Q: Doctor can physiotherapist help in osteoporosis?
A: Osteoporosis is a complex and progressive condition that affects millions of people worldwide, particularly as they age. It is defined by a significant reduction in bone mineral density (BMD) due to alterations in the microstructure of bone tissue, making bones fragile and more susceptible to fractures from even minor falls or low-impact incidents. Understanding the process of bone health is essential to comprehending osteoporosis and its profound effects on individuals' quality of life.

Throughout a person's life, bone tissue undergoes a continuous process of renewal, where old bone is absorbed, and new bone is formed. This delicate balance between bone resorption (breaking down) and bone formation (building) maintains bone strength. However, as people age, this balance can shift unfavorably. When the rate of bone absorption outpaces the rate of new bone production, bone mass gradually decreases. This is a natural part of aging, but when it becomes pronounced, it leads to osteoporosis.

The importance of reaching peak bone mass – usually around the age of 20 – cannot be overstated. Achieving maximum bone density during this crucial period provides a reservoir of bone strength for later life. Unfortunately, not everyone reaches this peak bone mass due to various factors, such as genetic predisposition, poor nutrition, or insufficient physical activity during childhood and adolescence. Individuals who start adulthood with lower bone density are more likely to develop osteoporosis as they age, putting them at higher risk for fractures and other complications.

Osteoporosis can be broadly categorized into primary and secondary forms. Primary osteoporosis, which is the most common, has no single identifiable cause, though a range of factors can contribute to its development. These include prolonged calcium deficiency, hormonal imbalances (particularly estrogen deficiency in women), and a sedentary lifestyle. For women, estrogen plays a crucial role in maintaining bone density. During and after menopause, when estrogen levels drop significantly, bone loss accelerates. Postmenopausal women are particularly vulnerable, losing up to 1% of their bone mass per year for the first eight years after menopause.

Senile osteoporosis, another type of primary osteoporosis, is associated with the natural aging process. As people grow older, the ability of the body to regenerate bone weakens, and bone mass declines more rapidly. Men and women alike experience this age-related bone loss, though it tends to occur later in life compared to postmenopausal osteoporosis.

Idiopathic juvenile osteoporosis, although rare, occurs in children and adolescents with no clear underlying cause. This form can be particularly distressing as it affects young individuals at a time when they should be building up their bone strength. While it often resolves as they grow older, the period of bone loss can cause fractures and physical limitations.

Secondary osteoporosis, on the other hand, arises as a consequence of other medical conditions or the prolonged use of medications that negatively affect bone health. Medications such as corticosteroids, commonly used for conditions like asthma or rheumatoid arthritis, can impair the body's ability to absorb calcium, leading to reduced bone density over time. Similarly, diseases like hyperthyroidism or chronic kidney disease can disrupt the body’s calcium balance, further contributing to bone loss.

The Role of Nutrition and Lifestyle in Bone Health
One of the most critical risk factors for osteoporosis is inadequate calcium intake. Calcium is a vital mineral that supports bone formation and maintenance. If the body does not receive enough calcium, it will begin to draw from the reserves stored in bones, weakening them over time. Maintaining adequate calcium levels throughout life – starting in childhood – is essential. It's not just about the teenage years when bones grow rapidly; it’s equally important for older adults to consume enough calcium to preserve the bone mass they’ve built. Vitamin D, which helps the body absorb calcium, is also crucial in this equation. A deficiency in either nutrient can significantly increase the risk of osteoporosis.

Moreover, excessive alcohol consumption has been shown to interfere with the body's ability to absorb calcium effectively. People who consume large amounts of alcohol are at greater risk of developing osteoporosis. Additionally, smoking has been linked to reduced bone mass, further compounding the risks.

A sedentary lifestyle can be just as detrimental as poor nutrition. Bone tissue responds to the mechanical load placed upon it. Therefore, individuals who are physically active generally have stronger, denser bones compared to those who lead more sedentary lives. Weight-bearing exercises, such as walking, running, and resistance training, stimulate bone formation and slow down the rate of bone loss. Conversely, a lack of physical activity can accelerate bone deterioration, making exercise an essential part of osteoporosis prevention and management.

to be continued...