Chiropractic approach to Osteoporosis

Osteoporosis is a disorder of reduced bone strength due to its low density. As bone density decreases, risk of fracture increases - often due to low force in areas of the spine, hip, proximal humerus, forearm, wrist, or pelvis. Osteoporosis is often asymptomatic until trauma occurs.

Globally, osteoporosis is by far the most common metabolic bone disease, affecting over 200 million people. approximately 50% of women and 20% of men over the age of 60 will experience a fracture that is attributable to osteoporosis.

Studies have shown that in the year following a new osteoporotic fracture,15% of patients develop additional fractures and nearly 20% die. Of the fractures from osteoporosis, hip fractures are the most dangerous, with a shocking 30% mortality within 12 months.

There are many risk factors to be aware of. These are modifiable and non-modifiable.

Modifiable

Medication and drug use

There are several medications that can facilitate bone wasting. Here are some of the medications ranked in order of risk:

-          Corticosteroids

-          Aromatase inhibitors

-          GnRH inhibitors / hormone blockers

-          Progesterone-only contraception (injectable, implant, highest dose IUD)

-          Anticonvulsants

-          Antiretroviral drugs

-          Vitamin K-antagonist anticoagulant

-          Statins

-          Inhaled corticosteroids

-          Methotrexate SSRI

-          Antibiotics (prolonged, oral)

-          Protein pump inhibitors

Diet:

The consumption of high and ultra-processed foods and refined sugars, as well as inadequate protein and nutrient intake have been linked to osteoporosis. These foods do not have adequate protein, fibre, vitamins A, C, D, and E, zinc, potassium, phosphorus, magnesium, and calcium, needed to support healthy bone. Sugar increases the urinary excretion of calcium, increasing inflammation, and hyperinsulinemia, hastening bone resorption. Sufficient dietary protein is also essential for bone health. 50% of bone volume and 33% of bone mass is composed of structural proteins.

Excessive alcohol consumption has direct and indirect effects on bone. Alcohol often displaces good nutrition, has a toxic effect on osteoblasts, and increases the risk of falls.

Sedentary lifestyle

Chronic weightlessness can lead to a rapid decline in bone density. Sedentary individuals are at risk of lower BMD due to the lack of mechanical stress placed on the bones.

Smoking

Smokers have twice the risk of osteoporotic fractures as non-smokers. Smokers have about 10% lower circulating levels of 1,25-dihydroxyvitamin D, the activated form of vitamin D.

Non-modifiable risk factors:

Ethnicity

Bone density differs among different ethnicities. Studies have found that Africans have higher BMD and lower fracture rates than both Asians and Caucasians.

Age

For a given bone mineral density, fracture risk increases as bone quantity and quality deteriorates with age. Reduction in muscle mass, strength, and balance all increase fall and fracture risk.

Sex and Hormones

The single greatest contributor to bone mineral loss and fracture risk is decreased hormone levels. In women, the abrupt reduction in oestrogen that occurs with menopause leads to an acceleration of bone mineral losses.

Prevention of osteoporosis:

Guidelines suggest eating whole foods, consuming adequate protein, having a diet with many dark green leafy vegetables, as well as avoiding excess sugar, alcohol, and smoking.

The table below extracted from J Contemp Chiropr 2023, Volume 6, illustrates the lifestyle behaviour and supplements known to improve bone density.

Exercise can safely increase skeletal loading and stimulate positive bony adaptations to mechanical stress. The overall goal of training should be to reduce the risk of falls and improve strength and mobility. Walking has been found to increase muscle tone and overall fitness, as well as reduce the number of fall events, but this has only shown minimal changes in BMD. Resistance and higher impact training such as weightlifting and running offer greater benefits to BMD. Yoga, tai chi, unipedal standing, and walking, though less beneficial for bone density than impact exercise, still show significant value for overall health, balance, and fracture reduction.

How can your chiropractor assist?

Chiropractors are neuromusculoskeletal specialists. Your spinal health (as well as every other joint and muscle group in your body) is the bread and butter of our profession. We can do a functional assessment, check muscle tone and balance, assess your nutritional intake and lifestyle factors. If necessary we can also refer for xrays and BMD assessments.

At your appointment we will improve your bony alignment, improve muscle tone and strength, and set you on the right track to take charge of your health.

Spinal adjustments/mobilisations are gentle and safe. They aim to improve posture and mobility. Adjustments can also improve balance and prevent falls.

Ready to book an appointment? Our practice is in Ballito and serves the surrounding North Coast community. We have got your back!