Non-medicinal management also has a role in treating osteoporosis. This includes use of orthoses such as spinal braces and hip protectors, exercise programs, calcium and vitamin D, fall prevention, and kyphoplasty. These complement drugs, and are part of an interdisciplinary comprehensive plan for the treatment of patients with osteoporosis.

Non-drug management is critical in patients who cannot or will not take anti-osteoporotic medicine. There is limited data on the long-term use of osteoporosis medicines and thus concern about side effects. As debate surrounds the ideal drug plan, these interventions are important when considering treatment.

There are many braces on the market. A posture training support vest with a 1.5 pound weight reminds patients to extend their thoracic spines. The Spinomed brace has a back pad and strap system to strengthen the trunk muscle and improve posture. Although braces may provide pain relief by reducing the loads on the fracture sites and aligning the vertebrae, long-term bracing may lead to muscle weakness and further de-conditioning. Hip protectors contain padding over the trochanters to help absorb the impact of a fall. The use of hip protectors is controversial and contradictory. Their use has been shown to be cost-effective, but often they are not used because of discomfort or appearance.

Exercise can result in many benefits and increase strength, flexibility, balance, and lessen the risk of falling. Exercise has also been shown to increase bone mineral density. Larger changes are made in patients who undergo exercise and take medicine than in patients who only take medications for osteoporosis. Patients with osteoporosis should do regular weight bearing and thoracic-stabilization exercises. Weight-bearing exercises, such as walking, help to stimulate osteoblasts to form bone. Thoracic- stabilizing exercises that strengthen the back extensor, help to improve posture and may reduce the risk of falls. Flexion-biased exercises such as abdominal crunches, lifting heavy weights, and excessive twisting and bending should be avoided if you have osteoporosis of the spine. It has been theorized that strong back extensors might reduce the risk of developing thoracic vertebral compression fractures.

Both calcium and vitamin D are essential for osteoporosis. Calcium is available in different forms. The most common are calcium citrate and calcium carbonate. Calcium carbonate requires an acidic environment to be activated therefore should be taken with meals. People using antacids or who lack this acidic environment should not take calcium carbonate. Vitamin D allows calcium to be absorbed thus promoting bone health. Vitamin D deficiency can cause osteoporosis in the elderly, and failure in adolescents to reach peak bone mass. The body makes vitamin D with sun exposure. Sunlight converts 7-dehydrocholesterol in the skin to vitamin D3 that is metabolized in the liver to 25-hydroxy vitamin D3, which in turn is metabolized to the biologically active form, 1,25-dihydroxy vitamin D3 in the kidneys. Air pollution, overcast weather, and use of sunscreen all impact on vitamin D’s production. 5-10 minutes of sunlight to the arms and legs, or hands, arms and face 2 or 3 times a week is recommended. Current RDA is 400 IU, but it is suggested at least 800 IU daily be taken and more may be necessary in some. Serum level of 25-hydroxy vitamin D should be maintained at a minimum of 20 ng/ml and optimally between 30-55 ng/ml.

Top of Page

Each year falls occur in one third of older adults and are a major cause of morbidity and mortality. Those with osteoporosis are at highest risk for developing fractures and functional limitations after falling. Gait and balance disorders, weakness, dizziness, environmental hazards, confusion, visual impairment, and postural hypotension all contribute to falls. Other causes of falls and injuries include leg weakness, gait and balance instability, poor vision, cognitive and functional impairment, sedating and psychoactive medicines, and use of diabetes drugs. Patients who have fallen in the past year are more at risk for falling. Gait and balance should be assessed to help determine fall risk and specific steps started to help minimize this risk.

Fall prevention involves home modifications, medication review, exercise interventions, gait assessment, use of assistive devices, and attention to conditions resulting in unsteady gait. Home modifications consist of minimizing clutter, altering slippery surfaces, and providing grab bars and other supports in tubs and near toilets. Multiple medications play a key role in falls. For example, excessive doses of blood pressure medicines can cause hypotension resulting in lightheadedness and subsequent falls. Review of medicines should be done regularly eliminating unnecessary and potentially harmful ones.

Exercise can include specific balance exercises as well as tai chi, beneficial in reducing falls. Tai chi has also been shown to have positive psychological effects, may decrease fear of falling and result in improvements in self-perceived health.

Assistive devices such as canes and walkers can be used for steadier gait. Canes should be properly fitted and patient instructed as to their proper use. Conditions such as cervical myelopathy, lumbar spinal stenosis, vitamin B12 deficiency, normal-pressure hydrocephalus, and Parkinson's disease can result in abnormal gait thus increasing falls. These problems should be considered when diagnosing the cause of recurrent falls. They require prompt, appropriate treatment to improve gait.

This is a minimally invasive procedure that puts bone cement into a fractured vertebral body with a balloon tamp relieving acute painful compression fractures after conservative treatment has failed. It can also reduce kyphosis. Some risks to this procedure include spinal cord compression, nerve root compression, venous embolism, pulmonary embolism, and recurrent vertebral fracture (estimated 10% within first 90 days following procedure). A study by Garfin showed that balloon kyphoplasty resulted in rapid, significant, and long-term improvements in back pain, back function, and quality of life.

For patients who cannot or will not take osteoporotic medications, non-drug management is important. As debate continues around the ideal medicine, the above interventions will have a more definitive role in future treatment options.

Top of Page