Osteoporosis and Role of Physiotherapy

My Physiotherapy career has taken me from St. John’s, Newfoundland to San Jose California. Along the way, I worked in a wide range of clinical settings: from neuro to ortho, acute to chronic, ICU to wellness/fitness training.  During my coast-to-coast professional journey, I realized that the common denominator of all of my patients, regardless of their age or medical condition, was that each had a skeletal system that I could help optimize.

Osteoporosis and Our Skeletal System

Our skeletal system constantly changes throughout life. When we are young, our skeletons are in a rapid modeling phase – with a burst around puberty.  As we move into our adult years, bone re-modeling allows a turnover of our entire skeleton every 10 years.  Some have said that osteoporosis is a pediatric condition that manifests itself later in life. Paying attention to bone health in the later years of life is akin to starting your dental care as an adult.  Physiotherapists are well positioned to influence the bone health of all those we come in contact with – from the young to the old!

Below is a presentation I made on the Role of Physiotherapy in the Treatment of Osteoporosis in September of 2013 to the Association of Physiotherapists of Montreal.

Think  Bone Health

Physiotherapists are musculoskeletal experts.  Regardless of the setting you work in and no matter the age or physical condition of your patient, you can have a positive impact on your patients’ skeletal health.  This is the philosophy I follow in my Physiotherapy practice today.  I manage my own clinic in Ottawa, Canada where I treat patients with a wide variety of conditions superimposed on low bone density and osteoporosis.  I have a popular online service for patients who want a safe and effective osteoporosis exercise program and I offer online training for Physiotherapists who treat patients with osteoporosis.

Eat, Move, Breed

The health of bone and the potential onset of osteoporosis are influenced by a number of factors. The most prominent ones within our control are nutrition, physical stressors to the skeleton in the form of weight bearing and muscle pulling on bone, and the delicate balance of hormones that influence bone growth.

Physiotherapists are in a unique position to influence each of these variables. I refer to this as the Eat, Move, Breed strategy, where Eat refers to the nutrition component, Move refers to the movement and exercise recommendations, and Breed refers to the hormones essential for building bone.

There are three distinct stages of life that require our attention and the Eat, Move, Breed strategy will vary depending on the age of your patient:

  1. Utero to University
  2. Kids to careers
  3. Post-Menopause to Post-Op

Utero to University

In the presentation I made in Montreal (see above), I present case summaries of two of my clients and their bone status at the age of nineteen. These case summaries illustrate how crucial this stage of life is to the development of strong bones.

The time from utero to university is critical for the development of not only good density, but more importantly, good bone quality.  These are the years when a little effort goes a long way in adding to your bone bank. Shortfalls in the first two decades of life can have huge impact on quality of life in the last decades of life.

Physiotherapists working with patients within the timeframe of utero to university can:

  • Educate pregnant women about the significance that their own nutritional status has on their baby’s skeletal health.
  • Encourage young parents to optimize their nutritional, lifestyle and exercise behavior so as to act as role models for their children.
  • Encourage bone building through active play, multiple sports, and nutrient dense lunch programs.
  • Question their teenage patients about the regularity of their menstrual periods, their nutritional and caloric intake, and other factors that can affect hormonal balance and the health of their bones.

Kids to Careers

These same questions are appropriate as our patients enter the next stage of life: Kids to Careers. Life gets busy making it difficult to find time for exercise and to prepare and eat healthy meals. Pregnancy and lactation or the late usage of depo-provera as a birth control does not allow many years to rebuild bone before the onset of menopause. Physiotherapists should remind their patients to include weight bearing and strength training into their routine. In the presentation above I share a case about a patient of mine who seemed to be doing all the right things until a sled ride with her kids changed her life.

Post-Menopause to Post-Op

Life moves by quickly and, before you know it, you and your patients are already entering Post menopause/andropause to Post-Op phase of life! In the last phase of life, loss of estrogen in women and testosterone in men is one of many challenges our skeletons face. Numerous medications and co-morbidities add to the challenge of keeping our bones strong.  Declining health, activity, strength and balance make us more vulnerable to falls and fractures.

Emphasis on fall prevention becomes a hallmark of our work with individuals as they age. But when it comes to bone health there is so much we should and can do before this last stage of life. Physiotherapists should seize the opportunity to act as promoters and protectors of bone health through all stages of life.

To learn more, please register for my free course on treating patients with osteoporosis at my website