PT on the Net Research

Osteoporosis in Young Client


Question:

I was diagnosed with osteoporosis last year at the age of 38 (-2,7 in lumbar spine and -1 in hips). I was told to stop running and rock climbing, the two activities I liked best. I have continued to lift weights and am currently doing regular yoga, even though I've been told to avoid yoga due to the flexion and rotation postures. I am being treated like I am older, and I am not happy with my choices! There is very little information out there for those who are YOUNG with osteoporosis. The research I have found is for people who are inactive and over the age of 55. I want to know how this affects me at my age and activity level. I have been told to use the vibration units. The research I have read on this is conflicting. Perhaps I am just refusing to accept the truth, but I just can't imagine the rest of my life with no impact, rotation or flexion!

Answer:

(EDITOR'S NOTE: This response is not intended to replace medical advice. Please consult with your doctor or therapist before beginning any exercise program.)

The reasons for early onset of osteoporosis are most commonly via genetic factors, which would often be highlighted by a similar pattern in the family history. Another reason could be hormonal, resulting from very low body fat levels, diet, certain drugs or (most commonly) early menopause. From a dietary perspective, a high intake of protein will increase the net acid load on the body, in which case calcium may be taken from the bone to restore homeostasis. This is one of the many reasons that a high dairy intake is not recommended, as the net acid load from the protein leads to a net loss in bone calcium.

The –2.7 in the lumbar spine is significant and cause for concern. However, you need to have some impact occurring through your spine in order to stimulate osteogenesis (bone building). Hence, at this stage, I would not rule out running, but I would recommend gait analysis from a physical therapist to ensure that you are not placing undue or uneven stresses on the lumbar vertebrae. Rock climbing should be fine, provided that most of the work is done through the lower body. Excessive periods of time in hanging or flexed postures (i.e., when attacking overhangs) could place stress on the spine in a manner more likely to produce damage, but again, the emphasis is on careful management of the exercise, rather than outright exclusion.

Yoga can be adapted so as to have no negative repercussions. Firstly, it should mostly be performed standing, rather than sitting or lying. Rotation, provided that it is within a natural range of motion, should produce no adverse effects (osteophyte build up, as associated with osteoarthritis, might preclude this but not osteoporosis). Flexion, however, is not recommended, and this does require a drastic adaptation of the common yoga postures. The reason is that if, for example, you try to touch your toes with your legs straight, then the curvature in the spine causes the individual vertebrae to tilt forwards. This can happen in such a way as to place stress on the front of the bones, and it can potentially cause fractures.

Regarding the vibration units, it has recently been suggested that the machines contravene health and safety regulations, with potentially serious repercussions for general health. There is scant good quality evidence to suggest that these machines are beneficial for delaying the progression of osteoporosis, particularly in comparison to effective weight-bearing exercise. The evidence that does exist is based upon older patients who are sedentary. There certainly is no good evidence to suggest you should give up running and/or weight training in order to use vibration machines in the treatment of osteoporosis. At this stage, it is not possible to say that the units would be detrimental (although time will tell), but it is simply the case that some light running, plenty of walking and a good resistance training program will be far more beneficial.

Finally, weight-bearing activity is the stimulus for osteoblasts to build new bone, but without sufficient oestrogen and nutrients, there will not be the raw material to increase bone density with. Hence, delaying and potentially reversing the progression of osteoporosis may require the integration of hormonal, nutritional and activity-based interventions.