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Toni Talks about PT Today

Osteoporosis

Published June 24, 2008 10:59 AM by Toni Patt
This semester my class is about woman's health from midlife to beyond. We're studying disease processes that typically affect older women.  Last week the topic was osteoporosis. I thought that would be pretty basic. It's caused by loss of bone mass. It's treated with weight-bearing exercises. I've never had a patient with that as a sole diagnosis so I thought there wouldn't be much to it. I was wrong.

My eyes were opened. I was surprised at how little I actually knew.  At the same time, I found myself making connections between things I knew but never saw as significant. I always associated osteoporosis with compression fractures.  It never occurred to me that other bones such as hips and wrists are also involved. I had the misconception that osteoporosis is responsible for broken bones. I learned that falls break bones. You can have osteoporosis for years and never break a bone. Falling will break a bone whether or not the person is osteoporotic. I was right about compression fractures, but wrong that there is no treatment therapy can offer.

I had to stop and think. Fractured hips are one of the most devastating problems an older person can face. Billions are spent annually on treatment alone. Falls are one of the top five causes of death in the elderly. PTs can do something about this. We can teach fall prevention. Reducing the number of falls will reduce the number of fractures. Prevention of one fall keeps one elderly person home longer. Extension and back strengthening exercises have been shown to reduce a thoracic kyphosis. A kyphosis impairs breathing mechanics. Inadequate lung expansion has many nasty side effects.  

There are other things we can do. We can include resistance exercises in treatment programs. We can encourage women to become more active. We can promote weight-bearing exercises such as walking.  We can educate women on improving their diets and taking calcium. We can encourage those taking antiresorptive agents to be complaint. These drugs work, but take time.

I'm rethinking how I will approach older women patients. I'm going to add some bone strength education and include weight bearing and/or resistive exercises when I can. I'm also looking at myself.  Fortunately I'm already doing the right stuff like taking a calcium supplement. I get weight-bearing and resistive exercise when I ride. I'm in the sun a lot so I'm getting plenty of vitamin D.

I'm sharing this with as many PTs as I can. I think others have the same misconceptions I had. I wouldn't have learned differently without this class. I'm sharing in my blog because many of us treat older women. This is something we need to think about when planning treatments and providing education. I have one last thought. While women are predominately the ones who have this, it isn't exclusively a disease of women. Men can benefit from education, too.

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