Nail Clinic: Osteoporosis

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Make no bones about it: Women are four times more likely than men to be affected by this silent disease.

The United States' population has experienced a major shift, resulting in an aging population with specific needs. If you or your clients are over the age of 50, it's time to sit in a well-supported chair and learn about a condition that threatens this age group: osteoporosis. According to the National Osteoporosis Foundation (NOF), the condition is considered a "major public health threat" for an estimated 44 million Americans, or 55% of people aged 50 years and older. While it's true the disease is more prevalent among older people, osteoporosis can strike at any age—and because 80% of those affected are women, you, your co-workers and your clients may be at risk. With the addition of celebrity spokeswomen, the condition has been relatively well-publicized, but many people may not realize what preventative measures can stop osteoporosis from affecting them later in life. In this month's Nail Clinic, you'll learn more about the causes, prevention and treatments for a disease that affects so many Americans—with numbers expected to increase because of a growing senior population—and how you can make living with osteoporosis a little easier.


Close to the Bone


The NOF reports that osteoporosis (which means "porous bone") is "characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist." But that doesn't mean other bones aren't affected. "The weakened tissue is due to changes in the amount and structure of the bone," notes Susan Randall, senior director of science and education for the Washington, D.C.-based foundation. "Bone breaks often occur with minor accidents such as falls, or banging into objects, but can even occur without any injury." Even a simple sneeze can cause a bone fracture in a person with a severe case of osteoporosis.
This reduced bone density is a natural progression that occurs as a by-product of the aging process, and many osteoporosis sufferers may not realize they have it. "This is a silent disease—you can't necessarily feel it," explains Georgeanne Botek, DPM, FACFAS, spokeswoman for the Chicago-based American College of Foot and Ankle Surgeons (ACFAS) and surgeon at the Cleveland Clinic in Cleveland. "The progression may accelerate in women who smoke, are naturally petite or are less physically active, but many find out they have osteoporosis only when they break a bone."
As Botek alludes to, some risk factors are present, and lifestyle choices can lessen the risk of the development. Randall recommends the following preventative steps:

  • Get the daily recommended amounts of calcium and vitamin D
  • Engage in regular weight-bearing and muscle-strengthening exercise
  • Avoid smoking and excessive alcohol
  • Talk to your healthcare provider about bone health
  • Have a bone density test and take medication when appropriate

Randall explains that, ultimately, the best steps to take are education and dialogue with a medical professional. "The single most proactive thing you can do to prevent osteoporosis is to know your risk factors for the disease," she says. "You're more at risk based on factors such as your family history, diet, activity level, race and ethnicity, or other medical conditions you may have." Indeed, some medicines, such as steroids, and some conditions—as diverse as celiac disease, menopause, diabetes, arthritis, breast cancer and even mental illnesses such as depression—can also contribute to bone loss.

Detection and Treatment


At a certain point, women and men should have a bone density test to determine if they are susceptible to osteoporosis (the age varies according to factors such as gender and the occurrence of recent bone fractures). A related condition, osteopenia, may be detected in such a test; this is a lower bone density caused by bone loss or simply natural bone structure, and if left untreated may advance to osteoporosis. "A bone density test should be given every three to five years as part of regular screening, especially as people are living longer, more active lives," notes Botek. "Rather than waiting for a fracture, a preventative screening test can lead to early identification, preventing further damage." She adds that a normal X-ray may not recognize bone density loss, because a person would need to suffer a 30% bone loss for it to show up on X-rays.
After diagnosis of osteoporosis with a bone density test, an individual has a range of treatment options available. "To minimize the effects of osteoporosis, the patient should talk to her healthcare provider to determine what treatment options would be best for her," recommends Randall. "Those options may include prescription medications, physical therapy, or changes to one's diet and exercise routine." Randall points out that the Food and Drug Administration has approved a range of medications that can slow or stop bone loss and reduce the chance of a broken bone, including bisphosphonates, calcitonin, estrogen, parathyroid hormone and others.
Lifestyle changes can also help greatly if osteoporosis is diagnosed. "Managing your risk factors and improving your bone density test are the goals, but there is no cure," Botek reminds us. "However, simple steps, such as building up to physical activity and not walking in ill-fitting shoes, can prevent injuries or fractures." The ACFAS recommends that clients protect their feet from stress fractures by wearing shoes that provide support and cushioning, such as athletic running shoes, to provide extra shock absorption and protection. Custom orthotics may also be recommended to protect the foot from pressure and provide shock absorption, particularly during exercise.


Tips for Techs


Understandably, this silent disease can have a significant impact on one's physical and mental well-being. How can you help a client who has osteoporosis? What if you're the one affected? Randall recommends the following for techs and their clients:

  • Ask a client if she has any discomfort in a particular area of the body before starting massage, and instruct the client to tell you if she experiences pain at any time while you are working. If pain occurs, stop massaging that area or change the level of pressure.
  • Have appropriate seating available for clients with back pain. Often, the most comfortable seating is in a straight-backed chair, rather than a low-sitting, overstuffed chair.
  • Help older clients stand up, if needed, and make sure to clear away any obstacles that may cause falls.
  • Maintain good posture and proper body mechanics to prevent back injury, and stay active. (For those with osteoporosis, proper posture can help limit the amount of kyphosis, or forward curve of the upper back, that can result from broken bones in the spine.)
  • Practice proper alignment to put less stress on the spine. For example, when sitting in a chair, try to keep your hips and knees at the same level. Place your feet flat on the floor. Keep a comfortable posture. When sitting in bucket seats or soft couches or chairs, use a rolled-up towel or pillow to support the lower back.

As we get older, certain changes are a natural part of life—perhaps we notice a few more wrinkles or find it more difficult to lose those last five pounds.
The bone density changes that cause osteoporosis are also inevitable. However, prevention and early detection can go a long way toward minimizing how this disease affects us. And if you do encounter a client who has the condition, with the proper precautions, you can ensure that one life change she doesn't have to face is giving up the soothing time she spends at your salon.

Tracy Morin is a freelance writer and editor based in Oxford, MS.