It is not osteoporosis that causes fractures.


We all know someone who has had a bone mineral density test and been diagnosed with osteopenia or osteoporosis.  This means they have lower than normal bone mineral density and hence their bones may be more fragile.  This in itself does not necessarily cause fractures but does need to be addressed.

A comprehensive, multifaceted approach to the treatment of osteopenia and osteoporosis will have a significant impact on bone density.  Clearly there are suitable medications one can take which your physician can address (beyond my scope of practice for sure).  I am sure you have all seen the numerous commercials on TV for these medications with that classic … “Ask your doctor about Boniva (or whatever medication they are advertising)” at the end.

The predictive value of bone mineral density measurements has been called into question in that it can under or overestimate density by 20% to 50%.  If it underestimates the density of the bone, you may receive unnecessary treatment.  If it overestimates bone mineral density you may not receive the most effective treatment.  So, what should you do?

Recognize that it is the fall that causes fractures and not the osteoporosis or osteopenia.  So if you address the physical limitations causing falls you will reduce the frequency of falls and thus reduce fractures.  75% of fractures occur in people without osteoporosis.  80% of low impact fractures occur in people who do not have osteoporosis.  Yes, it is the falls.

Preventing falls among older adults reduces the incidence of fractures, sometimes by over 50%.  Scientific evidence supports a reduction in fall frequency through strength and balance training, followed by reductions in the number of psychotropic drugs, dietary supplementation with Vitamin D and calcium and, in high risk populations, assessment and modification of home hazards.

This is where physical therapy is involved.  A fall prevention program should include targeted strengthening and stretching, static and dynamic balance training, posture modification, home hazard removal and of course an ongoing home exercise program which should be completed on a daily basis.

How do you know if you, a friend or a family member may need a fall prevention (and hence fracture prevention) program?  Answer “YES” to one of the questions below and you should consult with a physical therapist.

  1. Do you have difficulty going from a sitting to a standing position?
  2. Have you fallen without a known precipitating event?
  3. Have you fallen more than once in the past 6 months?
  4. Does it take you longer than 13 seconds to get up from a seated position and walk 10 feet?
  5. Do you have osteopenia or osteoporosis?
  6. Are you unsure if you would benefit from a fall prevention program?

Do your own assessment and decide if you, a family member or a friend may need to address balance issues with a physical therapist.  You will be glad you did.

Motivated to Get Healthy Via the Cost of Healthcare.


My last post on hip pain suggests the need for us all to be educated healthcare consumers and takes us back to the original goal of this blog – to be a credible, unbiased (by selling, advertizing or marketing products, for example) healthcare information source within the expertise of the writer.  Clearly, if it takes 21 months and three providers to correctly diagnose hip pain, we must all be willing and able to ask questions of our healthcare providers (doctors, physical therapists, physicians assistants, nurses, hospitals, insurance companies).

$2.8 trillion ($2,800,000,000,000 – enough zeros?) is estimated to be spent on healthcare in 2013. In 2010, we spent just over $8000 per capita in the US and our life expectancy at birth ranks below countries that spend far less. Spain spends about $3000 per capita and has a life expectancy at birth of 82 and Japan spends $4000 per capita and has a life expectancy of 83.

Consider that the healthcare industry spent $5.36 billion lobbying Congress from 1998 to 2012 while the defense lobbyists spent $1.53 billion. Will this system change to your benefit as a patient?  I do not think it will change in the near future and will thus continue to cost us all way more than we can afford.

I suggest we make the healthcare system challenges a mute point by using this reality as motivation to take charge of our own health. For example, what small lifestyle change can you make to start on the road to a healthier you today?

As a physical therapist I am partial to movement so why not move more each day. That means doing little things such as walking stairs, walking at lunchtime, taking family time and walking around your neighborhood after work with your kids, standing up from your office chair 10 times every two hours, anything you can think of that will increase your activity level.

A dietician may have ideas such as portion control, cutting out refined and fatty foods, eating more fruits and vegetables, drinking more water.  All you dieticians out there, feel free to post your ideas of simple, easy ideas people can use to start the process of improving their health.

What about a wellness visit to your primary care doctor?  Dr Ronald Hicks in Sparks, Nevada has been my primary care physician for almost 17 years.  Every visit I have with him involves discussions about some form of healthy living (sun block, exercise, diet, stress), and I am a health person.  He tells me he has many diabetic patients who do not control their blood glucose using simple dietary restrictions, exercise, regular montoring and medication use.  I am floored by this.  If we know what we need to do to control a disease which is potentially fatal, why do we not do it? (A lead into a future post maybe?)

In conclusion, at Custom Physical Therapy I have the priviledge of working with a variety of wonderful people all of whom have different needs.  Everyday, there are people who can make small changes in lifestyle and thus have large gains in health.  However, such lifestyle changes do not come easy and require motivation.  With this post, I am suggesting we use the cost of healthcare as motivation to make the needed changes to become healthier.  You will save on  healthcare costs down the road as we will only use the expensive healthcare system when we truly need to.  Prevention is the word.

YOUR TO DO LIST:

  1. What one aspect of your lifestyle will you change today to start on the road to a healthier you? 
  2. Post your idea on this blog – I would love to read about it.
  3. Send this post to someone you would like to join with on the quest to save $$$ by becoming a healthier you.
  4. Schedule a wellness checkup with your primary care physician – let the doc know your desire to become healthier.
  5. Be happy and get healthy!