Chiropractic; If you get back pain from gardening, it is likely that you already have an underlying problem that needs attention.
Osteoporosis and Chiropractic Treatment
Osteoporosis is something that can cause pain, heartache and severely limit your daily activities, especially if it becomes severe. The good news is that you can prevent it from becoming severe.
On this page we are explaining what osteoporosis is, the causes, treatments, risk factors and how you can prevent it from becoming a problem. One good thing is that you can still receive chiropractic treatment despite having osteoporosis.
We might have to modify the treatment but there is always a chiropractic treatment method that will suit you.
What is Osteoporosis?
Osteoporosis (porous bone) is a condition where the bones become weak and thin. It is characterised by low bone mass and structural deterioration of bone tissue, causing bone fragility and an increased likelihood of fracture.
Normal bone structure has the appearance of honeycomb – a thick outer shell and a strong inner mesh. The holes between the bony mesh become larger in osteoporosis meaning the bone structure is weakened and susceptible to breaking with the slightest knock or fall.
How common is Osteoporosis?
In the UK, one in two women over the age of 50 will break a bone, predominantly due to osteoporosis.One in five men over 50 are also affected. It affects an estimated 75 million people in Europe, USA and Japan. In 2000, there was an estimated 9 million new osteoporosis fractures, 1.6 million being in the hip, 1.7 million in the forearm and 1.4 million in the vertebrae.
Europe and the US accounted for 51% of these fractures. 30 – 50 % of women and 15 – 30 % of men will suffer a fracture related to osteoporosis in their lifetime. If there is a 10% loss of bone mass in the vertebrae, it will double the risk of vertebral fracture and a 10% loss of bone mass in the hip can result in a 2.5 times greater risk of hip fracture.
In females, the lifetime risk of hip fracture is 1 in 6, compared with a 1 in 9 risk of a diagnosis of breast cancer. In males, the estimated lifetime risk of experiencing an osteoporosis fracture over 50 years is 30%, similar to the lifetime risk of developing prostate cancer.
Unfortunately, if you have had a prior fracture due to osteoporosis, there is an 86% increased risk of another fracture. Also the great majority of individuals at high risk (80%) who have already had at least one osteoporosis fracture are neither identified nor treated. That is why osteoporosis screening is important.
Signs and Symptoms of Osteoporosis
Unfortunately, you cannot feel your bones getting weaker. Often, osteoporosis is diagnosed in patients when x-rays are taken in our chiropractic clinics. Most people are unaware that they have osteoporosis until they fracture a bone. Osteoporosis sufferers can fracture a bone from a minor fall, or in serious cases, from a simple action such as a sneeze or even just spontaneously.
Vertebral fractures may initially present as back pain, loss of height or spinal deformity e.g. kyphosis, Dowager’s hump or stooped posture. In many cases, a vertebral fracture can occur without causing pain and is found on x-rays as an incidental finding without the patient being aware of previous fractures.
Women can lose up to 20% of their bone mass in the first 5 – 7 years after menopause, making them more likely to develop osteoporosis.
Risk factors for osteoporosis
Certain people are more likely to develop osteoporosis than others. The risks for developing osteoporosis include:
- Being female
- Older age
- Family history of osteoporosis. Osteoporosis has been shown in studies to have a large genetic component.
- Being small and thin. Studies have provided evidence that weight in infancy is a determinant of bone mass in adulthood.
- Certain race/ethnicities such as being Caucasian, Asian or Hispanic/Latino, although African Americans are also at risk.
- History of broken bones
- Low sex hormones: 1. Low oestrogen in women: including menopause, surgical removal of ovaries, or pituitary problems. 2. Missing periods (amenorrhea). Some young females, particularly those training for elite athletic competitions, with extreme levels of exercise, eating too little may experience amenorrhea due to reduced oestrogen levels, which puts them at risk. People suffering from Anorexia Nervosa may also experience amenorrhea and put them at a greater risk of developing osteoporosis. This is because once the body fat levels go below a certain point oestrogen production stops. 3. Low levels of testosterone and oestrogen in men
- Diet: 1. Low calcium intake 2. Low vitamin D intake 3. Excessive intake of protein, sodium (salt), alcohol and caffeine (tea and coffee)
- Inactive lifestyle. Physical inactivity and a sedentary lifestyle as well as impaired neurological and muscular function (e.g. decreased muscle strength, impaired gait and balance) are risk factors for developing fractures.
- Smoking can lead to lower bone density and high risk of fracture and this increases with age.
- Alcohol abuse, over 4 units a day can double the risk of hip fracture.
- Certain medications and conditions such as cortico-steroid medications (for asthma and chronic inflammation), some anticonvulsants (medication for epilepsy) and others. Prolonged use of corticosteroids is the most common cause of secondary osteoporosis. It has been estimated that 30 – 50 % of patients on long-term corticosteroid therapy will experience a fracture with an increased risk of hip fracture by 2 fold in females and 2.6 in males.
- Certain diseases and conditions such as anorexia nervosa, rheumatoid arthritis and gastrointestinal diseases causing malabsorption (Chron’s, Celiac, Gluten intolerance).
Fractures and Osteoporosis
This is one of the most serious complications of osteoporosis. A hip fracture unfortunately often results in increased dependency or even death. It is common to get pneumonia or deep vein thrombosis (DVT) as a complication.
Nearly 75% of all hip fractures occur in females over 50. They have a 2.8% risk of death related to hip fracture after the age of 50, which is equivalent to the risk of death from breast cancer and 4 times higher than from endometrial cancer.
Hip fractures cause the most morbidity with reported mortality rates up to 20 – 24 % in the first year after hip fracture and greater risk of dying may persist for at least 5 years afterwards. Loss of function and independence among is common with 40% of them being unable to walk independently and 60% requiring assistance even a year later. Due to this, a third of people are totally dependant or in a nursing home in the year following a hip fracture.
A 50-year old female has a 16% lifetime risk of having a vertebral fracture compared to 5% in a male. A 65-year old female with 1 previous vertebral fracture has a 1 in 4 risk of another fracture over 5 years, however this can be decreased to a 1 in 8 risk by treatment.
Vertebral fractures can cause back pain; loss of height; deformity; immobility, increased number of days in bed and even reduced lung function. The impact on quality of life can be huge as a result of loss of self-esteem, distorted body image and depression. Also there can be a significant affect on normal daily living activities.
Vertebral fractures are associated with an increased risk of both further vertebral and non-vertebral fractures. It is estimated that only a third of vertebral fractures come to clinical attention and non-diagnosis of vertebral fractures is a worldwide problem.
Vertebral compression fractures is one of the most common pathologies we see in the Isis Chiropractic Centres.
Diagnosis of Osteoporosis
Specialised tests called bone mineral density scans (BMD) can measure density in various sites of the body, most commonly the heel. Experts recommend using a central DEXA scan (dual energy x-ray absorptiometry), combined with laser technology. This test is painless, safe and requires no preparation from you. The test will tell if you have low bone density and are at risk of having a fracture in the future. It compares your bone density with that of a healthy young adult. The result is given as a T-score.
Some bone density tests measure the strength of the hip, spine and/or wrist, the areas commonly fractured in osteoporotic patients. Although no test is 100% accurate, it is the single most important diagnostic test to predict whether a patient will have a fracture in the future. Screenetics offer monthly osteoporosis screenings at all the Isis Chiropractic Centres.
Treatment of osteoporosis
Although there is no cure for osteoporosis, it can be treated in a variety of ways. There is a range of drug treatments available for post-menopausal osteoporosis. Studies have shown that depending on the drug and patient population, treatment decreases the risk of vertebral fracture by between 30 – 65 % and of non-vertebral fracture by 16 – 53 %.
Treatment of established osteoporosis is cost effective irrespective of age. Identifying and treating patients at risk of fracture but who have not yet had a fracture, will substantially reduce the long term burden of osteoporosis, reduce the risk of first fracture from 8% to 2% which can reduce the 5 year fracture incidence from approximately 34% to 10%.
Sunlight exposure can increase the BMD in vitamin D deficient bone and aid prevention of non-vertebral fractures.
A balanced diet rich in calcium, adequate vitamin D, regular weight-bearing exercise programme and fall prevention are important in maintaining strong and healthy bone.
Medication for Osteoporosis
There are two types of cells in our bones, bone dissolving cells, osteoclasts (break down old bone) and construction cells, osteoblasts (build new bone). Some drugs work by slowing down the activity of the bone dissolving cells whilst others stimulate the construction cells. The aim of medication is to strengthen bones to prevent them from fracturing. Types of medication that are used include:
- Bisphosphonates – these slow bone loss, reduce fracture risk and in some cases, increase bone density. They decrease the activity of the bone dissolving cells. Complications may include osteolysis of the jaw and, according to our local dentist, makes dental implants impossible.
- Alendronate (Fosamax & Fosovance, which has added vitamin D) come in tablet or liquid form and can be taken daily or weekly by both men and women.
- Risedronate (Actonel) come in tablet form and can be taken daily, weekly or twice monthly by both sexes.
- Ibandronate (Bonviva) is available in a 3 monthly injections for women. Side effects may include nausea, heartburn and stomach pain if not taken properly.
- Selective oestrogen receptor modulator (SERM) – SERMs mimic the female hormone oestrogen, giving protection to bones while also blocking the oestrogen’s effect on other organs, such as the womb and breasts.
- Raloxifene (Evista) comes in a daily tablet and is currently the only SERM licensed to treat osteoporosis and is generally given if bisphosphonates are not suitable.
- Calcium and vitamin D – these daily tablets (e.g. Calcichew, Cacit, Sandocal) are most often prescribed to older people to help prevent fractures. They may also be used as dietary supplements for those taking other medication. Less commonly used medication includes:
- Calcitonin – is available as a nasal spray or injection. The injection is useful as a short-term treatment after spinal fracture. It has a pain relieving effect in some people and it can help with acute pain whilst giving bone protection. It is usually only prescribed by specialists.
- Calcitriol (Rocatrol) – is taken daily in tablet form. It is effective in reducing fractures in women but needs to be monitored regularly.
- Hormone replacement therapy (HRT) – replaces oestrogen (and sometimes progesterone) in women and testosterone in men. HRT is not being used as much for osteoporosis treatment after menopause as there are more effective treatments.
Prevention of Osteoporosis
Maintaining a healthy diet and active lifestyle will help prevent osteoporosis. Regular weight-bearing exercise is the best way and it is never too late to start. If you have already been diagnosed with osteoporosis, you will need to be careful of vigorous, high impact exercise. Here at the Isis Chiropractic Centres we have the facilities to help develop a suitable exercise programme for you. We recognise the need to keep exercise fun otherwise you will not continue.
Did you know that lifting weights is the most effective way to help you maintain and build your bone density, jumping on a trampoline is also a great way to help you.
Now, you might not like the idea of ‘pumping iron’ or trampolineing, so we have alternative exercise routines we can suggest. Dancing, walking, Tai Chi, gardening and golf are good forms of exercise for all ages. Leading an active lifestyle, whatever you decide to do, will ensure that you stay healthier in your old age.
All the Isis Chiropractors are able to advise each patient on exercises, which will help improve core stability musculature and maintain bone density. We have rehabilitation suites at the Northampton and Milton Keynes Clinics and your chiropractor will be able to refer you to the suite where an individual programme will be structured specific to your needs.
Calcium and vitamin D are important for bone health. A varied diet including milk, hard cheese, certain vegetables and fruits, oily fish and meat will help to ensure you are eating the correct amount. It is not necessary to eat dairy or meat products to get enough calcium in your diet. Supplements can help to boost your intake of the necessary nutrients to. It is important to reduce intake of salt, fizzy drinks, too much caffeine and alcohol.
Available at all Isis Chiropractic Clinics are Mega Greens plus MSM supplements and Synoflex. Mega Greens plus MSM is designed and formulated by medical doctors and is a special combination of 34 highly nutritious grasses, vegetables, sprouted grains, herbs and MSM formulated to provide the body with nutrients and sustain energy, while providing the body with alkaline-forming ingredients to help balance the body’s pH levels. MSM (methylsulfonylmethane) is an organic sulphur derived from plants. It is also a naturally occurring essential nutrient found in healthy tissues and joints. MSM is known for its anti-inflammatory benefits because it helps reduce the rigidity of cells in soft tissues of the body.
We should all eat 5 servings of fruit and vegetables a day. Mega Greens plus MSM compares to 5 – 7 servings per day.
The body continuously regenerates new cells. Skin cells are regenerated on 30- day cycles, while bone cells are regenerated on 120-day cycles. If our cells do not receive proper nutrition, then they will fall into a state of degeneration. Proper nutrition means you provide your body with the necessary vitamins, minerals, amino acids and proteins. Mega Greens plus MSM are gluten free and suitable for all ages.
Synoflex supplements help relieve painful symptoms of joint inflammation and degeneration. Using Synoflex can significantly reduce use of NSAID’s (anti-inflammatory tablets) for people with osteoarthritis and joint problems, and is less likely to cause any stomach irritation. Synoflex contains glucosamine HCL, chondroitin sulphate and N-acetyl glucosamine and zinc sulphate.
Smoking and being overweight will also have an effect on bone density so quitting smoking and losing weight will decrease your chances of bone fracture due to osteoporosis.
Isis clinics now offer monthly Screenetics health screenings to assess for any potential problems, such as osteoporosis and high cholesterol. Smoking cessation is also available at all Isis Chiropractic Clinics.
Chiropractors do not treat osteoporosis but we are able to reduce some of the symptoms, particularly relating to spinal compression fractures and we offer important advice to help prevent further fractures and loss of bone density. We often identify compression fractures and osteoporosis on x-rays and we are able to advise patients to have further tests to establish the severity of the problem. With the help of Screenetics we are now able to offer a convenient and quick way to diagnose osteoporosis in all Isis Chiropractic Clinics.
We can all be affected by osteoporosis but it pretty difficult to know if you are affected until you have a test.
We know that the higher your bone density is at the age of 30 the better it tend to be in later years, so it is important to tell our children to eat well, exercise and look after themselves.
We also know that if we do weight bearing exercise, eat well and have a good lifestyle in our later years we are less likely to suffer osteoporosis, so we need to tell our parents about it.
Remember, it is never too late to improve your bone density, so don’t delay telling the people you love and care for what they should do.
Please let us know how we can help you get started.