• Emily Reul, PT, DPT

Osteoporosis

Hi friends, happy Bone and Joint Health Action Week! Tuesday, October 20th was World Osteoporosis day so for this week’s blog we are going to dive into what osteoporosis is, how to help prevent it, and, of course, how it affects the pelvic floor.


WHAT IS OSTEOPOROSIS?

Essentially, osteoporosis is a disease where the bones become less dense causing them to be weak and fragile. You may here it referred to as “brittle bones.” You may also hear the term osteopenia which is a more mild form of the disease.


Osteoporosis is more common in women than men. 1 in every 3 women over age 50 is affected by osteoporosis! Starting around 45-50 years old, everyone starts to experience some age-related bone loss. In fact, on average, age-related bone loss causes a 0.09% loss of height every year.


But why is osteoporosis important? It makes it much easier to get fractures (broken bones). Fractures can be cause by minimal trauma such as sneezing, bumping into an object, or sudden movements. Common sites of fractures include the hip and spine. Fractures in the spine are often caused by bending, lifting, and twisting motions.

Some people are more at risk for fractures than others. Things that can increase the chance of a fracture include: older age, smoking, alcohol use, certain medications (i.e. steroids, anti-depressants, seizure medications, heparin) rheumatoid arthritis, and having a fracture before.


HOW CAN WE PREVENT OR TREAT OSTEOPOROSIS?

There are a few different ways to prevent osteoporosis, including exercise and diet. With exercise, a mechanical load is placed on the bones and the body builds them up to get stronger as a response. Research has shown that dynamic movements are better at stimulating this bone growth than stationary activities.


Activities, like running, jumping, step classes, agility exercises, or games with movements in multiple directions have been shown to help increase bone density in premenopausal women. Aerobic exercise and weight bearing activities, like walking, helps improve and maintain bone density in postmenopausal women. In one study, walking for four hours per week lowered hip fracture risk by 41%. Fast walkers had a 65% lower risk of getting a fracture than slow walkers.


Exercise can have lasting effects, too! Studies have shown that vigorous exercise during childhood and adolescence can reduce fracture risk later in life and xercise in adulthood was shown to have lasting effects of up to 8 years after.


Studies have found that resistance exercise, sometimes called weight training, is most effective at improving bone density when exercises are performed 1-3 sets of 6-8 repetitions each at a “moderately hard” intensity.


Keep in mind with exercise, that inadequate caloric intake can lead to decreased bone density. For those with menstrual cycles, absence of or irregularity of periods can be a sign of overtraining. With overtraining, our bodies begin to break down bones with exercise instead of building them up making us more at risk for developing osteopenia or osteoporosis.


Along with getting enough calories, there are a few nutrients that are important for optimal bone health.


The first is calcium. Bone contains about 99% of the body’s calcium, but it’s also important for other parts of the body to function properly like muscles, nerves, and blood clotting. You’ll find the highest levels of calcium in milk and dairy products, but it can also be found in green vegetables (e.g. broccoli, kale, bok choy), sardines, nuts, and tofu set with calcium.


Another important nutrient is vitamin D. Without vitamin D, the body is unable to use the calcium you eat. You can either get vitamin D through oral supplements or sun exposure. Sun exposure needs to be at least 15 minutes of unfiltered sunlight daily. Sunscreens reduce the amount of vitamin D production, but remember that prolonged sun exposure can lead to skin cancer.


Adequate protein intake has been shown to improve bone density in those taking calcium and vitamin D supplements. Be sure to avoid excessive salt intake and caffeinated beverages, as these tend to cause calcium to leave bones. These can also lead to bladder irritation causing urinary urgency, frequency, and incontinence!


Working with a healthcare provider like a registered dietitian can help you get proper amounts of all nutrients.


If exercise and dietary intake are not enough to prevent osteoporosis, your doctor may prescribe medications like estrogen, bisphosphonates, selective estrogen receptor modulators (SERMs), calcitonin, and parathyroid hormone. These medications to help stop the weakening of bones and increase bone density.


HOW DOES OSTEOPOROSIS AFFECT THE PELVIC FLOOR?

Research has shown there is a significant link between overactive bladder (OAB) and urinary incontinence with falls and fractures. This may be partly due to the fact that with OAB and urinary incontinence, individuals are often rushing to the bathroom to avoid leaks. Having fractures can require surgery to fix them and are often associated with catheterization, prolonged immobility, and pelvic floor dysfunction. Our goal should be to treat these symptoms before a fracture occurs, but a pelvic floor physical therapist can help with address any lingering symptoms, like pain or issues with peeing, pooping, or having sex after a fall or surgical repair.


Physical therapists are trained to help improve overactive bladder and urinary incontinence symptoms which make it less necessary to rush to the bathroom. Physical therapists can also improve balance and ability to get to the bathroom and develop exercise plans to improve overall bone density.

Here are some steps you can take now to help prevent or treat osteoporosis:

What experiences or tips do you have that can help others? We’d love to hear them. Please join the conversation in the comments section below.  


Written by Emily Reul, PT, DPT

References

1. Lindsey C, Johnson Bookstein N. Physical therapy for osteoporosis: prevention and management. APTA section on women’s health.

2. Siracusa C et. al. Pelvic health physical therapy level 1. APTA section on women’s health. 2018.

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This information is for awareness purposes and not individual medical advice. You should seek your own professional counsel for any medical condition or before starting or altering any exercise or fitness program.

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