematologic conditions. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins Health.

  2. Bello MO, Garla VV. Osteoporosis In Males. [Updated 2020 Jan 20]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538531/

  3. APA Glaser, David L., MD*; Kaplan, Frederick S., MD*† Osteoporosis: Definition and Clinical Presentation, Spine: December 15, 1997 - Volume 22 - Issue 24 - p 12S-16S