Katy McConkey is an Osteopath at Osteopatía del Mar. She trained in the UK and Spain and has been based in Barcelona for over 25 years. She is passionate about her work: keeping up on the latest research, seeing people improve after treatments, and being in the position of meeting a variety of great people who come to the clinic every day.
This year, 2023, we celebrate the Year of the Rabbit and my call to you is to hop, jump, thump and race through the year … all in the name of your present and long-term health. Read on to find out why hopping, jumping and skipping is good for you.
Today I am talking about Osteoporosis (also about Osteopenia, and Sarcomenia) to fill in information gaps and dispel misconceptions you may have. I also want to push the point that early diagnosis of Osteoporosis is a great thing for long-term treatment outcomes. You’ll find information that you can put into practice today to help the future you. Being a mobile elderly person is a good goal; mobility is your main source of independence.
Osteoporosis is brittle or fragile bones. The bones in your body have a hard cortical outside and inside they have a trabecular structure making them light yet strong and resilient.
While we may not be aware of it the tissue of bone is in constant renewal; bone is formed and bone is reabsorbed. Loss of bone mass is a naturally occurring process of ageing and it is the consequence of poor or less effective calcium uptake in the body. It is the degree to which this occurs that causes Osteoporosis.
When there is an imbalance in this cycle it leads to a loss of bone mass, along with micro-structural deterioration in the tissue and this causes bone fragility.
Your bones become brittle and their weight-bearing function becomes impaired; hence the high number of fractures in the hips and spine. Having fragile bones means that should you slip, fall, or receive an impact (or even sneeze or cough) the likelihood of fracture is much higher.
Osteopenia is where bone density loss is seen (relative to age/sex), but has not reached a critical point.
Sarcopenia (Penia is a loss/lack of and sarcomere is the base unit of a muscle) refers to a loss of muscle mass. When you lose muscle mass your muscle function deteriorates, for example, you losing gripping strength or are less stable so have a higher chance of falls; and subsequently a high risk of fracture. There is known to be a reciprocal relationship between Sarcopenia and Osteoporosis. It is thought to affect between 5-37% of community-dwelling adults.
Many people are only diagnosed with Osteoporosis after they have suffered a fall and a subsequent fracture hence the name the “silent” disease. It can be undetected even in those with vertebral fractures as these can be pain-free. In Spain, there is a 64% gap between those who are diagnosed to those who are treated (this figure is similar to other countries in the EU).
Both men and women suffer from Osteoporosis. However, women are at a higher risk than men and onset is earlier, particularly for spinal fractures. This is partly due to the drop in oestrogen secretion in post-menopausal women (oestrogen helps bone reabsorption). Also, women are generally smaller so muscle and bone mass loss are more noticeable. The current SCOPE score sheet states that 1 in every five women in Spain has Osteoporosis. Other sources put your lifetime risk of osteoporotic fracture at 40-50%. So we can see it is imperative to put prevention and early detection at the forefront.
How do you know if you are in a high-risk group? Some risk factors are non-modifiable such as your age (the older the higher the risk) and your sex (higher risk for women) or chronic disease. Other risk factors are modifiable: smoking, drinking, sedentary habits, type of diet, nutritional factors and protein intake and types and history of physical exercise. Long-term use of some medications such steroids increases your risk, and your fall risk increases with sarcopenia, eyesight problems and vitamin D deficiency).
Once you have ascertained your risk group you can seek assessment, test and diagnosis.
To know whether you have Osteoporosis you have to measure your Bone Mass Density (BMD), this is done with a special X-ray called a DXA (dual x-ray absorptiometry). It is painless and non-invasive. Your local healthcare provider will refer you.
You have given two readings a T score, this is your BMD value compared to that of a 30-year-old. Your Z score compares you to someone of the same age/sex. If your score falls below a certain value you will be diagnosed as being Osteopenic (some mass loss) or having Osteoporosis
I cannot stress how important early testing is. Critically, it can detect low bone density before osteoporosis develops and flag changes that are out of the normal range. So if you are found to have Osteopenia you can start a management programme early on. This will improve the condition and your long-term outcome will be better.
The answer is a definite yes. Treatment is managed with medication and supplements, and dietary and exercise changes. Medication may be prescribed by your doctor to improve deficits in bone formation and/or absorption, or correct hormone deficiencies. Changes in diet and changes in exercise routine will improve bone health, build muscle mass and help minimise deterioration. The areas of focus are balance improved walking gait, resilience and muscle mass building. Management of diet is focused on having a full-calorie, balanced diet with optimal calcium and protein intake to readdress imbalances.
A balanced and full-calorie diet is recommended to ensure you receive your full complement or minerals and vitamins and specifically adequate levels of vitamin D, calcium, protein and zinc. Recommended calorie intake values vary with age so check you know yours.
Two good things about living in Spain are that the sun is a good source of vitamin D and a daily dose is recommended and calcium-rich sources of food are all easily at hand. These include dates, dried apricots, figs, lemons, oranges, strawberries, almonds, broccoli, collard greens, dandelion greens, kale, Swiss chard, and then the dairy, meat and cheese groups.
Management of physical exercise (type, duration and intensity) should be based on an informed history of each individual (age, sex, fall history, exercise history etc)
Resistance exercise has been shown to be the best option: This is where you use your own body weight or resisted exercise to build up muscle mass and strength. For example deadlifts, squats, leg and chest presses, lateral pull-down wood chop. Aerobic exercise includes walking, cycling, swimming, jogging, skipping and sprinting. Balance and flexibility include single-leg stands, heel-toe forward walking, yoga, tai chi, and walking in circles.
See your GP or local health provider for screening, and do a FRAX assessment (to detect your fracture risk) or DXA x-ray if you are concerned. If you have been diagnosed with osteopenia or osteoporosis be active in your approach; ask a specialist for advice or get a fitness regime set up and have the confidence to know it is helping you.
Your local osteopath (and other physical therapists, fitness instructors etc.) can play a role in your management plan. As an osteopath, I can help in risk assessment for example with balance tests, testing lower limb strength, or assessing your gait control, footfall and ankle flexibility (which is indicative of your risk of falls). Your treatments are aimed at improving the range of motion in joints, flexibility, improving posture, balance and stability all of which will reduce your falls risk. Personalised exercise sheets can be made and your progress is monitored over your sessions.
Keep an eye on elderly friends or relatives particularly if they have new unexplained back or hip pains, have trouble walking or unexplained falls, don’t eat well, or have lost height and lead them toward the right specialist. Early detection will help identify those at risk of low BMD before falls (and fractures) occur.
Instil healthy eating and exercise habits in the young.
For the mid-life age group be proactively committed to prevention: know that following a good varied exercise routine that includes resistance-based exercise, and a full-calorie balanced diet is your best investment toward healthy bones in older age rewarding you with a happy, mobile, independent elderly life.
If you are able to visit an osteopath regularly do so they can dedicate time to you in assessment, diagnosis and treatment: they will bring out your best in terms of movement, flexibility, posture and balance.
Get that spring back in your step! In fact, hop, bound and skitter through the Year of the Rabbit. Have a great one!
This article is a summary of two master classes from the osteopathy magazine IJOM and the SCOPE report for Spain from the International Osteoporosis Foundation. If you want to read more, choose your information from reputable medical sites such as PubMed. Or specialist sites such as NIH. If you would like exercise sheets or information call me on +34 609 143 690
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