Late in 2010 I came across an interesting article in the Canadian Medical Journal (CMA) in which new guidelines were outlined to help physicians deal with managing and preventing osteoporosis. According to the study’s lead author, Professor Alexandra Papaioannu, the goal is early identification of those most likely to develop full blown osteoporosis later in life.
The approach recommended in the guidelines is quite different to that currently taken. Instead of relying on bone mineral density (BMD) testing -read more about BMD and testing here- http://www.west4thphysio.com/archives/530 , and then using diet and drugs to boost bone mass, the new guides place much more emphasis on recognising and treating what they are terming “small fragility fractures”. These are the tiny breaks of the spine, hips and wrists that typically occur during minor falls. Up until now these small fractures have often been dismissed as the aches and pains of aging but they should be recognised as a key indicator that the bones are in fact weakening. Early recognition and treatment can prevent a more severe and disabling injury.
And the suggested treatment? Exercise! Long recommended but often taking second (or third or fourth) place behind drugs and diet, resistance training and weightbearing aerobic exercise are promoted as the mainstay of preventing further bone loss and avoiding a downward spiral into full osteoporosis. read more about exercise for osteoporosis here – http://www.west4thphysio.com/archives/979 and here http://www.west4thphysio.com/archives/659 .
Not to downplay the importance of diet. The guidelines strongly suggest adequate Vitamin D and calcium intake. For vitamin D, 1000 IU’s or international units daily if you are healthy and 2000 IU’s if you have already had a fragility fracture. As for calcium, 1200mg from either diet or supplement daily. read about diet and osteoporosis here – http://www.west4thphysio.com/archives/563 .
But I think the main message for physiotherapists is that we have an important role to play in the prescription and management of suitable exercise for the prevention of osteoporosis. By advocating for the role of physical activity of the right kind and providing our patients with specific instruction, we can help prevent a debilitating spiral into disability and premature death.
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