Rehabilitation Assoc. Of Long Island
Osteoporosis Program at RALI
Osteoporosis is a serious problem that can lead to bone fractures. Worldwide, osteoporosis causes more than 8.9 million fractures annually, resulting in an osteoporotic fracture every 3 seconds. It is a very common disease and affects over 10 million Americans. Osteoporosis primarily affects women, but men can develop the disease. In fact, approximately 2 million men have osteoporosis—that’s 20% of all cases in the U.S.
Osteoporosis risk factors include cigarette smoking, alcohol use, carbonated beverages with phosphoric acid and certain medication, such as steroids, antacids, antidepressants, and anti-seizure medication. Physical inactivity and a sedentary lifestyle as well as impaired balance are risk factors for developing fragility fractures.
There are 3 types of cells involved in maintaining healthy bone. They are the osteoblasts, which make bone. Osteoclasts, which remove bone and the cell that manages their activity called the osteocyte. When they work in coordination bone is kept strong and healthy. Bone is kept strong by a process called Remodeling. In this process, weak; brittle old bone is removed by osteoclasts and new bone is made to replace it by osteoblasts. Normally this process is balanced and the bone removed equals the bone made. But in osteoporosis there is an imbalance with the osteoclasts working more than the osteoblasts. This results in the net loss of bone. It affects both men and women but postmenopausal women are more affected due to estrogen loss associated with menopause. Estrogen decreases the actions of the osteoclast and increases the action of the osteoblasts. When estrogen levels drop, osteoclasts are more active than the osteoblasts and bone is decreased at a faster rate. In fact, woman lose 30% of their bone mass in the first 5 -8 years after menopause starts.
Osteoporosis is diagnosed by measuring the density of the bone by a DEXA test. This test examines the amount of bone in the body; usually the hips and the spine. People with T scores of -2.5 or less have osteoporosis. Lab tests are also done to check for other causes of bone loss.
Osteoporosis can be treated and managed effectively with a combination of risk factor reduction, exercise, diet, lifestyle improvements and medication. Sclerostin is a protein made osteocytes that decreases the activity of osteoblasts. Recent research has found that weight bearing exercise decreases sclerostin levels and increases the activity of the osteoblasts. The daily consumption of foods or supplements with 1000-1200 mg of calcium and 800 units of vitamin D are important for the treatment of osteoporosis.
Medications that treat osteoporosis are divided into antiresorptive medications and anabolic medications. Antiresorptive medications decrease the activity of osteoclasts. These medications are divided into Bisphosphonates and a Monoclonal antibody that decreases osteoclast function. Bisphosphonates inhibit resorption of the bone by causing the osteoclast to undergo aptosis, or cell death. They do this by decreasing the osteocytes ability to make energy.
The oral bisphosphonates are alendronate (Fosomax), risedronate (Atelvia and Actonel) and ibandronate (Boniva). Intravenous forms are zolidrinic acid (Reclast, Zometa and Aclasta). Denosumab (Prolia) is a biologic antibody medication that decreases osteoclast activity by blocking RANKL. RANKL is an important cell signaler that stimulates osteoclast activity.
The other class of medications are the anabolic medications that increase bone formation. The only medication now is teriparatide (Forteo). This medication increases bone formation.
The use of bisphosphonates and Prolia have been associated with bone fractures and jaw necrosis. Forteo use has been linked to developing a form of bone cancer. These occur very rarely.
We have developed a program to fight the effects of osteoporosis and decrease your risk of getting a fracture and increasing your bone strength.
Our program provides 3 areas of patient involvement;
Education about normal bone structure and function. Information on how aging affects bone, risk factors for osteoporosis, the role of estrogen and other hormones, information about medications and conditions that can cause bone loss. The education program will consist of individual and group discussions and short quizzes to improve your knowledge about osteoporosis. Education is key to improvement of your condition.
Nutrition information about how to get the proper amount of Calcium and Vitamin D from foods and information on Vitamin K, boron, collagen and magnesium which are important in healthy bone function.
Exercise Our program is individualized to your level of fitness. The program consists of many different types of exercise that have been found to contribute to increasing bone strength.
Before starting the program your strength, flexibility and balance will be tested. Special tests including the BERG, Tinetti, TUG, and Timed sit to stand will be done.
Based on the results of these tests a personalized exercise program will be developed for you. The program contains specific exercises that have been found to improve bone strength and prevent falls.
The program has 5 types of exercise:
1.Strength training of the arms, legs and spinal area muscles.
2. Flexibility exercises to decrease the stiffness of your legs and back.
3. Moderate impact weight bearing exercises to increase your bone density.
4. Coordination exercises to improve your balance and decrease your fall risk.
5. Endurance training to improve your stamina and cardiovascular system.
During the program your vital signs and oxygen saturation will be monitored by the staff to ensure a safe work out.
Your progress will be evaluated on a regular basis and your exercises advanced to attain maximal improvement. You will be provided homework during your program to maintain your gains.
After the program, you will be more confident, stronger and be better able to deal with your osteoporosis.