Osteoporosis is characterised by a loss in bone mass and mineral density as well as alterations in the composition and strength of bone. It is a metabolic bone disease that arises from osteoclastic bone resorption that is not counteracted by osteoblastic bone synthesis at the cellular level. As a result, there may be a drop in bone strength and a higher chance of fractures.

Osteoporosis is also known as silent diseases, because it usually causes no symptoms and may go undiagnosed until a bone breaks. In elderly men and postmenopausal women, osteoporosis is the primary cause of fractures.

It mostly affects women above 60 (60%) and men above 70 years of age (20%). Approx. 30% of women and 20% of men aged 50 and above experience osteoporosis-related fractures.

In this disorder there is increase in bone degradation than bone formation cells which will lead to bone dengeration, increasing osteophyte production, articular cartilage degradation, and subchondral bone cyst expansion. The loss in bone strength also leads to fragility fractures. Most common sites for fracture are spine, hip and wrist.

It is of 2 types

1. Primary Osteoporosis: (mainly occurs in menopausal women due to decrease level of estrogen)

2. Secondary Osteoporosis:  (occurs due to prolonged use of medications or secondary to another disease or condition )

Fracture Risk Assessment Tool (FRAX) is also a precise method of estimating the fracture.

The diagnosis of osteoporosis is primarily determined by measuring bone mineral density (BMD) using noninvasive dual-energy X-ray absorptiometry.

Bone health	T score
Normal	-1 to +1
Osteopenia	-1 to -2.5
Osteoporosis	-2.5 to -4

Clinical Signs and Symptoms

• Back pain (acute/episodic)
• Stoop posture
• Spinal Compression fracture
• Bone fractures
• Decrease in height 
• Decreased activity tolerance
• Shortness of breath (Decrease in lung capacity)

NON-PHRAMCOLOGICAL TREATMENT OF OSTEOPOROSIS

• The main goals of Osteoporosis treatment are to minimize symptoms, prevention of fall and slow the disease’s progression. The mainstays of Osteoporosis management are targeted advice and education regarding exercise, self-care, and weight loss.
• For OP patients at all stages of the disease, exercise therapy has been shown to be generally safe and notable improvement is seen in pain, balance, physical function, and quality of life when engage in therapeutic exercise, particularly muscle strengthening exercises, aerobic exercises and hydrotherapy pool exercises.
• All individuals with Osteoporosis in their knees are advised to exercise, regardless of the condition’s severity, age, function, discomfort, or coexisting conditions because Mechanical loading and muscle contraction exercise promote bone formation. Non-weight-bearing exercises, such as swimming, can improve muscle strength, cardiovascular fitness, and coordination, but they are not bone-loading exercises. Vitamin D augments the effect of strengthening exercises.

Physiotherapy Treatment of Osteoporosis:

1. Strengthening and flexibility exercises: Both postural control and general physical function may be enhanced by them. It will help to enhance postural control to lower the risk of falls. Also, include balance exercises to further lower the chance of falls. such as The Otago Programme
2. Body weight training: Walking and hopping are examples of exercises that have been demonstrated to preserve or increase bone density in this population. It has also been demonstrated that performing strength training with weights or resistance bands can preserve or increase bone density where the targeted muscle attachments are located.
3. Postural exercise: Chin tucks, scapular retractions, thoracic extensions, and hip extensions are examples of extension exercises that should be a part of any osteoporosis programme. Strength in the extensor muscles group will help with balance and posture.
4. Balancing exercise: Tandam walk, tandam stance and coordination exercise will be helpful in preventing the fall in patients.
5. Aerobic training and Hydrotherapy: also the patients with osteoporosis to strengthen the muscle and help in improving bone mass density.

• Minimum 4-6 weeks with 3-4 times per week exercises should be done to see results.
• Body Weight Supported Treadmill Training, Plyometrics and manuplations should be avoided during exercises.
• Activities That Person With Osteoporosis Should Take Care
• Maintain a nutritious diet that contains enough calcium and vitamin D
• Avoid sloppy slippers & wear sensible, well-fitting shoes as they can both cause trips and falls.
• Avoid low lying sitting or cross leg sitting.
• Make sure stairs are luminescent; 
• Regular eye exams are recommended;
• Reduce heavy lifting; consider home delivery purchasing groceries
• Conclusion
• Osteoporosis is a low bone mineral density condition that degrades over the time if not properly care taken. It is a multifactorial disease process that requires management from multiple health care providers including physicians, nurses, and physical therapists.
• Physical therapy is the first line treatment to prevent progression and for symptomatic relief. The treatment plan is designed according to the stage of osteoporosis & fracture risk.
• Consult your physiotherapist before starting the exercise program.
• Dr. Mamta (PT)