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According to the National Osteoporosis Foundation,¹ osteoporosis affects 44 million Americans. It also leads to more than 300,000 fractures in people over the age of 65. It is expected that by the year 2025, osteoporosis-related fractures will cost more than $25 billion. Fractures can lead to temporary or permanent disabilities, institutionalization and even death.

As physical therapists, it is our responsibility to educate patients, particularly the elderly, on this disease. Although there is no cure for osteoporosis, critical steps must be taken by those inflicted by the disease in order to prevent rapid progression of the disease and also to prevent fractures. A diet rich in Vitamin D and calcium, use of medications, and a prescribed exercise program consisting of weight bearing and strengthening exercises, will help someone with osteoporosis remain safe and healthy.

Recently, therapists from Genesis Rehab Services provided osteoporosis clinics at several retirement communities in Montgomery County, PA. The primary focus at the clinics was educating attendees on the disease process, as well as ways to improve posture and preventing fractures. The clinics offered several stations, as described below, manned by PTs/PTAs/OTs to allow for individualized discussions between residents and therapists.

The Osteoporosis Risk Assessment questionnaire was given to each attendee and their results were reviewed with a therapist.¹ This questionnaire asks about certain risk factors, such as gender, occurrence of menopause, use of thyroid medication or glucocorticoids, physical activity level, and use of alcohol/cigarettes. The therapists discussed the importance of having a bone scan, particularly for those at high risk, as this is the standard measure for diagnosing osteoporosis.

Posture assessments were offered at one station. Using either digital photography and/or the Reedco posture scale², therapists discussed the results with residents. They also discussed the consequences of having poor posture, such as pain, range of motion limitations, gait abnormalities and effects on organ systems. Information on improving posture was also provided, using the APTA's brochure, "The Secret of Good Posture: A Physical Therapist's perspective."  

Other stations offered fall screens and endurance tests. Using the Functional Reach Test, Timed Up and Go, and/or Single Leg Stance, the therapists discussed normative values compared to the resident's results. Handouts were provided on fall prevention. It was emphasized to each resident that the higher fall risk, the higher fracture risk if they had osteoporosis. General fall prevention tips, such as addressing environmental hazards, using adequate foot wear, and exercising, were discussed with each resident. Back and arm endurance were assessed used the timed loaded stance test.³

Nutritionists from the community attended the clinic and provided samples of calcium supplements. Education on the importance of the role of nutrition, particularly foods high in calcium and Vitamin D, and medication in the management of osteoporosis was also provided.

A representative from MediUSA⁴ attended the seminar to demonstrate the latest brace used in managing osteoporosis, the Spinomed. The Spinomed brace is considered an active brace, as it has shown to improve posture, increase abdominal and back extensor strength, and decrease low back pain.⁵ These improvements have been shown by use of the brace for just two hours a day. Compared to traditional "hard shell" braces, the Spinomed is easily donned and provides comfort.

In summary, osteoporosis is a disease that affects millions of Americans. An osteoporosis clinic, similar to that mentioned above, can be easily replicated at health care centers to provide the necessary education the public needs on this disease. Without education, the number of incidences of osteoporosis and osteoporosis fractures will continue to be on the rise.

References

1. National Osteoporosis Foundation (www.nof.org)

2. Manufacturer's Report. Auburn NY: REEDCO; 1974.

3. Shipp, K., et al. (2000). Timed loaded standing: A measure of combined trunk and arm endurance for people with vertebral osteoporosis. Osteoporos Int. 11, 914-922.

4. MediUSA (www.mediusa.com)

5. Pfeifer, M., Begerow, B., & Minne, H. (2004). Effects of a new spinal orthosis on posture, trunk strength, and quality of life in women with postmenopausal osteoporosis: A randomized trial. Am J Phys Med Rehabil. 83(3), 177-186.

Jaime Karas Bayzick is a master clinician in management of osteoporosis for Genesis Rehab, Fort Washington Estates/Gwynedd Estates, PA.