Commonly in physical therapy we treat patients with osteopenia or osteoporosis, however, they are usually in our office for another diagnosis such as back, hip, or pelvic pain as the primary complaint and we learn about the osteoporosis from health history review. Physical therapy is an opportunity to provide them with not just relief from their primary complaint, but a chance to learn from a professional how to move in a more healthy way and learn the right ways to exercises to make a regular routine that can help them to protect their body and even slow or stop bone mineral density loss. This is important as the primary concern for a patient with the diagnosis of osteoporosis is risk of fracture (especially of the hip or spine) due to minimal trauma because of low bone mineral density. So let’s make sure we are giving patients comprehensive exercise programs that address their primary complaint, however be comprehensive and include exercise modes that may reduce fractures and may improve bone mineral density.
An interesting article by Palombaro et al1 in 2013 from Physical Therapy discusses a Cochrane review by Howe et al2 and applies the findings from this review to an example patient similar to the participants reviewed in the study. The goal of the article is to link evidence in the literature with how we practice as PT’s. The topic explored in the systematic review by Howe et al was exercise for the management of osteoporosis in women postmenopause and which exercise approaches reduce the loss of bone mineral density or reduce chance of fractures in women who are healthy postmenopause. The systematic review2 included 43 randomized controlled studies of postmenopausal women age 45-70 where the intervention groups included exercises that improved aerobic capacity or improved aerobic capacity and muscle strength and had a comparison group completing “usual activity: or placebo intervention. The duration of exercise lasted from 6 months to 2 years in the various studies. The results of the review demonstrated decreased bone loss (of the spine or hips) in groups who performed any type of exercise compared to the control groups. The review also performed additional sub group analysis to take into account the various types of exercise programs in the studies and found favorable effect for all types of exercises completed (dynamic, low force, high force, weight bearing, or non-weight bearing) all had favorable effect on bone density. The take home message from this systematic review is that exercise programs combining various forms of exercises lasting 6 months to 2 years resulted in reduced risk for fracture, and a slightly beneficial effect on bone mineral density of the spine, trochanter, and neck of the femur in postmenopausal women with osteoporosis.
At the end of this article1 the authors give a case of an active, postmenopausal female patient with history of osteopenia without a fracture seeking PT for an unrelated complaint. The authors took the findings from this review and showed the relevance of the findings, applying it to the patient and the outcome of care for this patient when giving her an exercise program. We can implement findings from this review simply to the common question posed by our patients… “what exercises should I be doing to help with my osteoporosis?”
Exercises for a patient with osteoporosis should be forms of exercises that may improve bone density by loading bones (weight bearing exercise) and by increasing muscle mass (strengthening resistive exercise) to produce mechanical load and stress to the bone. Also as we age we tend to experience changes with not just a reduction of bone mineral density, but also a reduction of muscle mass. Additionally complicating the natural progression of aging are balance and gait changes leading to impaired physical performance. We should be giving our patients a comprehensive exercise program including safe weight bearing exercises and a strengthening program. Common examples of weight bearing exercises include regular walking, jogging, jumping, dancing, and racquet sports. Common examples of strengthening activities would include use of resistive exercises for upper and lower body with bands, free weights or resistive equipment. All of these classifications of exercise were considered as beneficial in the review.
To learn more about helping postmenopausal patients, consider joining Michelle Lyons, PT, MISCP for "Menopause Rehabilitation and Symptom Management". This course will be taking place March 19, 2016 - March 20, 2016 in Atlanta, GA. Another great resource to consider is "Geriatric Pelvic Floor Rehab: Modifying Treatments for Seniors and Older Patients" with Heather S. Rader, PT, DPT, BCB-PMD, taking place January 16-17, 2016 in Tampa, FL.
1 Palombaro, K. M., Black, J. D., Buchbinder, R., & Jette, D. U. (2013). Effectiveness of exercise for managing osteoporosis in women postmenopause. Physical Therapy, 93(8), 1021-1025.
2 Howe, T. E., Shea, B., Dawson, L. J., Downie, F., Murray, A., Ross, C., ... & Creed, G. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women (Review).