Managing Osteoporosis
In addition to treating osteoporosis with diet and medication, there are ways to manage the disease.
In this section, you will find information on:
Avoiding falls
Who falls?
The number of falls and the severity of injury increase with age and in seniors who, for whatever reason, experience loss of physical conditioning, mobility, and balance. Users of many prescription and over-the-counter medications (polypharmacy) fall more often. The prescription medications that are most associated with falls include sedatives and hypnotics (e.g., sleeping pills) and blood pressure medications that might cause postural low blood pressure.
Alcohol use often contributes to falling problems. Those with medical conditions affecting balance and walking ability, such as Parkinson's disease; stroke; and lower extremity problems such as arthritis in the knee, ankle, or foot, also are vulnerable.
Where do falls occur?
Although you might expect falls to occur with risky activities, such as walking outdoors or in bad weather, most falls (more than 60 percent) happen in the home. Falls in the community account for 30 percent, and only 10 percent of falls occur in institutions such as nursing homes. Remember that falls can happen at any time, in any place, and to anyone, even when the person is engaging in ordinary activities.
What to do to reduce your risk of falls:
- Get regular follow-up visits. Get proper medical evaluation and treatment for conditions causing physical changes. Do not assume you are just "getting older."
- Consult with a physical therapist for a balance/fall assessment and training.
- Remove all loose wires, cords, and throw rugs from floors. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its accustomed place.
- Install grab bars and nonskid tape in the tub or shower.
- On rising from bed, sit on the edge for a minute before getting up.
- Grab a support when getting to your feet.
- Make sure halls, stairways, and entrances are well lighted. Install a night light in your bathroom. Turn lights on if you get up in the middle of the night.
- Install nonskid rubber mats near the sink and stove in the kitchen. Clean up spills immediately.
- Make sure treads, rails, and rugs are secure on stairs.
- Wear sturdy, rubber-soled shoes.
- Keep your intake of alcoholic beverages to a minimum.
- Ask your healthcare provider whether any of your medications might cause you to fall.
- Take a Tai Chi class.
- Take action. Exercise improves strength, balance, coordination, and flexibility.
Alcohol
Calcium is important for many functions in the body, where it serves as a key nutrient in the maintenance of bone density. More than 99 percent of the body's calcium is stored in the bones and teeth. The remaining 1 percent is found in the blood. Blood levels of calcium depend upon how much of this nutrient is consumed in the diet, how well the nutrient is absorbed, and how much of it is excreted. Calcium balance is regulated by many factors, including parathyroid hormone (PTH) and vitamin D.
Alcohol can disrupt calcium balance in many ways. To begin with, alcohol exposure increases PTH levels. In cases of chronic alcohol abuse, blood levels of parathyroid hormone can remain elevated, resulting in a strain on the body's calcium reserves. In alcoholics, continuous elevations in parathyroid hormone can precipitate the condition known as secondary hyperparathyroidism, the effects of which further deplete calcium stores.
Alcohol can inhibit the production of enzymes found in the liver and kidney that convert the inactive form of vitamin D to its active form. This interference in vitamin D metabolism results in an impairment of calcium absorption. Vitamin D deficiency can lead to osteomalacia, a bone condition associated with pain, fractures, and deformity. Alcohol also increases magnesium excretion, an effect that can further negatively impact bone health.
But while the toxic effects of alcohol abuse are well established, moderate alcohol consumption may actually have a modest favorable effect on bone density in post-menopausal women. This effect may be explained by the fact that after menopause, alcohol enhances the conversion of testosterone into estradiol. Moderate alcohol intake may also be beneficial because of its ability to increase calcitonin, a thyroid hormone that inhibits bone resorption. (Note: More than two drinks a day, or 14 grams a day, is considered to be excessive intake and a risk factor for osteoporosis.) On the other hand, there is no evidence to suggest that moderate alcohol intake is beneficial to bone density in pre-menopausal women or in men.
In this section, you will find information on:
Alcohol and fractures
Because of the effects of alcohol on balance and gait, alcoholics tend to fall more frequently than the general population. Heavy alcohol consumption has been associated with an increased risk of fracture, including hip fracture. An analysis of alcohol use in an arm of the Framingham study concluded that heavy alcohol consumption increased hip fracture risk in both men and women. As expected, older alcoholics are at substantially greater risk of fractures than younger alcoholics.
Vertebral fractures, which tend to be uncommon in individuals under 50 years of age, are more prevalent in those younger than 50 who abuse alcohol. Additionally, alcohol consumption is linked to other types of fractures, including those of the wrist and ribs.
Alcohol and hormones
Chronic heavy drinking can result in hormonal deficiencies in both men and women. Alcoholic men tend to produce less testosterone, a hormone known for its positive effect on bone density. Low testosterone levels have been linked to decreased activity of osteoblasts, the cells that stimulate bone formation.
In pre-menopausal women, chronic alcohol exposure can result in irregular menstrual cycles, an occurrence that increases osteoporosis risk. Conversely, in post-menopausal women, alcohol increases the conversion of testosterone into estradiol, a hormone commonly used to prevent bone loss after menopause. For this reason, alcohol consumption may actually have a positive effect on bone density in women after menopause.
Alcoholics have been shown to have high levels of cortisol, a corticosteroid. Excessive levels of cortisol have been linked to decreased bone formation and increased bone resorption. Corticosteroids impair calcium absorption, which leads to an increase in PTH secretion, which can result in further bone loss.
Bone loss is evident in a large number of individuals who drink heavily. Alcohol appears to have a direct toxic effect on osteoblasts, suppressing bone formation. On the other hand, osteoclasts (cells responsible for the resorption or breakdown of bone) may be stimulated by alcohol exposure.
Exercise
Exercise is vital at every age for healthy bones and is an important part of an osteoporosis prevention and treatment program. Not only does exercise improve your bone health but it also increases muscle strength, coordination, and balance and leads to better overall health.
In this section, you will find:
Basics
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Young women and men who exercise regularly generally achieve greater peak bone mass (maximum bone density and strength) than those who do not. We have until about age 30 to reach peak bone mass. After that time, we can begin to lose bone. Women and men older than age 30 can help prevent bone loss with regular exercise.
The best exercise for your bones is weight-bearing exercise. This is exercise that forces you to work against gravity, such as walking, hiking, jogging, stair climbing, tennis, and dancing. Some examples of nonweight-bearing exercises are swimming or bicycling. However, these exercises, as well as many weight-bearing exercises, have excellent cardiovascular benefits.
If you have health problems, such as heart trouble, high blood pressure, diabetes, or obesity, or if you are over age 40, check with your doctor before you begin a regular exercise program. The optimal goal is 30 minutes to an hour at least four times per week.
Listen to your body. When starting an exercise routine, you may have some muscle soreness and discomfort at the beginning, but this should not be painful or last more than 48 hours. If it does, you may be working too hard and need to ease up. Stop exercising if you have any chest pain or discomfort, and see your doctor before your next exercise session.
If you have osteoporosis, it is important that you consult with your doctor to learn which activities are safe for you. If you have low bone mass, experts recommend that you protect the spine by avoiding exercises or activities that flex, bend, or twist the spine. Furthermore, you should avoid high-impact exercise in order to lower the risk of breaking a bone. You also might want to consult with an exercise specialist to learn the proper progression of activity, how to stretch and strengthen muscles safely, and how to correct poor posture habits. An exercise specialist should have a degree in exercise physiology, physical education, physical therapy, or a similar specialty. Be sure to ask if he or she is familiar with the special needs of patients with osteoporosis.
Do's and don'ts
Don'ts for safe movement:
- Don't walk or exercise on slippery surfaces.
- Don't wear "scuffs" or "mules" (backless bedroom slippers) or shoes with slippery soles.
- Don't slouch when standing, walking, or sitting at a desk.
- Don't sit in a deep, cushioned chair or couch that causes you to sink into it. Use upright chairs with arms. Place your feet on a footstool if they don't rest flat on the floor.
- Don't move too quickly.
- Don't engage in sports or activities that require twisting the spine or bending forward from the waist, such as conventional sit-ups, toe touches, or swinging a golf club.
- Don't force yourself to complete a task or exercise if you feel short of breath, are in pain, or are fatigued.
- Don't take to your chair or bed for extended periods of time. Inactivity is one of the worst things for osteoporosis.
Do's for safe movement:
- Always pay attention to proper posture.
- Lift your breastbone.
- Keep your head erect and look forward.
- Keep your shoulders back, lightly "pinch" shoulder blades.
- Tighten your abdominal muscles and buttocks.
- Whenever possible, walk or climb the stairs. When walking on the stairs, always use the handrail.
- Always bend from the hips and knees, not from the waist.
- Almost every activity can be adapted to meet your age, ability, lifestyle, and strength. Therefore, you may wish to speak with your doctor, a physiatrist, or physical therapist about your special concerns regarding safe movement and posture before practicing any of these movements.
Body mechanics and posture
By practicing proper posture and learning the correct way to move (called body mechanics), you can protect your bones while remaining physically active. One of the most important concepts in body mechanics and posture is alignment, which refers to the relationship of the head, shoulders, spine, and hips to one another. Proper alignment puts less stress on the spine and ensures good posture. A slumped, head-forward posture puts harmful stress on the spine, as does bending forward or twisting your spine.
For the person with osteoporosis, general muscle strength and flexibility are especially important. Keeping active helps maintain muscle tone, reflexes, and balance. Follow these guidelines to move safely throughout your day.
Properly align your spine:
- Stand with your back against a wall with your heels 2 inches from the wall.
- Tighten your abdominal muscles and flatten your back against the wall.
- Lift your breastbone, keep your head up and look straight ahead.
- Bring your shoulders back toward the wall. There should be a small hollow at the small of your back.
- Maintaining this position, move away from the wall and check your posture in a full-length mirror from the front and side.
When standing:
Keep your head high, chin in, shoulder blades slightly "pinched." Maintain the natural arch of your lower back as you flatten your stomach. Your feet should point straight ahead with your knees lined up over your second toe. If you are standing in one place for any length of time, put one foot up on a stool or in an open cupboard. Switch feet periodically.
When sitting:
Use a rolled towel or pillow to support your lower back. The support should be thick enough to cushion your lower back and maintain the normal arch. Keep your head, back and hips in alignment, and keep your hips and knees at the same level. If your feet do not rest flat on the floor, use a small footstool. When reading, do not lean over your work, but maintain the natural curve of your back. At a desk, prop up a clipboard so it slants toward you like a drafting table. Use a footstool or foot rest when seated for long periods of time. To stand up from the chair, move your hips forward to the front of the chair and use your leg muscles to lift yourself up.
When walking:
Walk with your chin in, head held high and shoulder blades slightly "pinched." Your feet should point straight ahead, not out to one side. Your knees should be lined up over where your second toe is in your shoe. You may need to turn the knee outward consciously in order to line your foot up properly. Do not let your knees lock back as you bring your weight over your foot, but keep them slightly bent. Keep hips, knees, and toes properly lined up when climbing stairs as well.
When bending and lifting:
To pick up an item, stand with your feet flat and about shoulder width apart from one another. Both arms should touch your ribs or thighs unless you are using one hand for support. Maintaining your lower back curve, squat, kneel, or sit in a chair. Keep one foot flat on the floor to keep equal force at the hip, knee, and ankle. Bring the item close to your body at waist level. Gently breathe in while using your leg and thigh muscles to lift the object and straighten up. When you reach an upright position, exhale. Never lift objects, packages, or babies weighing more than 10 pounds.
When tying your shoes or drying your feet:
Sit in a chair, place your foot on a footstool or box, maintain proper back alignment and lean forward from the hips to tie or dry. When carrying groceries, request that the bags be packed light. Divide heavy items into separate bags and hold bags close to your body. You may also use a cart with wheels to transport bags from the store to home or from the car into the house. When unpacking, place packages on a chair or counter top instead of the floor.
When doing housework:
For the person with osteoporosis, proper body mechanics when doing chores is essential. To protect your back from injury, consider these movements for vacuuming, mopping or sweeping floors, cleaning the bathtub, or gardening. For vacuuming-type activities, maintain proper alignment by imagining your upper arms strapped to your chest from shoulders to elbows so they cannot move. Always face your work directly to keep from twisting your back. Keep your feet apart with one foot in front of the other. Shift your weight from one leg to the other to move the vacuum, broom, mop, or rake back and forth. Lean forward from the hips and bend at the knees instead of the waist. Avoid polishing floors to a high gloss, which makes them slippery. If you wish to scrub a spot on the floor on your hands and knees, that's fine as long as you can move up and down from the floor easily and safely. Putting yourself in an "all fours" position is a way to protect your back when gardening as well. In the bathroom, use a scrub brush or sponge on a long handle so you can scrub in an upright or kneeling position to keep your back straight.
When getting in or out of bed:
Sit on the edge of the bed. Lean toward the head of the bed supporting your body with both hands. As you lower yourself toward the mattress, bring your legs and feet onto the bed. When lying in bed on your side, use pillows between your knees and under your head to keep your spine aligned or roll onto your back keeping your knees bent and moving your head, shoulders, and hips together. To get out of bed, reverse these steps. Keep both arms in front of you. Breathe in and roll onto your side. Use your hands to raise your upper body as you move your legs over the side of the bed in one motion. Sit on the edge of the bed for a moment before standing up.
When reaching:
Use both arms together to avoid twisting your spine. Don't reach for a shelf higher than you can easily reach with both arms. Stand on a safety step stool with high handrails or use a reaching device, but lift only lightweight objects. Reorganize work areas so items that are used regularly are stored at waist or eye level.
When coughing or sneezing:
Develop the habit of supporting your back with one hand whenever you cough or sneeze. Place your hand behind your back or on your knee. This protects the spine and intervertebral disks (the tough cushions of cartilage between the vertebrae that act as shock absorbers) from damage caused by a sudden bend forward.
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