An ounce of prevention saves billions in disability

Simple exercises fight off debilitating disease

By Bruce R. Wilk, PT, OCS, Director

Karen Fischer, PT, Therapist

Orthopedic Rehabilitation Specialists Miami

Employers increasingly are demanding that their managed care plans provide wellness programs designed to reduce the risk of injuries and disability. Industry observers predict that case managers will find themselves called on more often to prevent disability costs as well as manage them.

Osteoporosis is often called the "silent disease" because bone loss occurs without symptoms. A bone density test is the primary method of diagnosing osteoporosis, but educating patients on proper nutrition and exercise, combined with early intervention, can minimize the debilitating effects of the disease or, in many cases, even prevent the full onslaught of osteoporosis.

Costs are rising

In fact, case managers have good reason to care about preventing osteoporosis. The estimated direct expenditures for osteoporosis and associated fractures is $13.8 billion, or $38 million each day, and rising, according to the National Osteoporosis Foundation (NOF) in Washington, DC. Other facts about osteoporosis from NOF include:

• 10 million Americans have osteoporosis.

• 18 million Americans have low bone mass.

• Osteoporosis is responsible for 1.5 million fractures annually:

— 300,000 of those are hip fractures;

— 700,000 are vertebral fractures;

— 200,000 are wrist fractures;

— more than 300,000 are at other sites.

Osteoporosis is characterized by low bone mass and structural deterioration of bone tissue, which lead to bone frailty and increased susceptibility to fractures of the hip, spine, and wrist. It’s common for the collapsed vertebrae initially to be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.

The decrease in estrogen production that occurs during menopause, in conjunction with generally lighter, thinner bones, are the primary reasons that osteoporosis affects women to a greater extent than men. The main risk factor for men is a low testosterone level. For women, in addition to gender, there are several other risk factors for osteoporosis. Those include:

• thin or small frame;

• advanced age;

• family history of the disease;

• early menopause;

• abnormal absence of menstrual periods;

• anorexia nervosa or bulimia;

• diet low in calcium;

• use of certain medications, such as cortico- steroids and anti-convulsants;

• inactive lifestyle;

• cigarette smoking;

• excessive use of alcohol.

Some good news

The disease is highly preventable. Eating a balanced diet rich in calcium, regular exercise, smoking cessation, and limited alcohol intake greatly reduce the risk of osteoporosis. In addition, specific exercises can help prevent the disease, as well as minimize the effects of the disease if it is present. These include weight-bearing, weight lifting, and postural endurance exercises. During these exercises, calcium is deposited throughout the skeletal structure in accordance with the stress put on it. In turn, the bones respond by strengthening.

A typical physical therapy program includes posture and body mechanics. A generalized strengthening program in which the patient learns proper lifting techniques will help protect the back. Flexibility and endurance exercises are included. Also, injury prevention and energy-saving techniques help arrest the symptoms of osteoporosis. This program, when developed and closely monitored, can lead to improved overall function with less chance of disability.

(Editor’s note: For an example of a 10-exercise program developed at Orthopedic Rehabilitation Specialists in Miami to fight osteoporosis, see insert.)