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In the last newsletter, I defined Osteoporosis and discussed assessment, treatment and prevention.  In addition, I initiated the discussion on treatment with Chiropractic care for someone with osteoporosis.  I will take that discussion further in this newsletter to further educate you on how chiropractic can help for certain conditions even when osteoporosis is present.  

Firstly, I would like to discuss the chiropractic treatment, the adjustment.  An adjustment, also referred to as a spinal manipulation, is the term used to describe the treatment provided by a chiropractor.  More specifically, an adjustment can be delivered in many ways, the most common being the HVLA thrust, high velocity low amplitude thrust.  The chiropractor contacts the spine after setting up the patient in a specific position depending on the area of the spine being treated, and delivers a thrust through the joint to move that joint just beyond its passive range of motion.  With this type of treatment, often a “pop”, technically called a cavitation, occurs.  A cavitation is the formation of vapour cavities in a liquid which occur when the liquid is subjected to rapid changes in pressure.  As the cavitation bubbles collapse, there is energy released in the form of heat and sound.  

What we don’t hear or see, is the stimulation to the nervous system which occurs with this HVLA thrust to the joint.   The small nerve around the joint that is treated becomes stimulated causing numerous local reactions, including but not limited to an inhibition of the surrounding musculature and inhibition of pain stimulation.  Although many other things occur, these are the two affects the patient notices.  Other “chiropractic techniques” have other influences on the body, but for now, I will refer to the HVLA treatment when we use the term adjustment.  

Should this form of treatment be provided to someone that has osteoporosis?  Well, in my opinion, that depends on a few more variables.  Some of the questions I will be asking the patient include the following:

  • Has there been any fractures in the spine or other bones of the body as a result of osteoporosis?
  • If there have been fractures, how did they occur? Small motions? Or big traumatic falls?
  • Is the patient currently on a medication for osteoporosis?
  • Is the patient doing resistance exercise?
  • Is the patient eating foods that are high in calcium?
  • Has the patient had a Bone Density test and what are the results?  

When osteoporosis is listed in the patients medical history, the answers to the above questions will determine how this patient is treated.  I address the decision to treat by age and current health status.  Generally speaking, in anyone over the age of 70, treatment is going to be modified regardless of their bone density.  Other techniques that use a lower velocity thrust or assisted device to gently apply motion are used more frequently in this population.  Those in the age category of 60-70 years old, may be able to tolerate a HVLA treatment but that decision will really depend on their current health status and the particular condition they are presenting with.  Anyone that has a bone density in the t-score range of -2.5 and lower that has had a osteoporotic fracture is at a higher risk of further fracture and caution must be taken independent of age.  

When someone presents with pain from an osteoporotic compression fracture there are many options for treatment in a chiropractic office.  A fracture is not treated with a treatment that has the risk of causing another fracture.  Yes, there is a risk of fracture with chiropractic care.  And as I say in my informed consent to chiropractic treatment, “chiropractic treatment to healthy tissue should not cause a fracture, however, if pathology is present, which includes many types of bone disorders, a fracture may occur”.  There are few if any research studies done addressing the efficacy on adjustments to spines with osteoporosis as osteoporosis is generally considered to be a relative or an absolute contraindication to manipulation (1).  There are however, many published case studies and conservative treatment guidelines outlining various methods on treatment options for these cases.

The number one priority when a patient’s current issue is pain coming from a compression fracture due to osteoporosis is the pain.  There are many options to treat pain in addition to over-the-counter medication.  Laser therapy has been shown to be effective at treating musculoskeletal pain (2).  Treating the acute pain with modalities like laser (as in my office), electrical stimulation (including IFC) and heat or ice can dramatically reduce the pain level from the compression fracture.  Zambito et al (3) demonstrated that IFC was effective at alleviating pain and disability from multiple osteoporotic fractures.  Bracing has also been shown to be effective in reducing pain by promoting healing  and stabilizing the spine (4).  Often, the muscles in the area are very tight as a result of altered postures that occur to avoid pain.  

When the diagnosis of osteoporosis is new to the patient, a chiropractor that is well versed in exercise prescription will be able to provide safe exercises to prevent further injury, but also to help increase the bone building effects of exercise.  In addition, nutritional advise can be provided to ensure foods with adequate calcium levels are being consumed.   In the premenopausal female, it is important to recognize the presence of osteopenia or osteoporosis as these cases are often associated with a secondary cause of bone density loss like vitamin or mineral deficiencies, prior eating disorders, presence of gastrointestinal disorders, use of high dose steroids and other medications.  Chiropractors are trained to recognize these issues and make the appropriate referral (5).  If a bone density test has not been done before, a referral back to their family doctor or the appropriate healthcare provider will help further initiate care for these patients.  

Treatment for someone with osteoporosis does need to be modified and monitored closely.  But note that there are many options besides the HVLA adjustment that can be provided by a chiropractor.  Modalities for pain modification like laser therapy, IFC, heat and ice as well as education, nutritional advise and exercise instruction are all treatment options that can be received from a chiropractor.  If you are concerned about your diagnosis of osteoporosis or that of a friend or family member, please contact us at info@mmdchiropractic.ca.  MMD Chiropractic is a chiropractic clinic in Hamilton, ON.  We would be happy to guide you in the proper direction if we can’t help you ourselves.  For further information on osteoporosis in Canada please visit osteoporosis.ca

References:

  1. Gatterman, M. I. (1991). Standards of practice relative to complications of and contraindications to spinal manipulative therapy. The Journal of the Canadian Chiropractic Association, 35(4), 232.
  2. Clijsen, R., Brunner, A., Barbero, M., Clarys, P., & Taeymans, J. (2017). Effects of low-level laser therapy on pain in patients with musculoskeletal disorders: a systematic review and meta-analysis. European Journal of physical and rehabilitation medicine, 53(4), 603-610.
  3. Zambito A, Bianchini D, Gatti D, Rossini M, Adami S, Viapiana O. Interferential and horizontal therapies in chronic low back pain due to multiple vertebral fractures: a randomized, double blind, clinical study. Osteoporos Int. 2007 Nov;18(11):1541–5.
  4. Mazanec DJ, Podichetty VK, Mompoint A, Potnis A. Vertebral compression fractures: manage aggressively to prevent sequelae. Cleve Clin J Med. 2003 Feb;70(2):147–56. 
  5. Halloran, S., Corcoran, K., & Lisi, A. (2020). OSTEOPOROSIS AND OSTEOPENIA IN PREMENOPAUSAL WOMEN: A REVIEW OF RISK FACTORS AND MANAGEMENT CONSIDERATIONS FOR THE CHIROPRACTOR. Journal of Contemporary Chiropractic, 3(1), 64-74.