Prevention before treatment

Osteoporosis is a metabolic disease of the bone, which is characterised by a reduction of its mass, resulting in a fragile bone tissue increasing the bone’s vulnerability to fractures.

It seems consensual that bone density increase occurs until the age of 30 and from then on a decline is observed. This varies from individual to individual, depending on several factors which influence this: physical inactivity, reduced sun exposure, reduced weight, use of corticosteroids, and poor eating habits.

According to the World Health Organisation, a third of white women over the age of 65 have osteoporosis. Although it is a disease which is more prevalent in women, it also affects men. It is estimated that about a fifth of males over the age of 60 are 25% more likely to suffer a fracture due to osteoporosis.

Articles have been written reporting a strong correlation between muscle strength and bone quality. People with stronger muscles have stronger bones, and the opposite is also true.

For this reason, physical activity is advised as an important contribution in maintaining healthy bones. Structured physical exercise is fundamental in the prevention and treatment of osteoporosis. Exercise benefits bone mineral density when it starts to decrease, strengthens muscles and improves balance.

The types of exercises that produce the best results in osteoporosis are strength exercises. High-impact, high-intensity aerobic exercises should also be introduced in the exercise plan.

Isometric trunk muscle strength exercises and open kinetic chain exercises are very useful because, by strengthening the posterior body muscles, they contribute in reducing the risk of vertebral fractures, a very vulnerable region in the elderly who suffer from osteoporosis, besides also strengthening the thigh muscles, very important in maintaining balance and also in the prevention of neck and femur fractures.

Due to the transmitted impact aerobic exercises, such as running, help in calcium retention. However, walking as an exercise is not very efficient in improving bone density.

On the other hand, balance and coordination exercises have multiple but less consistent benefits. They are, however, widely used in the treatment of osteoporosis, mainly due to their effectiveness in improving static and dynamic balance, contributing significantly in reducing the risk of falls.

Osteodensitometry is the test used to evaluate bone density. It is also the standard method used in the diagnosis and follow-up of people with osteoporosis, who need to control the evolution of the disease. This test is performed in a part of the body with the highest propensity for osteoporotic fractures such as the proximal femur and the lumbar spine.

A osteodensitometry is recommended in the following situations:
a) Women over the age of 65 and men over the age of 70;
b) Women under the age of 65 who are postmenopausal and men over 50 who present 1 major or 2 minor risk factors;
c) Premenopausal women and men under the age of 50, only if there are known causes of secondary osteoporosis or major risk factors.

Major risk factors for osteoporosis are: age (+65); previous vertebral fracture; family history of hip fracture in one of the parents; corticoid therapy (+3 months in a row), early menopause (<40 years), hypogonadism, primary hyperparathyroidism, increased propensity for falls. Minor risk factors are: rheumatoid arthritis; history of hyperthyroidism; chronic therapy with anti-epileptics; diet with low-calcium intake and excessive consumption of caffeine (+3 cups per day); smoker; excessive consumption of alcohol (+3 drinks per day); body mass index lower than 19kg/m2; weight loss greater than 10% relative to the individual’s weight at age 25; chronic heparin therapy; prolonged immobilisation. By Rui Cintra || [email protected] Rui Cintra is a physiotherapist, specialising in Cardiopulmonary and Chronic Disease Exercises at Hospital Particular do Algarve