OSTEOPOROSIS IS A CHRONIC, PROGRESSIVE CONDITION that deteriorates bone in the body, leading to fractures. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass (osteopenia.)1 Osteoporosis is most common among older people, especially older women. Half of all women and a quarter of men older than 50 will break a bone due to osteoporosis.2
As musculoskeletal experts, chiropractic physicians can determine patients’ bone mineral density through evaluation and testing and provide effective and evidence-based treatment plans to maintain or regain the bone strength necessary for optimal health.
The U.S. Preventive Services Task Force (USPSTF) recommends that all women older than 65 and women younger than 65 at high risk for fractures receive a bone density test. The USPSTF finds that current evidence assessing the balance of benefits and harms of screening for osteoporosis in men is insufficient.3
Risk factors for osteoporosis include old age, being female, menopause, a family history of osteoporosis, low body weight and broken bones or height loss. The controllable risk factors include smoking, excessive alcohol use, an inactive lifestyle, lack of essential nutrients and various medications (e.g., glucocorticoids).4
To further determine who may be at high risk, doctors of chiropractic (DCs) can use FRAX® (Fracture Risk Assessment Tool) developed by the World Health Organization, to estimate 10-year fracture probability for patients age 40 to 90-years old, available at www.shef.ac.uk/ FRAX. The tool relies on easily obtainable clinical information, such as age, body mass index (BMI), parental fracture history, as well as tobacco and alcohol use.
R. Keith McCormick, DC, author of the book “The Whole-Body Approach to Osteoporosis,” recommends that women get a screening at age 45, five years before the average age of menopause, to detect low bone density. “The way I look at it is that it’s easier to keep the bone density rather than to wait until it’s lost,” he says.
A commonly used bone measurement test for screening osteoporosis is DXA (dual-energy X-ray absorptiometry) of the hip, lumbar spine and forearm.5 DXA produces test results in the form of both Z- and T-scores. To better understand bone mineral density (BMD) test results, read the National Institutes of Health webpage on bone mass measurement at http://1.usa.gov/1R43GLQ.
DCs can also check the rate of bone density loss by testing for various biomarkers that reflect both bone formation and bone resorption. When the rate of bone resorption exceeds the rate of bone formation, there is a net loss of bone mass.6 These lab tests include NTx, CTx and Dpd, among others.7 “You will notice the NTx and CTx results may be elevated in those who have a high rate of loss of bone density,” says Dr. McCormick. “You can almost always bring these levels down with nutrition,” he says.
Dr. McCormick, known as the osteoporosis doctor in Belchertown, Mass., refers his patients to medical doctors for bone density exams and lab tests to ensure the services are covered. The MDs return his patients’ results, and he is able to create individualized treatment plans for his patients.
In a 2015 study, researchers found osteogenic loading therapy (axial compression of the bone), as an adjunct to standard care, or as a preventive measure, is effective in improving bone mass density.8 Researchers discovered a statistically significant increase of functional bone performance and bone mass density in subjects with 24 weeks/sessions of osteogenic loading intervention. Osteogenic loading stems from Wolff’s law, which states that bone in a healthy person or animal will adapt to the loads under which it is placed.9
Researcher John Jaquish, PhD, explains that axial compression of the bone at multiple levels of one’s body weight provides the level of loading necessary for bone building and strengthening, and created a device that allows such loading.
“What I wanted to do with the device was to create something that would give the benefit of high impact without the risk of high impact,” he says. “With this device, patients use their own comfort to load into their body; the device helps to build peak bone mass.” Dr. Jaquish recommends that patients receive osteogenic loading therapy no more than once a week.
In addition to osteogenic loading, proper nutrition is essential in maintaining optimal bone health. Eating a well-balanced diet full of calcium and Vitamin D is paramount in maintaining or improving bone health. “If you’re not getting enough of these nutrients in your diet, then you should incorporate supplements into your daily regimen,” says Dr. McCormick.
Dr. McCormick, the founder of a supplement line, recommends vitamin D3, vitamin K2 (MK-4 and MK-7), alpha lipoic acid, N-acetyl cysteine and berberine HCL, among other nutrients, as a daily regimen.10 “The combination can decrease low-level chronic systemic inflammation and improve calcium absorption,” notes Dr. McCormick. “After my patients take these supplements, I notice that the bone resorption markers go down.”
He also encourages more individuals to add goat kefir into their diet. “It is a good source of calcium and probiotics that is both easily digestible and alkalizing.” A 2015 research study found that a 12-week treatment with kefir reduced levels of C-terminal telopeptides of type I collagen (CTx) and increased trabecular bone mineral density, bone volume and trabecular thickness.11
DCs may prompt their patients to download and use the mobile app Food4Bones created by the National Osteoporosis Foundation to manage their diets by accessing healthy recipes or finding information about the nutritional facts of their favorite foods.
It is also important to discuss fall prevention with your patients. “Increased strength, agility and coordination will prevent falls,” says Dr. McCormick. “Getting on an exercise regimen is important.” The U.S. Department of Health and Human Services recommends that older adults at risk of falls get at least 150 minutes per week of moderate-intensity physical activity. In addition, they should incorporate muscle-strengthening activities twice per week and balance training three or more days per week.12 (See sidebar.)
DCs should offer guidance to heavy drinkers and smokers, especially as research studies have shown that both negatively affect the bones.13 (See Dec. 2015 ACA News, “Cigarette Cessation: Tobacco’s Public Health Crisis” at http://bit.ly/1QX3dN3 for more information on speaking with patients who smoke. See “Public Health Crisis: Alcohol Abuse” on Page 14 of this issue to learn more about speaking with patients about alcohol abuse.)
DCs have the knowledge and now the resources to evaluate, diagnose and create an appropriate treatment plan for their at-risk or already osteoporotic patients. “DCs bring a whole different approach to osteoporosis without the use of medicine,” says Dr. McCormick. All DCs should take advantage of the opportunity to be a part of helping patients with osteoporosis – a common condition among older Americans.
The Whole-Body Approach to Osteoporosis
IN HIS BOOK, “THE WHOLE_BODY APPROACH TO OSTEOPOROSIS," R. Keith McCormick, DC, discusses the foods osteoporotic individuals (and those at risk of osteoporosis) should incorporate into their diets, as well as the medications that may be contributing to bone loss. Read about the book here: http://bit.ly/1JEK0Iq.
Fall Prevention Resources
FALL PREVENTION IS AN IMPORTANT INTERVENTION in preventing fractures in individuals with osteoporosis or osteopenia, who are at greater risk of fractures. ACA offers doctors of chiropractic (DCs) many resources to share with their patients to help them reduce the likelihood of falling (see www.acatoday.org/falls.) Resources include fact sheets on staying healthy as you age and infographics with advice that are perfect for social media sharing. In addition, the U.S. Preventive Services Task Force (USPSTF) offers recommendations on preventing falls: http://bit.ly/1OUoDEy.
A RETROSPECTIVE COHORT STUDY PUBLISHED in January 2016 in the JAMA Internal Medicine found that two-thirds of women receiving medication for osteoporosis may not have needed treatment. Sixty percent of the women who underwent DXA screening were between the ages of 40 and 64 years and lacked any osteoporosis risk factors. To avoid overtreatment, the authors write that doctors should follow the International Society for Clinical Densitometry diagnostic guidelines available here: www.iscd.org/official-positions/2013-iscd-oThcial-positions-adult.
8) https://79471b720a5838746911-88d50621e0f8da6d-50792584fec156ec.ssl.cf5.rackcdn.com/hunte-jaquish-huck- 2015-fbp-and-bmd-gains.pdf.
9) www.angle.org/doi/pdf/10.1043/0003-3219(1994)064%3C0175 %3AWLABSA%3E2.0.CO%3B2.