Osteoporosis, also known as the silent bone thief, will affect 1 in 3 women and 1 in 5 men at some point in their life.   As we age, bone density diminishes as a result of multiple factors.  As a result of diminished bone density, the risk of fracture increases.  Fractures can be life altering to many.  When there is an osteoporotic hip fracture, more hospital bed days are consumed than stroke, diabetes or heart attack combined. 

Chiropractic care involves the assessment and treatment of joints of the spine and extremities to improve mobility.  There are many different adjustment techniques that can achieve this.  However, in addition to joint treatment, chiropractors may also provide education on various conditions, recommendations for exercise, nutrition and lifestyle modifications.  Is there a place for chiropractic care to make an impact on patients with osteoporosis?   

In this two part series, I will first discuss what Osteoporosis is and the conventional treatments for preventing and treating low bone density.  In the second part, I will dive a little deeper into chiropractic care for those with Osteoporosis and the cautions that must be considered.  

What is Osteoporosis?  

Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue which can lead to increased risk of fracture.  On Bone Mineral Density (BMD)testing, a T score of -2.5 or lower (-3.0, -3.5, …) indicates Osteoporosis.  Osteopenia is another term you may see which indicates that bone mineral density is diminishing, but is not at the same fracture risk as Osteoporosis.  On BMD testing, Osteopenia has a T score of -2.0 to -2.49.  At any given time, there is a balance between building and removing bone tissue.  We rely on our bone for calcium, phosphorus and other minerals and nutrients.  

On closer look at the bone tissue, the two main bone cells are termed osteoblast cells and osteoclast cells.  Osteoblast cells, BUILD bone.  Osteoclast cells, REMOVE bone.   The osteoclast cells will help in the process of removing these nutrients from our bones and providing other tissues with adequate supplies.  Osteoblast cells take nutrients from our blood to lay down and build more bone.  As we grow during our adolescent years, the osteoblastic activity is significantly higher.  When osteoporosis is present, the osteoclastic activity increases beyond that of the osteoblastic activity resulting in diminished bone mass.  

Because osteoporosis takes years to progress the first symptoms of osteoporosis generally start with a fracture which would not normally occur.  Sometimes these may result with a simple sneeze, cough, a reach forward or overhead.  A fracture without an associated mode of onset often feels like a deep ache very specific to one bone.  Another sign of osteoporosis is the loss of height.  A loss of height of 2 cm is a warning sign that spinal fracture could be present.  A loss of 6cm or more is a warning sign that a spinal fracture is present.  As one reaches the age of 50, height should be monitored and x-rays taken if height decreases more than 2cm.  

Current treatments for osteoporosis and osteopenia include lifestyle modifications like exercise and fall prevention education, dietary modifications and medications.   

Lifestyle modifications can make a very large impact on preventing and treating bone density loss.  Understanding the importance of adequate bone density is the start.  Making changes to our surroundings can help us prevent falls.  Home modifications like removing area rugs and decluttering our living spaces may prevent a fall.  In addition, adding handles in bathrooms and near showers will assist those that need some extra support transitioning from seated to standing positions.  Please refer to the Osteoporosis Society of Canada for more educational materials for you and your family.  

Exercise, in particular, weight-bearing exercises, helps bone density by increasing resistance or pull on the bone.  This is very important as bone is stimulated to BUILD when there is increased force on a bone (Wolff’s law).  We can see the effects of this law even in non-osteoporotic examples where a fracture is casted.  The muscle-wasting and diminished bone density after the removal of the cast is quite evident.  Examples of weight-bearing exercises include walking, running, stop and start activities like volleyball, basketball and pickleball.  Using resistance exercises with either body weight or the added weight of dumbbells, kettlebells or bands increases the pull of muscles on bones, adding to the stress on bones and thus contributing to bone building.  

Dietary modifications focus on increasing the amount of various nutrients like calcium and Vitamin D (as Vitamin D helps in the absorption of calcium) that we take in through food.  

Dietary sources of calcium are plentiful and are the preferred source of increasing calcium stores.  Dairy products like milk, cheese and yogurt are among the best sources of calcium.  Canned salmon or sardines with the bones provide not only calcium but are excellent sources of Vit D and protein.  Click here for nutritional recommendations and more sources of foods containing calcium, vitamin D and protein to help with bone density.  

Many doctors will try to have their patients make dietary changes first to see if they can either improve or maintain their current bone density.  However, for some, in particular those that have had multiple fractures, medication may be necessary.  The medications are grouped according to their actions.  The 2 most common bone density medications are listed below.  

Bisphosphonates like Actenol, Fosamax and Aclasta, work on stopping or slowing down the activity of osteoclastic cells, thus stopping the REMOVALof calcium and other minerals from the bone.  

Denosumab drugs like Prolia, act on another aspect of preventing bone loss by stopping the production of osteoclast cells.   

These are just 2 of the multiple categories of medications to treat decreased bone density.  To learn more about other bone density medications please visit this link which shows the drugs available in Canada by province. 

This ends our discussion on Osteoporosis.  In our next post, I will discuss Chiropractic care and the cautions a chiropractor must take when a patient presents with Osteopenia or Osteoporosis.  Be aware that there are many options with chiropractic care.  

If you or someone you know is experiencing bone pain that you may think is an osteoporotic fracture, please see a healthcare professional.  

The links used in this post take you to the Osteoporosis Canada website.  If you need further information, please use this as a resource.