Osteoporosis is a disorder that few of us will be unfamiliar with. Stemming from low bone mineral density or impaired bone microarchitecture, this disorder of decreased bone strength elevates the fracture risk of its sufferers. Sadly, changes to bone density often go unnoticed and untreated until an injury occurs. So what exactly is best practice when it comes to caring for those who live with the condition? A recent study published in the Journal of Contemporary Chiropractic laid it all out for chiropractors. While it does not delve into the specifics of adjusting those with osteoporosis, it tells us what the literature currently offers up in terms of holistic approaches to wrap around the person under care with an eye to inform chiropractors of the recommended treatment and prevention of osteoporosis present in current literature. [1]
Current statistics emerging from The Australian Institute of Health and Welfare show that the condition is relatively common. The Institute estimates the prevalence of osteoporosis among those ages 50 and over sits at 23% of women and 6% of men. [2] While we can already see that women are more at risk than men, another particularly vulnerable subgroup is women over the age of 60.
Hip fractures as a result of osteoporosis are particularly dangerous, with a staggering 30% mortality within 12 months. Over half of survivors are permanently impaired, with many remaining bedridden. Annual osteoporotic hip fracture occurrence worldwide is projected to increase fivefold by 2050. [3,4]
Current preventative paradigms for osteoporosis recommend supplemental doses of calcium and Vitamin D. While pharmacological interventions suggest bisphosphonates and oestrogen, neither can be recommended for long-term use due to the risks associated with their ongoing use. The review published in the Journal of Contemporary Chiropractic reviewed current literature pertaining to osteoporosis and the major themes associated with its diagnosis, treatment, and prevention.
The method of review for the advisory study was thorough, with keyword searches run to turn up 188 human intervention trials and basic science articles. What then did the study find?
Some of the included data is unsurprising. Still, the collation of basic science and human intervention trials for the purpose of informing chiropractic practice remains invaluable. The authors of the study reminded readers that bone is a living tissue composed of organic compounds such as collagen, inorganic calcium hydroxyapatite, and other minerals. It is metabolically active and is constantly responding to our external stressors and mechanical stimuli.
As it is a living tissue, it renews itself through ‘remodelling’ whereby tissue is removed and replaced as required by specialised cells.
By the time you reach adulthood, most of your bone mass has been developed, with the rate of bone removal and replacement relatively balanced. In conditions such as osteoporosis, more bone is being removed and reabsorbed into the bloodstream than is being laid down, increasing the porosity of the bone.
Cases of osteoporosis can be divided into two categories: primary and secondary. Primary osteoporosis is associated with normal ageing and results from decreased levels of sex steroid hormones. Secondary osteoporosis arises from other medical conditions or the use of medications that interfere with bone reformation. Disorders of calcium metabolism and bone demineralising medications account for approximately 78% of the secondary causes.
How is it diagnosed? Bone strength, Dural energy X-Ray absorptiometry, fracture risk assessment tool (age, sex, weight etc), and lab testing for bone turnover markers all contribute to the diagnostic picture.
It is important to note that while risk factors do indeed exist, they can be classed as modifiable and non-modifiable. For the former, things under our control include medication, diet, lifestyle, smoking status, and environment. Non-modifiable risk factors include age, ethnicity, genetics and hormones.
Where the paper gets interesting – prevention and treatment
The paper put forth the current guidelines for prevention and treatment, and it’s no surprise that a holistic approach is best. Dietary guidelines for prevention include eating whole foods, consuming adequate proteins, and dark green leafy vegetables, and avoiding excess sugar, alcohol and smoking. Ensuring patients are achieving adequate vitamin and mineral intake from their diet is also an important aspect of prevention and treatment. Vitamin D and calcium do contribute to skeletal health across the lifespan, and a well-balanced diet and overall adequate intake of vitamins and minerals are also important.
The paper makes particular note of Vitamin C, Vitamin K, B6, B9, B12, Magnesium, and some other compounds such as collagen, melatonin, and dried plums. The authors also point out that while prescription treatments have grown over time, compliance and risks are still concerns.
The final set of recommendations includes exercise therapies that should seek to safely increase skeletal loading and stimulate positive adaptations to mechanical stress. Improved strength and fitness reduce the risks of falls and improve mobility. Improved fitness also improves the ability to recover from incidents. For those above 60, exercises such as volleyball, weight training and even dancing have been singled out as helpful for bone formation. Movement-focused exercises like yoga, tai chi, uni-pedal standing, and walking, though less beneficial for bone density than impact exercise, have shown significant value for overall health, balance, and fracture reduction.
The authors noted that the majority of American guidelines have a predominantly focus on treatment with medication. However, this review emphasised that treatment and prevention protocols should be viewed as guidelines that should be personalised to suit the individual.
Another worthy consideration is that chiropractic care has been found to reduce falls risks in older adults. This followed a swag of studies that look at sensorimotor integration and found improvements under chiropractic care. What’s the takeaway here? If we can reduce a patient’s falls risk through regular chiropractic care, and encourage them to continue in healthy active lifestyles with supplemental support, we can support their healthy aging journey.
Further research is needed to look at chiropractic care and osteoporosis directly. However, with the research indicating ongoing concerns around long-term pharmacological approaches and the clear indication that a holistic approach is best, it seems that chiropractic belongs somewhere in this picture.
References:
- Cook A, Moss T, Malaya C. OSTEOPOROSIS: A REVIEW FOR CHIROPRACTIC CLINICIANS. Journal of Contemporary Chiropractic. 2023; 6(1):29–51
- Estimating the prevalence of osteoporosis in Australia, Summary – Australian Institute of Health and Welfare. Australian Institute of Health and Welfare. 2014. Available from: https://www.aihw.gov.au/reports/chronic-musculoskeletal-conditions/estimating-the-prevalence-of-osteoporosis-in-austr/summary
- Fractured neck of femur. Prevention and management. Summary and recommendations of a report of the Royal College of Physicians. J R Coll Physicians Lond. 1989;23(1):8-12 5.
- Cooper C, Campion G, Melton LR. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2:285–289
