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John Seivert: Managing osteoporosis for the young and old

John Seivert
Columnist

I remember my early years of studying osteoporosis as a PT student back in Flagstaff, Arizona. My thoughts and beliefs around this “old person’s weak bones” resulted from a sedentary lifestyle past fifty. I soon found out those beliefs were only half true, and the research has shown that it is more about what we eat when we are pre-teen and teens that will determine our bone health at fifty and older.

Prevalence of Osteoporosis

Osteoporosis is a severe age-related metabolic disorder that causes demineralization of bone and reduction in bone mass. Over 200 million people worldwide have osteoporosis. Ten million Americans have osteoporosis as of a 2014 study, and it is predicted to reach a 50% prevalence rate by 2025. Osteoporosis often results in fractures of the hip, spine, and wrist and is a leading cause of fractures in older women resulting in pain, disability, and costly rehabilitation.

The Teen Years

Currently, there is no cure for osteoporosis, but measures can prevent or deter the development of osteoporosis. Increasing peak bone mass in young females through increased calcium intake and increased weight-bearing exercises may prevent osteoporosis later in life. There is mounting evidence that a healthy diet with lots of exercises early in life will significantly affect our bone health in our twilight years. There is a fine line in teen girls exercising the right amount. Once a young woman becomes amenorrhea, her risk of creating weaker bones can occur. This is a common theme with teen girls on track and cross country teams. Breaking up the running with other weight-bearing sports such as weight training can load the spine and extremity joints but not challenge the body’s metabolic systems like running.



Signs that you may be at risk for osteoporosis

• Walking upstairs and getting out of chairs has become more difficult. One of the many clinical tests PTs do is a 30-second chair stand test. This is an excellent way for seniors to assess their lower extremity strength.

• Sit in the middle of the chair that has a seat 17” high



• Cross arms over your chest

• Feet flat on the floor

• Keep your back straight and keep arms against your chest

• “GO” rise to a full standing position, then sit back down again

• Repeat for 30 seconds.

• You are taking medications that can cause bone demineralization. High levels of thyroid hormone can interfere with the formation of new bone mass. Your physician will manage the correct thyroid hormone dose to satisfy the body’s metabolism needs. Other medications that can cause trouble with bone health are steroids like hydrocortisone and prednisone.

• Loss in height of more than 1 ½ inches. I hear about this all the time in my practice. Patients routinely complain that they have lost an inch or two. If the loss in height is associated with low back and mid back pain, it could result from the vertebral bodies changing shape and the person getting a bit smaller with the compression on the spine. Vertebral body compression fractures are usually associated with significant pain, and then an x-ray ordered by their physician could diagnose the spinal dysfunction. I have had many patients with a loss of height of 2-3 inches. This is associated with a compression fracture in the lower thoracic spine or the upper lumbar spine levels. The spine may even become a bit more curved in the upper back.

• Hearing Loss. A recent article in the AARP bulletin stated that one study of nearly 144,000 women found that osteoporosis and low bone density were independently associated with up to 30% higher risk of developing moderate or severe hearing loss. This makes sense because there are three bones in the ear responsible for hearing, and if the body is undergoing bone demineralization, a loss in hearing can occur.

• Vigorous exercise for the elderly is essential. Here I go again, promoting vigorous exercise for yet another way to manage a problem in our bodies. Extremely high volumes of training may overwhelm a person’s adaptive capacity, leading to stress fractures. Stress fractures can happen in young adolescents or the elderly if volumes are not controlled. We all have seen the aging woman running along the trail. She looks a bit emaciated from her thousands of miles of running over her 40-year running career, but she is missing a key element to staying healthy with running. As a result, she has dealt with umpteen stress fractures in her feet, shins, and hip joints but she keeps going. This “Eveready Battery” needs a change in exercise. The body needs to be loaded and then unloaded for recovery. Weight training is one of the best ways to load the spine, and extremity joints heavily and then rest for a day or two and back at it.

Most importantly, have fun exercising. I would never tell a patient to do something they don’t want or like to do. Your choice of exercise should be something you love to do. As a matter of fact, I think it’s time for a mountain bike ride. It is “Hero Dirt” out there. See ya.

John Seivert is a doctor of physical therapy and he has been practicing for 34 years. He opened Body Logic Physical Therapy in Grass Valley in 2001. He has been educating physical therapists since 1986. Contact him at bodylogic2011@ yahoo.com

One of the many clinical tests PTs do is a 30-second chair stand test. This is an excellent way for seniors to assess their lower extremity strength. You should fall within the numbers on this chart. If you cannot reach these numbers, you need to improve your lower extremity strength to prevent a fall.
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