Physical Therapy for Osteoporosis/Osteopenia

What is Osteopenia and Osteoporosis?
Osteopenia is a decrease in bone mineral density (BMD) below normal values for an individual’s age. If BMD continues to decrease, osteopenia can progress to osteoporosis.

Normally, the body constantly absorbs and replaces bone tissue. With osteoporosis, new bone creation doesn’t keep up with old bone removal. This results in weakening of the bones and increases one’s risk of bone fractures.

How do I know if I have Osteopenia or Osteoporosis?
Osteopenia and osteoporosis can be diagnosed with the performance of dual-energy X-ray absorptiometry (DXA) bone scans and comparing the results to the BMD norms of younger adults of the same sex, resulting in a t-score (t-score of 1.0 is 1.0 standard deviation less than the bone density of the younger adult). Normal BMD indicates healthy bones that are at low risk of experiencing a fracture.

Osteopenia is the presence of low BMD with a t-score of -1.0 to -2.5. Osteoporosis BMD decreases further with a t-score of < -2.5, indicating that the individual is at an increased risk of fracture. DXA scans are used as a screening tool in women > 65 years and men > 70 years. Consult your primary care physician for guidance if you have questions on whether a DXA is recommended for you. Areas of the body that are closely screened for low BMD include wrists, lower back, and the hips. BMD can vary from one side of the body to the other and it is important to communicate with your physical therapist on areas of low BMD so specific exercises can be performed.

What causes bone mineral density (BMD) to change?
BMD is constantly changing between breaking down old bone and laying down new growth. The main factors that can affect the rate at which breakdown and growth of bone is occurring are calcium, vitamin D, estrogen and physical stress. Wolff’s Law is how your bones adapt and change to the physical stress that they are subjected to which can be manipulated with exercise.

How can Physical Therapy help Osteopenia and Osteoporosis?
In addition to treatments from other providers (i.e. family physician, nutritionist), physical therapy can help with guided exercises to improve the strength of your bones and the surrounding muscles. Exercises will be progressed based on tolerance. Graded stress to your bones will tell your body to build more bone. Further, building and strengthening your muscles will help protect your bones while physical therapy will work on improving balance to lessen the chances of a fall and resultant fractures.

References:
Kahwati, L. C., Weber, R. P., Pan, H., Gourlay, M., LeBlanc, E., Coker-Schwimmer, M., & Viswanathan, M. (2018). Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA, 319(15), 1600–1612. https://doi.org/10.1001/jama.2017.21640
Langdahl B. L. (2021). Overview of treatment approaches to osteoporosis. British Journal of Pharmacology, 178(9), 1891–1906. https://doi.org/10.1111/bph.15024
Watson, S. L., Weeks, B. K., Weis, L. J., Harding, A. T., Horan, S. A., & Beck, B. R. (2018). High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial. Journal of Bone and Mineral Research: the Official Journal of the American Society for Bone and Mineral Research, 33(2), 211–220. https://doi.org/10.1002/jbmr.3284

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