Osteoporosis

The osteoporosis is a bone disorder characterized by loss of bone mass, bone architecture is altered, it becomes weaker and thus predisposes to fracture more likely.

In principle, osteoporotic bone is a healthy bone, it has all the components but to a lesser extent. The amount of bone mass varies throughout life, thus in the first decades the maximum bone mass is reached, at 30-35 years it begins to lose slightly and when we reach the third age there is much less.

Causes of osteoporosis

A secondary cause of osteoporosis is menopause , after which the annual loss is 1%. There is a type of osteoporosis that appears with age, also called physiological and another that is due to other factors such as hormonal imbalances, lack of physical activity, weightlessness (as occurs when a person has to rest in bed for a period of time or when we wear a cast), genetic background, thin people, belonging to the white race, nutritional factors, specific habits such as coffee, tea or cola drinks, excess protein, alcohol abuse, smoking, drugs such as corticosteroids or heparin in long-term treatments or endocrine diseases such as diabetes .

Osteoporosis can occur throughout the skeleton or only in a specific area, the latter being the case with local immobilizations with plaster. The symptoms of osteoporosis are mainly three: pain, fractures and deformities. In many cases, the pain does not appear until the fracture does, which can be spontaneous or caused by a sudden movement. All bones in the body can have osteoporosis, but it is more common in the spine, hip and wrist.

Symptoms and prevention of osteoporosis

• Pain.
• Fractures: due to extreme weakness of the bone. In some cases they are spontaneous and other times they are caused by extreme movements.
• Deformities in the lower limbs and spine fundamentally.

This aspect is important in the sense that in order to preserve as much mass as possible when reaching advanced ages, the organism must be covered for certain needs, mainly in the time of adolescence, although not only in adolescence. The purpose of this measure is that you can maintain your reserves of calcium, one of the main components of bone. These needs are mainly the contribution of calcium, through the intake of the corresponding foods, and the practice of regular physical exercise.

How is it treated?

The two main therapeutic weapons that we have against osteoporosis are physical exercise and calcium intake. Whenever you exercise, your heart rate must be controlled to avoid any cardiovascular problems. The number of beats that we must not exceed is calculated by subtracting the age from 220 and multiplying the result by 0.70. It has been shown that exercising three times a week for one hour can increase 4% of vertebral bone mass in nine months.

It is essential to eradicate the aforementioned risk factors: coffee, tobacco, long-term corticosteroids …

To make up for the lack of calcium in the bone, several alternatives have been proposed. One of them is taking estrogens, which prevents bone loss in women as long as it is prescribed very early in postmenopause. It’s not actually used much because, in turn, it increases the risk of breast and endometrial cancer. Another more commonly used hormone is calcitonin. But the most natural way to get calcium is by ingesting it, calcium is found in large quantities in milk and its derivatives (cheese, yoghurts), in vegetables (artichokes, carrots, collard greens and watercress), in fruits (orange , olives and dried figs), in nuts (almonds and hazelnuts), in legumes (chickpeas and beans), in white bread and in fish (sardines, sea bream, clams and prawns).

Diets not very rich in protein help to preserve bone mass. Treatment will depend on the joint that is affected, whether there has been a fracture or not, and the cause that produced it. Taking into account the cause, we distinguish between physiological osteoporosis and osteoporosis caused by immobilization:

Physiological osteoporosis

It is the one that occurs with age, it usually appears after 55 and 65 years. It is characterized by pain that is aggravated with effort and movement, especially in the back. It is usually accompanied by deformities such as kyphosis. It also causes fractures with minimal effort. It evolves in several years, that is, it is fully established in not a long time. Physiotherapy will fight preventively and curatively against those factors that favor the disease: lack of exercise, immobilization and deformities.

Preventive methods

General exercises and sports adapted to the age of the person: swimming, cycling, general gymnastics … When there has been a previous immobilization, it is necessary to ensure that this previous period has been as short as possible and to gain time, even in During the rest period, exercises are carried out that maintain muscle tone and we can try to confront the patient with the force of gravity by placing him in an upright position and properly supported for a minimum of two hours per day divided into four times.

During a crisis

If we are talking about a spinal injury, the affected person will have to rest on a hard bed, breathing exercises can be done to promote ventilation, mobilize the arms and legs and perform a circulatory massage on the limbs. As soon as the patient admits it (depending on his pain) we will use hot hydrokinesitherapy. Once the injury has stabilized, we will begin with kinesitherapy of the damaged region and adapted to the patient’s age, the objective of which is to maintain general physical condition.

Osteoroposis due to immobilization

It is the one that appears when a specific part of the body has been subjected to prolonged rest. It is usually local. Physiotherapy must be essentially preventive during the period of immobilization. Can be done:

• Circulatory massage: promotes blood circulation.
• Active mobilization.
• Rest the foot on the floor in a discontinuous way if what is altered is the leg.
• Avoid immobilization as much as possible, which is the most comfortable for the person himself.
• Progressive confrontation with the force of gravity.
• Stimulating and invigorating massage when there is no longer any danger of fracture again.

Treatment of osteoporosis of the spine

It is mainly based on:

• Avoid any movement in exaggerated flexion because we would increase the risk of kyphosis. You never have to reach the maximum amplitude in the exercises.
• Avoid lumbar hyperlordosis, both in a sitting and lying position. A correction exercise consists of performing abdominal contractions and holding them for 15 seconds from a sitting position.
• Respiratory exercises: very important to avoid stiffness of the rib cage and allow better oxygenation.
• Strengthen the muscles of the back to maintain active cushioning.
• Maintain the ideal position: supine with the knees and hips flexed.
• Superficial and deep thermotherapy : a great improvement is referred to with it.
• Electrotherapy analgesic: it has very good results.
• Magnetotherapy: excellent results due to its analgesic and anti-inflammatory effect.
• Massotherapy: to eliminate muscle contractures or stimulate if we are facing atrophy due to disuse.
• Spine kinesitherapy: you have to get correct postural attitudes. These are very slow and directed movements aimed at releasing the vertebral discs of tension. Basically trunk extension exercises are indicated,
  also flexion but more restricted.
• Hydrotherapy: due to the de-gravitational, decontracting and analgesic effect, good results are achieved.
• Sports activities: swimming, stationary bike and the simplest exercise of all, walking.
• Orthopedic girdles can be used in the dorsal and lumbar area.

Treatment of hip osteoporosis

It is very common in the population over sixty years of age. Pain in the groin that subsides with rest and increases with loads is typical. Limit all movements. The leg is placed in a flexion position and approaching the other leg. The most serious complication is the fracture.

Physiotherapy focuses on the following points:

• Reduce body weight.
• Use one or both sticks to unload the joint.
• Avoid prolonged walking and sitting. You have to walk just enough and on regular ground.
• Rest in the prone position.
• Swimming and cycling.
• Electrotherapy analgesic and thermotherapy.
• Avoid vicious hip positions.
• Correct walking with poles.
• Passive and active kinesitherapy.
• Strengthen all the muscles of the leg.
• Hydrokinesitherapy: underwater gait.