People with osteoporosis don’t experience symptoms until they have a fracture and they may not know they have the disease until they break a bone or they have a bone density test.
Dual energy X-ray absorptiometry (DXA) is the technique most commonly used for measuring bone mineral density. Two X-ray beams with different energy levels are use to estimate the patient’s bone density. The radiation exposure is extremely low.
DXA testing is recommended for:
- Women over age 65
- Postmenopausal women under age 65 with additional risk factors for osteoporosis
- Patients with fragility fractures (fractures occurring without much trauma)
- Patients with diseases associated with osteoporosis or on medications associated with osteoporosis
- Men over age 70
- Patients on osteoporosis treatment (to monitor response)
In addition to DXA, patients typically undergo a laboratory evaluation (blood and urine) to check for problems that may cause bone loss. About one-third of postmenopausal women with osteoporosis have an underlying problem contributing to bone loss, such as vitamin D deficiency or an intestinal disorder that affects the absorption of nutrients.
Vertebral fracture assessment (VFA) is done for selected patients along with the DXA test. This consists of evaluating DXA images of the spine to identify compression fractures of the vertebrae. When combined with the bone mineral density test, VFA helps determine the person's risk of future fracture.
Treatment for osteoporosis is designed to prevent further bone loss and/or increase bone density and decrease fracture risk. Treatment is based on the unique needs of each patient and may include:
- Calcium and vitamin D supplements
- Prescription medications to prevent bone loss or to increase bone density
- Physical therapy to strengthen back muscles and help prevent falls
- Weight-bearing exercise
- Lifestyle changes such as quitting smoking decreasing alcohol use
Occasionally, when patients have persistent pain after a vertebral compression fracture, vertebroplasty or kyphoplasty may be done. These are both minimally invasive procedures. In vertebroplasty, a physician uses image guidance to inject a special “cement’ mixture through a needle into the fractured vertebrae. In kyphoplasty, a balloon is first inserted through the needle into the fractured vertebrae in an attempt to restore the height of the bone. The balloon is then removed and cement is injected into the space created by the balloon.
Rehabilitation and Physical Therapy
Treatment and management of osteoporosis may include physical therapy at one of our rehabilitation locations. Therapy incorporates education and training in the following areas:
- Appropriate and safe weight-bearing activities to help promote bone formation or slow bone loss.
- Appropriate and safe exercises for:
- Posture — To maintain proper posture or prevent unwanted posture changes associated with osteoporosis.
- Flexibility — To maintain or improve flexibility and prevent muscle imbalances that may lead to stiffness and posture changes.
- Muscle strengthening — To help promote bone formation or slow bone loss.
- Correct body mechanics for activities of daily living to protect the spine and other vulnerable areas of the skeleton that are at risk for fracture.
- Fall prevention and safety to minimize the risk for a fracture. This may also involve balance training and training in use of a cane or walker to minimize the risk of a fall.
The most common areas of the skeleton for an osteoporotic fracture to occur are in the vertebral bodies of the mid- to lower-spine area, hip area and wrist. If an individual has sustained an osteoporotic fracture, the physical therapist can help with pain management, teach appropriate exercises and assist with return to functional independence.