Osteoporosis is defined as a condition that causes the structure of bone to weaken and leads to fragile bones that have higher risks of fractures. The condition has been classified into several types based on their etiology; localized and generalized osteoporosis are the two initial classifications, which are further differentiated into secondary and primary. As a rule, osteoporosis is not diagnosed clinically until a patient fractures a bone or bones. Signs and symptoms of the condition are all associated with pain in a localized area that occurs after minor trauma. Such pain is usually characterized as sharp or nagging, restricting the movement and often accompanied by spasms in paravertebral muscles. Since physical activity is known to exacerbate pain during osteoporosis, patients that are likely to suffer from the condition choose to remain motionless and spend as much time in bed as possible to avoid the pain. Acute pain during osteoporosis usually disappears within four to six weeks; however, the pain can become chronic if a patient experienced several bone fractures. In cases when bone loss and brittleness are diagnosed in time, osteoporosis prognosis is likely to be good since patients can implement dietary, medication, and physical treatment interventions.
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Diagnosis and Pathology
To diagnose osteoporosis, healthcare providers conduct laboratory testing that includes the complete blood count, tests of liver function, serum chemistry, thyroid hormone levels, testosterone levels, calcium testing, measurement of bone mineral density (women and men aged 65 and 70 respectively), as well as the assessment of family history3. In patients with osteoporosis, complete blood count tests can show such co-morbidities as anemia, which contributes to bone brittleness. Also, thyroid hormone testing is performed for determining whether there is a thyroid disease that can also lead to osteoporosis. Measuring calcium levels (through urine testing) is essential for diagnosis osteoporosis since such conditions and hypercalciuria have shown to be associated with the disease.
When it comes to elderly patients, osteoporosis should be carefully diagnosed since older age presents more difficulties for the management of bone brittleness. Such diagnosis strategies as BMD (bone mineral density) measurements are usually performed on all female patients aged 65 and older, and all-male patients aged 70 and older. Also, BMD can be used for the successful diagnosis of osteoporosis among postmenopausal women based on their profiles of risks as well as based on their previous history of adult bone fracture. BMD measurements occur with the help of dual-energy x-ray absorptiometry, which measures the mineral density of the bone in patients’ wrists. The texting provides healthcare specialists with t-scores; osteopenia is diagnosed when the t-score ranges between -1 and -2.5 SD (standard deviation), osteoporosis is indicated by t-scores lower than -2.5 SD, while -2.5 SD accompanied by bone fractures points to severe osteoporosis2.
When it comes to the condition’s pathology, it has been recognized that several pathogenetic mechanisms could play a role in the development of osteoporosis among patients. In normal bone remodeling and formation, two types of cells are responsible for the proper functioning, while osteoclasts are key contributors to the resorption of bone, osteoblasts form the bones. Osteoblasts are cells that need months in order to produce new bone, while osteoclasts can absorb bone for weeks. This means that processes that disrupt the normal rate of bone remodeling can lead to osteoporosis.
Interventions: Diet and Physical Therapy
High-quality care for patients with osteoporosis is insufficient due to the lack of awareness their healthcare providers regarding the importance of overcoming post-fracture challenges.This points to the need for developing effective interventions for managing osteoporosis and overcoming barriers associated with optimal care. Previous evidence has shown that suitable interventions for osteoporosis can include not only include medication but also physical therapy. Interventions that incorporate physical activities into the management of osteoporosis include balance, postural, flexibility, and strength exercises as well as weight-bearing. These interventions allow patients to improve their overall physical function and thus contribute to the strengthening of bone density and reducing risks of falls. For example, weight-bearing exercises such as muscle strengthening with the use of weights target specific muscles while improving bone density at the targeted muscle location. In patients 50 and older, the maintenance of adequate muscle weight is highly likely to prevent the occurrence of osteoporosis due to the patterns of declining bone mass with age6.
It is important to mention that the progression of physical therapy interventions throughout osteoporosis progress should be based on patients’ conditions as well as the effectiveness/ineffectiveness of previously implemented treatment. For instance, Shanb and Youssef4 found that BMD in patients with osteoporosis increased when they added weight-bearing exercises to the regular pattern of nonweight-bearing exercises. This shows that despite the possible benefits of such physical activities as stretching, posture improvement, or walking, the addition of weight-bearing played a critical role in the management of osteoporosis. As patients recover from fractures and start incorporating mild exercises, it is essential to monitor their physical progress and continue adding other types of physical therapy to strengthen bones and prevent possible fractures from reoccurring.
Apart from physical exercises, interventions for osteoporosis can also include dietary changes, especially for prevention. Incorporating calcium-rich foods in one’s diet will ensure that patients are getting the vitamins they need for healthy bone formation. It has been recommended to avoid high-protein diets since kidneys flush out calcium when they get rid of excess protein. Supplements have also been shown to be beneficial for patients with osteoporosis. Apart from calcium, patients have been recommended to take vitamin D and K supplements for retaining bone mass.
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Medication approved for the treatment of osteoporosis varies depending on patients’ needs as well as underlying causes of the condition. Apart from vitamin supplements, Slon5 suggested using hormone and non-hormone medication. Alendronate, risedronate, ibandronate, raloxifene, and zoledronic acid are all non-hormone medications that have been approved for the treatment of osteoporosis. All of them are targeted at the increase of bone density and reducing the likelihood of fractures. Hormone therapy such as teriparatide (PTH) is prescribed to patients with diagnosed hormonal dysfunction in order to improve bone formation. It is essential to note that prescription medication for managing osteoporosis can reinforce physical interventions and lead to the improvement of patients’ overall health. However, health care providers should be cautious of possible side effects of medication and make adjustments in patients’ physical activity in cases when the medication is essential.
Role of PTAs
Physical therapy assistants (PTA) can play a crucial role in the management of many physical issues since they will provide guidance and develop a cohesive rehabilitation/prevention plan for patients with a variety of health conditions ranging from osteoporosis to amputations1. Importantly, in cases when patients are afraid of falling and getting new fractures during physical therapy, it is essential for them to consider getting the assistance of a physical therapy assistant. A PTA will organize physical therapy activities into manageable and safe tasks to minimize risks of bone fractures. In addition to planning exercises and assisting in their completion, PTAs can help in finding patients the most suitable assistive devices if they require them for better movement during a period of healing after a fracture.
Interactions of the healthcare team with regards to treating patients with osteoporosis should be based on effective communication between care providers. For instance, a PTA can provide feedback on a patient’s progress to a physician, who, in turn, will give recommendations on new strategies of effective osteoporosis management. Such interactions are important because direct communication between care providers will ensure transparency and close monitoring of patients’ conditions. Also, patients are also encouraged to seek communication with their doctors and ask questions about their treatment to enhance their knowledge of the condition.
In summary, it is important to mention that osteoporosis is a complex condition that may have various causes and methods of management. The most important strategy is combining physical therapy with appropriate diet and medication interventions to get the most benefits from treatment. As patients who have suffered bone fractures recover, it is essential for them to seek the assistance of PTAs to ensure that the physical therapy efforts do not interfere with medical or diet interventions and vice versa. Careful attention to the needs of individual patients is needed since osteoporosis can have different causes based on patients’ health history.
About physical therapy. Web.
Kling JM, Clarke BL, Sandhu NP. Osteoporosis Prevention, Screening, and Treatment: A Review. Journal of Women’s Health. 2014;23(7):563-572.
Shanb AA, Youssef EF. The impact of adding weight-bearing exercise versus nonweight bearing programs to the medical treatment of elderly patients with osteoporosis. Journal of Family & Community Medicine. 2014;21(3):176-181.
Slon, S. Osteoporosis: A Guide to Prevention and Treatment. Boston, MA: Harvard Health Publication; 2010.
Zehnacker CH, Bemis-Dougherty A. Effect of Weighted Exercises on Bone Mineral Density in Post Menopausal Women A Systematic Review. Journal of Geriatric Physical Therapy. 2007;30(2):79-88.