Osteoporosis is a condition that makes bones thinner and less dense than they should be. Our chances of developing osteoporosis increases as we age, which coupled with other factors can lead to falls.
Exercise-based interventions can have shown to have a tremendous impact on falls prevention. In this article, we discuss the risk factors for developing osteoporosis, why falls occur in people with the disease, and how physiotherapy helps reduce osteoporosis-related falls.
Table of Contents:
- What is Osteoporosis?
- Risk Factors for Developing Osteoporosis
- Why Falls Occur in People with Osteoporosis
- How Physiotherapy Helps Reduce Osteoporosis-Related Falls
- Conclusion
What is Osteoporosis?
Osteoporosis is a medical condition characterized by the loss of bone density and the weakening of bone tissue, which makes bones more fragile and prone to fractures. The term “osteoporosis” literally means “porous bones.”
In healthy bone, small spaces exist within the structure, similar to a honeycomb. However, in people with osteoporosis, these spaces become larger, causing the bone to lose strength and density. As a result, the bones become brittle and are more likely to break from minor falls or, in some cases, even from simple movements like bending or coughing.
In Canada more than 2 million people live with osteoporosis.[i]
Risk factors for Developing Osteoporosis
These factors have been shown to contribute to the development of osteoporosis:[ii]
Sex: Women have lower peak bone mass and smaller bones than men making them more susceptible
Age: As you age, bone loss happens more quickly, and new bone growth is slower
Race: White and Asian women are at the highest risk for developing osteoporosis
Family history: Researchers are finding that your risk for osteoporosis and fractures may increase if one of your parents has a history of osteoporosis or hip fracture.
Changes to hormones: Low levels of estrogen in women and low levels of testosterone in men increase your chances of developing osteoporosis.
Diet: A diet low in calcium and vitamin D can increase your risk for osteoporosis and fractures
Medications: Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis, such as corticosteroids
Lifestyle: Low levels of physical activity and prolonged periods of inactivity can contribute to an increased rate of bone loss. Chronic alcohol consumption and cigarette smoking have also been to lead to osteoporosis.
Why Falls Occur in People with Osteoporosis?
Falls can occur for a variety of reasons, often due to a combination of physical, environmental, and situational factors. Some people are at higher risk of falls due to medical conditions, age-related changes, or certain medications, while others may fall due to hazards in their surroundings or unexpected events.
Osteoporosis often occurs alongside age-related muscle loss making it harder to maintain balance and recover from a trip or stumble. With osteoporosis, especially in older adults, balance and coordination may decline due to reduced physical activity, weakening muscles, or co-existing conditions, increasing the risk of falling.
Osteoporosis can cause vertebral compression fractures, leading to a hunched or stooped posture. This change in alignment can affect balance and increase the likelihood of tripping or falling. Vertebral fractures can also cause pain, reduced flexibility, and poor posture, all of which may impair walking and increase the risk of falling.
Individuals with osteoporosis may reduce physical activity out of fear of falling, which can weaken muscles and further impair balance. This creates a vicious cycle, as decreased strength and activity increase the risk of falling when movement does occur. Anxiety about falling may cause more cautious or awkward movements, making it easier to trip or lose balance.
How Physiotherapy Helps Reduce Osteoporosis-Related Falls
People with osteoporosis are at a significantly higher risk of falls, and when they do fall, they are more likely to suffer serious injuries, such as fractures. Fractures are a serious and often devastating consequence of falls, leading to increased morbidity and mortality, decreased quality of life and loss of independence.
Physiotherapy intervention can have a tremendous impact on falls prevention. In 2023, the Canadian Medical Association updated their recommendations for fracture prevention and osteoporosis. The extensive literature review recommended the following interventions around movement and osteoporosis:
- Balance and Functional Training – more than or equal to twice weekly – this includes increasingly difficult balance tasks that include static and dynamic balance tasks, as well as functional tasks such as stair climbing to improve everyday tasks
- Resistance Training – more than or equal to twice weekly – these exercises should include major muscle groups as well as abdominal and back extensor muscles to improve posture and core stability
- Walking, Yoga, and Pilates – and similar activities are encouraged in addition to, but not instead of, balance, functional and resistance training, and only if they can be done in a safe manner or modified appropriately.
- Caution – Any type of exercise and activity that involves “rapid, repetitive, sustained, weighted or end range-of-motion twisting or flexion of the spine may need to be modified, especially in people at high risk of fracture.”[iii]
- Professional Advice – If available, seek exercise advice from healthcare professionals experienced in working with osteoporosis clients and exercise prescription, progression and management.[iv]
Conclusion
Osteoporosis-related falls, the potential resulting fractures and immobility, can have devastating consequences on an individual leading to loss of independence and fear of future falls. Physiotherapy and exercise-based interventions including balance, functional training and resistance training have been found to decrease the incidence of falls and limit the side effects when someone does fall.
At Propel Physiotherapy our therapists are experienced in developing tailored and comprehensive falls prevention programs that help keep individuals independent and safe in their home and community.
Contact us to see how we can help you!
References
[i] Seniors’ falls in Canada, second report: protecting Canadians from illness. Ottawa: Public Health Agency of Canada; 2014:1–62. Available: https://www.canada.ca/content/dam/phac-aspc/migration/phac-aspc/seniors-aines/publications/public/injury-blessure/seniors_falls-chutes_aines/assets/pdf/seniors_falls-chutes_aines-eng.pdf (accessed 2023 April 11).
[ii] Overview of Osteoporosis, National Institute of Arthritis and Musculoskeletal and Skin Diseases
[iii] Clinical practice guideline for management of osteoporosis and fracture prevention in Canada: 2023 update, Canadian Medical Association Journal
[iv] ibid.
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