As a massage therapist, it’s likely you will see clients who present with osteoporosis, as the U.S. population continues to age. Up to 54 million Americans are affected by osteoporosis and low bone mass, with over 10 million confirmed diagnosed cases. It is predicted that 25% of individuals 80 years and above will acquire this condition.
What is Osteoporosis?
Osteoporosis is a metabolic bone disease featuring a gradual reduction in bone mass. The bone weakens, causing the body’s structural framework to become less stable. This will make a person more prone to fractures from falls or any direct impact upon bones.
Healthy bone matter appears as a honeycomb. Literally, the term osteoporosis means “porous bone,” as microscopically the gaps and spaces in among healthy bone matter structure are larger than expected. The normal honeycomb matrix of bone becomes atrophied and less dense.
Bone density at some point in our life begins to drop and the rate may accelerate due to lifestyle factors. Depending on one’s activity level, nutritional support and exercise routine, one’s bone density does not have to begin dropping until elderly years. Both spongy and compact bone may deteriorate over time.
In essence, osteoporosis is an advancement of osteopenia, a condition in which one’s bone density test score is between 1 and 2.5 standard deviation below the mean test score within similar age ranges. A typical bone density test uses X-ray imaging to measure grams of minerals such as calcium and phosphorous within segments of bone matter.
Current estimates from the International Osteoporosis Foundation suggest up to 54 million Americans are affected by osteoporosis and low bone mass, with over 10 million confirmed diagnosed cases. Eighty percent of cases are witnessed in females. It is predicted that 25% of individuals 80 years and above will acquire this condition.
Peak bone mass is achieved between the ages of 26 to 29 years of age. After this peak is achieved, one may experience an annual loss of bone density. Women tend to experience minimal reduction of bone mass from age 30 until the onset of menopause when bone mass reduction dramatically increases.
Signs and Symptoms
Osteoporosis is commonly referred to as a “silent disease,” as signs and symptoms may not manifest visibly while bones are weakening. Once bones have weakened to a significant level, common manifestations include:
• Shrinking in height
• Stooped posture
• Bones fracture easily
• Back pain caused by fractured or collapsed vertebrae
• Thoracic kyphyosis, aka “humped back”
Risk Factors
Here are general risk factors that may increase one’s chance of acquiring this condition.
• Bone cell activity—As we age osteoblasts, cells which build new bone, wane in activity whereas osteoclasts, cells which decay bone matter, remain constantly active.
• Physical activity—As one stays physically active, osteoblast activity can remain high keeping bones stronger later in life.
• Injuries—Prior history of injury can weaken bones more quickly.
• Hormonal influence—A decline in estrogen and progesterone levels may accelerate bone loss.
• Dietary influence—A diet deficient in calcium, phosphorous, magnesium and iron contributes to weakening of bone.
• Smoking—Chemicals within cigarettes will have a negative effect on all body tissues, including bone.
• Alcoholism—Long-term alcohol consumption has been shown to interfere with bone growth and repair.
In addition, patients with these medical conditions are also at higher risk of developing osteoporosis, as nutritional support for bone will be lacking:
• Hyperparathyroidism
• Thyrotoxicosis
• Severe hepatic failure
• Severe renal failure
• Pituitary adenomas
• Adrenal disease
• Malabsorption diseases
• Multiple sclerosis
• Rheumatoid arthritis
• Lymphoma
• Leukemia
• Diabetes
Treatments for Osteoporosis
These drugs have been directly linked in scientific study to increasing susceptibility to osteoporosis:
• Immune suppressors
• Steroids
• Seizure medication
• Heparin
• Lithium
• Thyroid medication
Bisphosphonates are a classification of drugs commonly used to treat osteoporosis patients. Their purpose is to slow the breaking down process of bone (slowing the progression of osteoporosis). Examples of these drugs include: Fosamax, Actonel, Boniva, Reclast and Xgeva.
Common side effects include heartburn, stomach ulcers, nausea, vomiting and other gastrointestinal concerns. Doctors will also recommend adding an exercise routine, improve nutrition, quit smoking and limiting alcohol consumption to further aid treatment efforts.
Strontium treatments are also employed by many health professionals in treatments. Strontium is a rare element found only in seafood. Chemically, strontium is similar to calcium. It is believed that women with osteoporosis cannot assimilate either calcium or strontium effectively. In many European nations as well as Australia, a product named Protelos has been used for the treatment and prevention of osteoporosis.
Forteo is a new medication now available to osteoporosis patients in adult males or postmenopausal women. This drug can only be utilized for a two-year period as of now due to long term side effect risks which include potential liver, kidney, stomach, spleen and nervous system damage.
Abaloparatide is another newer medication to aid osteoporosis patients in postmenopausal women, especially in individuals with a high risk of bone fracture. Side effects include bone pain, hypercalcemia, kidney stones and dizziness.
Both Forteo and Abaloparatide are administered via injections so it will be important for the massage therapist to be aware of injection sites.
One final treatment proven effective at slowing the rate of bone mass loss are SERMs (Selective Estrogen Receptor Modulators). The most popularly used of this brand of drug is called Evista and acts to provide women with the great benefits of estrogen without the hormone’s typical side effects. This drug is known as a “designer” estrogen, in that it may act to protect bone density and aid in birth control measures for females.
Massage for the Osteoporosis Patient
There are many measures a massage therapist can take to assist osteoporosis patients. Here are my recommendations:
• Include tapping, vibration or light percussion during sessions to stimulate osteoblast activity.
Include passive movements and stretching during sessions to aid joint health.
• Shiatsu massage and Thai massage are two modalities that include much passive movement and stretching.
• Perform massages in chair in case of patients with inability to lay upon a massage table.
• Be careful when applying deep compression force during sessions. Avoid causing too much deeper pressure force upon weakened bones.
• Ensure to inquire during intake on:
• How will drugs affect their body (side effects)
• Activity levels during their days (what hurts to do, what is easy to do)
• Where is most pain experienced today
Osteoporosis patients can experience less pain, slow progression of bone loss and experience fewer fall accidents when incorporating massage therapy into their health regimen.
About the Author
Jimmy Gialelis, LMT, BCTMB, is owner of Advanced Massage Arts & Education in Tempe, Arizona. He is a National Certification Board for Therapeutic Massage & Bodywork-approved provider of continuing education, and teaches classes on pathology and many other topics. He is a regular contributor to MASSAGE Magazine, and his articles include “Massage for Trauma: 3 Ways of Responding to an Emotional Release” and “This is How Proprioceptive Neuromuscular Facilitation Helps Muscular Function.”