Treatment of Osteoporosis and Menopause
In this article Audrey Redmond of Physiofusion explains how to manage osteoporosis. She recommends that we make sure that our weekly dose of exercise is effective in helping to prevent osteoporosis - by being active we can prevent the onset of this silent disease.
If you have been diagnosed with osteoporosis then there is still a lot that you can do to manage the disease.
Depending on your T-scores you may be advised to go on medication to help rebuild your bone integrity and this should be done with advice from your Consultant. Be sure to inform yourself of all the options and possible side effects of the medication. Additionally discuss follow up tests to help monitor the building of bone. DXA scans are usually repeated 2 yearly unless osteoporosis has been diagnosed in which case you may have a yearly scan.
Be sure to understand why you may have developed osteoporosis and the following are additional considerations over and above menopause:
- Is your digestive system working optimally (are you absorbing enough from your food?)
- Is your diet correct (is it time for some professional advice?)
- Address your stress levels (stress releases hormones which increases the risk of fractures – find ways to manage it better)
- Take food supplements (if you’re deficient in mineral/s then supplement it)
- Step up your exercise (weight bearing exercise is essential for bone health)
If you have osteoporosis then take care that the exercise you are doing does not cause further stress on your bones. See a professional who specialises in Osteoporosis to show you which exercises are safe and which movements or exercises to avoid or to be cautious of. There may be practical tasks and manual handling advice that could assist you in modifying your home that will further reduce your risk of a fracture.
What causes osteoporosis?
We don’t know the exact cause of osteoporosis but we do know how the disease progresses. Your bone tissue has a trabecular structure (sponge-like) and as the disease progresses the holes within the structure grow larger and therefore the bones get weaker.
How can I monitor if I have osteoporosis?
Usually there is no sign that osteoporosis is developing until a fracture occurs. Fractures are most common in the spine, hip and wrist and can occur after only a minor fall.
Osteoporotic fractures of the spine causes loss of height and a gradual development of a rounded and stooped appearance, you may even notice a gradual loss of height. These fractures may or may not cause pain.
Know the risk factors:
- Some are more at risk – this does not mean you will get osteoporosis, just that it increases your chances. The risk factors to consider are:
- Family history of osteoporosis
- Ethnicity – Caucasian and Asian woman are more likely to develop Osteoporosis, African women are relatively immune.
- Your periods stopped for over 6 months when you were younger
- You had anorexia
- You went through menopause before the age of 45
- You are (or were) a smoker
- You take medication like steroids, heparin, anti-convulsants, diuretics and long-term laxatives , thyroid medication
- You are inactive
- Slim build
- Digestive problems such as Chrohn’s or coeliac
- You drink more than seven units of alcohol per week
- You have more than 2 cups of coffee or regular tea per day
- Gender – females are 4 times more likely to get Osteoporosis
Diagnosing osteoporosis – DXA scan
If you have any of the risk factors above and going through menopause it is important to check your bone health by having a DXA scan – this is an easy and painless test that can be organised through your GP.
A DXA scan looks at the density of your bone in your hip and spine and will give you the diagnosis of normal bone health, Osteopenia (early stages of Osteoporosis) or Osteoporosis. The outcome of this test usually determines what your next course of action is but more importantly gives you a base-line reading from which you can monitor future bone health.
Other tests to help monitor bone health
- Ultra sound – Sound waves are passed through your heel bone to measure factors related to bone quality.
- Bone turnover – A urine test which shows rate of bone resorption.
- Hair mineral analysis test – this test assessed deficiencies in the main minerals (Calcium, magnesium and Zinc)
These and other tests are available but in Ireland the most commonly used diagnostic test is the DXA scan.
Understanding your DXA scan readings
The DXA test results are presented as a T-score and a Z-score. The T-score compares your reading with the bone density of a young woman (when peak bone mass is at its best) and the Z-score compares your reading with woman of the same age as you.
- A T-score more than -1 indicates Normal bone density
- A T-score between than -1 and -2.5 indicates low bone density (osteopenia)
- A T- score of -2.5 and less indicates Osteoporosis
Audrey Redmond is part-owner of Physiofusion (www.physiofusion.ie) which she set up with her business partner, Lorraine Hanrahan in 2010.
Explaining the work of the physiotherapy clinic and the origins of her interest in osteoporosis Audrey says:
"In the clinic we treat all injuries, sporting and other. More recently we have noticed an increase in posture related pain, overuse injuries and people diagnosed with osteoporosis, specifically after going through menopause.
Stoke Mandeville Hospital, UK
My interest in bone health first started when I was working in Stoke Mandeville hospital, UK with patients who had spinal cord injuries and complete paralysis. We spent a lot of time assisting these patients into standing frames (a frame that had straps to hold the paralysed limbs in place) this allowed the paralysed individual to bear weight through their limbs and ultimately promoted bone health and helped to avoid future osteoporotic fractures. Even with the knowledge that they would never use their limbs to walk again, this preventative measure ensured that future fractures or complications from fractures (infections etc) were avoided.
Is it not then imperative for us who are using our limbs to bear weight to similarly be proactive in preventing osteoporosis and reducing the risks of fractures?
Classes and individual consultations
That was many years ago .. but with that in mind and the link between menopause and osteoporosis and the simple solution of exercise as a big preventative measure encouraged me to start running osteoporosis classes. The classes are informal, can be adapted to suit anyone’s (and any age) needs and include weight bearing, posture, strengthening and balance exercises.
More recently there has been a higher demand for individual assessments of people already diagnosed with osteoporosis or osteopenia. Partly because people don’t really know what they can and can’t do. The aim of an individual assessment is to establish any muscle imbalances or weakness, flexibility issues and core strength is addressed. We include posture analysis as this is definitely a problem in modern world with all of us spending too much time in front of a computer in a stooped posture which is a poor position with anyone that has osteoporosis of the spine.
A tailored exercise program that includes good tips and practical advice is written for the individual. Thus, empowered with the knowledge of what to do we then play a part in preventing or managing osteoporosis.
Ideally we would like to see women before menopause to ensure their weekly dose of exercise is effective in helping them prevent Osteoporosis and in ultimately I would like to encourage teenagers and women in their early twenties to work hard at reaching peak bone mass and simply by being active they can prevent onset of this silent disease."