- Fall Risk/Fall Prevention
- Resisted Weight Training Program
- Weight Bearing Activities
- Vibrational Platform Therapy (VBT)
- Individualized and or Group Therapy Programs
- 8-week Class Program Periods
- Post Exercise Class Gym Programs for Maintenance
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What is Osteoporosis and Osteopenia?
Osteoporosis is a silent disease until it is complicated by fragility fractures – fractures that can occur in the absence of trauma or after minimal trauma. These fractures are common and place an enormous medical and personal toll on aging individuals and a major economic toll on the nation. Osteoporosis can be prevented and can be diagnosed and treated before any fracture occurs. Even after the first fracture has occurred, there are effective treatments to decrease the risk of further fracture.
Scope of the Problem
Osteoporosis is the most common bone disease in humans. It is characterized by low bone mass, microarchitectural deterioration, compromised bone strength and increased risk of fracture. Osteoporosis is often defined clinically by an intermediate outcome, low bone mineral density (BMD). Osteoporosis is a risk factor for fracture just as hypertension is for stroke. Osteopenia is related to osteoporosis in the respect that it is also bone loss, as measured by bone mineral density, a marker for how strong a bone is and the risk that it might break.
Osteoporosis and osteopenia affect an enormous number of people, and their prevalence will increase as the population ages. In the whole population, more than 7.8 million have osteoporosis, and an additional 21.8 million women have low bone density of the hip. One out of every two white women will experience an osteoporotic fracture at some point in her lifetime. The most common fractures are those of the vertebrae (spine), proximal femur (hip) and distal forearm (wrist). However, almost all fractures in older adults are due in part to low bone mass.
Fractures may be followed by full recovery or by chronic pain, disability and death. Hip fractures result in 10% to 20% excess mortality within one year; additionally, one-third of patients with a hip fracture will fracture the opposite hip. Up to 25% of hip fracture patients may require long-term nursing home care, and only 40% fully regain their prefracture level of independence.
Vertebral fractures also cause significant complications, including back pain, height loss, kyphosis and death. Postural and height changes associated with kyphosis may limit activity, including bending and reaching. Multiple thoracic fractures may result in restrictive lung disease, and lumbar fractures may alter abdominal anatomy, leading to constipation, abdominal pain, distention, reduced appetite and premature satiety.
Hip and vertebral fractures can also cause psychological symptoms, most notably depression and loss of self-esteem, as patients grapple with pain, physical limitation, and lifestyle and cosmetic changes. Anxiety, fear and anger may also impede recovery. The high morbidity and consequent dependency associated with these fractures strain interpersonal relationships and social roles for patients and their families.
Getting Tested for Osteoporosis/Osteopenia
Osteoporosis can be effectively treated if it is detected before significant bone loss has occurred. A medical workup to diagnose osteoporosis will include a complete medical history, x-ray, and urine and blood tests. The doctor may also order a painless, noninvasive bone mineral density test called called dual-energy x-ray absorptiometry (DXA). The bone density measurements from this test, known as T-scores, can identify osteoporosis/osteopenia, determine your risk for fractures and measure your response to treatment.
The risk of fracture increases as bone mineral density declines. A study published in theJournal of the American Medical Association in 2001 reported that a 50-year-old white woman with a T-score of -1 has a 16% chance of fracturing a hip, a 27% chance with a -2 score, and a 33% chance with a -2.5 score. This underscores the importance of getting tested and taking action before a fracture occurs.
Currently, the National Osteoporosis Foundation (NOF) recommends testing for:
- women 65 and older
- postmenopausal women younger than 65 who have one or more risk factors, which include being thin
- postmenopausal women who have had a fracture
Men Should Also Get Tested for Osteopososis/Osteopenia
A majority of American men view osteoporosis solely as a “woman’s disease.” Don’t be fooled. Osteoporosis and osteopenia also pose a significant threat to millions of men in the United States. Although, osteoporosis and osteopenia develop less often in men than in women because men have larger skeletons, in the past few years these bone diseases in men have been recognized as an important public health issue, particularly in light of estimates that the number of men above the age of 70 will continue to increase as life expectancy continues to rise.
Universal Recommendations for all Patients
Several interventions to reduce fracture risk can be recommended to the general population. These include an adequate intake of calcium and vitamin D, lifelong participation in regular weight-bearing and muscle-strengthening exercise, avoidance of tobacco use, identification and treatment of alcoholism and treatment of other risk factors for fracture such as impaired vision.
An adequate intake of calcium lifelong is necessary for the acquisition of peak bone mass and maintenance of bone health. The skeleton contains 99% of the body’s calcium stores; when the exogenous supply is inadequate, bone tissue is reabsorbed from the skeleton to maintain serum calcium at a constant level. Controlled clinical trials have demonstrated that the combination of supplemental calcium and vitamin D can reduce the risk of fracture. Providing adequate daily calcium and vitamin D is a sage and inexpensive way to help reduce fracture risk. The National Academy of Sciences (NAS) recommends that women over age 50 consume at least 1200 mg per day of elemental calcium. The safe upper limit for total calcium intake has been set at 2500 mg per day.
Vitamin D plays a major role in calcium absorption and bone health. Chief dietary sources of vitamin D include vitamin D-fortified milk (400 IU per quart) and cereals (40 to 50 IU per serving), egg yolks, salt-water fish and liver. Some calcium supplements and most multivitamin tablets also contain vitamin D. An intake of 400 to 600 IU of vitamin D per day is recommended by the NAS for all adults over age 50. The safe upper limit for vitamin D intake set by the NAS is 2000 IU per day.
KPPT recommends regular weight-bearing exercise and muscle-strengthening exercise to reduce the risk of falls and fractures.
Among its many health benefits, weight-bearing and muscle-strengthening exercise can improve agility, strength and balance, which may reduce the risk of falls. In addition, exercise may increase bone density modestly. The NOF strongly endorses lifelong physical activity at all ages, both for osteoporosis prevention and overall health, as benefits are lost when the person stops exercising. Weight-bearing exercise (in which bones and muscles work against gravity as the feet and legs bear the body’s weight) includes walking, jogging, tai chi, stair climbing, dancing and tennis. Muscle strengthening includes weight lifting and other resistive exercises. Before an individual with osteoporosis initiates a new vigorous exercise program, such as running or heavy weight lifting, a physician’s evaluation is appropriate.
Osteoporosis Exercise Information & Resources:
- National Osteoporosis Foundation (NOF)
- International Osteoporosis Foundation (IOF)
- Foundation for Osteoporosis Research and Education
- National Osteoporosis Society (NOS)
- Osteoporosis and Related Bone Diseases – National Institute of Health (NIH) Resource Center