Osteoporosis

Pathology (Goodman & Snyder, 2007; Dutton, 2008; ABH Website):
Osteoporosis (“porous bone”) is a systemic skeletal disorder of the bone that is characterized by decreased bone density.  Osteoporosis is the most prevalent bone disease in the world.  Osteoporosis often involves fractures of the hip, proximal femur, proximal humerus, distal radius, tibia, pelvis, and vertebrae. 

There are three different types of osteoporosis:
        - Type I and Type II osteoporosis are considered primary osteoporosis 
        - Type III osteoporosis is a form of the disorder which occurs secondary to the use of glucocorticoids or  
           other medications. 
                 * Secondary osteoporosis can accompany endocrine and metabolic disorders such as:
                             - Hyperthyroidism
                             - Hyperparathyroidism
                             - Cushing’s disease
                             - Diabetes mellitus
                * Secondary osteoporosis may also be associated with other disorders such as:
                             - Chronic renal failure
                             - Rheumatoid arthritis
                             - Chronic respiratory disease
                             - Malignancies
                             - Alcoholism 

Demographics:  Although osteoporosis can affect men and women alike, it is more prevalent among the female population.  It is estimated that more than fifty percent of the women ages 50 or older in the United States are likely to have a detectable abnormality of bone mineral density in the spine.  Of these women, more than one third of them will develop orthopedic problems associated with osteoporosis.  Most of the fractures sustained by these women are due to the fact they have decreased bone mineral density and/or osteoporosis (Goodman & Snyder, 2007). 

Incidence/epidemiology (Dutton, 2008; ABH Website):  Osteoporosis results from a combination of risk factors, some related to genetics and others related to the environment including:
         - Gender
                * Females are more likely to be diagnosed with osteoporosis due to the decrease in estrogen
                   production associated with menopause.  Also, a positive family history of osteoporosis can increase
                   an individual’s risk. 
          - Lifestyle
          - Ethnicity
                * Certain ethnicities are more likely to be diagnosed with this disorder such as Caucasian, Asian, or
                   Hispanic ethnicities.
          - Diet
          - Medications
          - Physical activity    

The modifiable risk factors associated with increasing the risk of osteoporosis include:
          - Iatrogenic menopause
          - Pregnancy at an early age
          - Smoking
          - Sedentary lifestyle
          - Alcoholism
          - Low body fat
          - Low calcium intake
          - High caffeine intake
          - Prolonged bed rest
          - Anorexia

Clinical Presentation:  In any physical therapy setting, the therapist is likely to encounter patients that seek services related to a fracture.  Due to the fact that osteoporosis is often silent, therapists may treat patients with undiagnosed low bone mineral density.  It is imperative that the physical therapist can recognize the potential risk factors for this patient population so that treatment techniques can be modified so that the program does not increase the patient’s risk for fracture.   

Differential Diagnosis:  The diagnosis of osteoporosis often goes undetected until there is the presence of an osteoporotic fracture on a radiograph; therefore, producing no visible signs and symptoms.  Due to this fact, the fracture may go undetected if the individual does not seek medical treatment and resumes regular daily activities.  However, there may be signs and symptoms that could be indicative of a fracture that may warrant x-rays to be taken.  Some of these signs and symptoms include:
          - Episodic, acute back pain
                 * Especially in the low thoracic and high lumbar regions
          - Vertebral compression fracture – please refer to thoracic vertebral compression fracture section from the
             home page for more information
          - Decrease in height
          - Kyphosis of the spine  
          - Dowager’s hump
          - Early satiety
          - Decreased ability to tolerate activity (Goodman & Snyder, 2007)

The patient would need to be referred to a physician for further diagnostic testing and/or imaging. 

Clinical Bottom Line:  If a patient presents with signs of a fracture, a referral to a physician is warranted.  However, if a fracture has been ruled out, these patients are a great candidate for physical therapy. 

References:
Please refer to the "Osteoporosis" section of the reference list.