Can Chiropractic Care Help Osteoporosis?

Chiropractic care does not treat osteoporosis directly, but some people with osteoporosis may wish to use it for symptoms associated with osteoporosis or other musculoskeletal conditions.

Because chiropractic manipulations apply pressure to bones, people with osteoporosis may be advised to avoid chiropractic care. Modified chiropractic care may be performed with special care taken to avoid injury if a person's healthcare provider approves.

In osteoporosis, bones lose minerals like calcium faster than the body can replace them. They become less dense and more vulnerable to fractures. Osteoporosis usually is treated and prevented with lifestyle practices, such as diet and exercise, and sometimes medication, but more treatment options are always being explored.

This article will discuss the benefits and risks of chiropractic care for someone with osteoporosis.

Osteoporosis Symptoms and Long-Term Effects

People with osteoporosis may experience no symptoms at all, especially in the early stages. Without testing, the first sign of osteoporosis is often a fracture.

Osteoporosis causes a loss in bone mass and structural deterioration in the bone. These changes can be found with proper screening and testing before a fracture occurs.

Fractures can happen anywhere, but the ones most commonly associated with osteoporosis are:

• Vertebrae (bones of the spine)
• Hip
• Wrist and distal forearm (part closest to the wrist)
• Pelvis
• Humerus (upper arm)

Complications from fractures due to osteoporosis include:

• Pain
• Height loss
• Kyphosis (an abnormal bending forward of the spine, resulting in a humped appearance, sometimes called a dowager's hump)
• Posture changes
• Loss of mobility
• Restrictive lung disease
• Gastrointestinal (GI) problems such as constipation
• Increased risk of further fractures
• Mental health difficulties such as depression or low self-esteem
• Increased risk of death (associated with hip fractures)

Is Chiropractic Treatment Helpful for Osteoporosis?

There is insufficient evidence to show that chiropractic care can treat osteoporosis directly or indirectly. While about 15% of people who see a chiropractor are age 65 or over, often they visit the chiropractor to address musculoskeletal problems.

Some chiropractors claim that although chiropractic care does not treat osteoporosis, it may help people with osteoporosis by:

• Reducing symptoms, especially those related to spinal compression fractures
• Identifying compression fractures and evidence of osteoporosis using X-rays
• Advising clients on steps they can take to prevent further fractures and loss of bone density, which further tests may be needed, and which healthcare providers to see
  

Safety and Risks of Chiropractic Care

Spinal manipulation can pose a risk of injury, including bone fracture, in people with osteoporosis. Some healthcare providers recommend against chiropractic care for people with osteoporosis in general or in certain areas, such as the spine or neck.

Making adjustments to the treatment, such as using lower-force techniques, may be an option for people with osteoporosis if their healthcare provider indicates it is safe for them to do so.

If you choose to see a chiropractor, check their credentials and whether they have training and experience treating people with osteoporosis.

Before providing treatment, chiropractors should screen for risk factors for osteoporosis. Some factors contributing to the incidence of osteoporosis are:

• Sex (osteoporosis is more common in women)
• Older age
• Lack of physical activity
• Smoking
• Alcohol intake
• Prolonged use of glucocorticoid/corticosteroid medication, such as prednisone
• Previous fragility fracture (a fracture that would likely not have occurred in a person without osteoporosis from the same action, such as a fall from standing height)
  

Other Ways to Prevent and Treat Osteoporosis

Osteoporosis doesn't have a standard, universal treatment. Care is determined based on a patient's specific needs and factors such as fracture risk.

Nutrition

If the body does not get enough calcium from outside sources, it will take it from the bones. Getting enough calcium in your diet is an important step to building healthy bones and keeping them strong.

How much calcium a person needs depends on factors such as age, sex, and whether pregnant or lactating (breastfeeding).

Foods that are a good source of calcium include:

• Dairy (highest)
• Spinach
• Almonds
• Sardines
• Foods fortified with calcium, such as some juices, cereals, or cereal bars

If you aren't able to get enough calcium through diet, your healthcare provider may recommend that you take calcium supplements.

An adequate amount of vitamin D is also important for helping the body absorb calcium. Most vitamin D humans get is produced by the body after exposure to the sun. But it can be hard to get enough vitamin D this way because of vital safe-sun practices like sunscreen.

Vitamin D can also be obtained through some foods, but getting enough vitamin D through diet alone is unlikely. Small quantities of vitamin D can be found in foods such as:

• Eggs
• Fatty fish (herring, salmon, mackerel)
• Liver
• Foods that are fortified with vitamin D, such as some dairy products
  

Talk to your healthcare provider about testing your vitamin D levels to see if you would benefit from taking vitamin D supplements.

Exercise

Weight-bearing exercise (activities that make the body work against gravity) doesn't treat existing osteoporosis, but it encourages bone density and is a good way to help prevent osteoporosis. It can also improve balance which reduces the risk of falling (a common cause of osteoporosis-related fractures).

Benefits from exercise start to diminish once exercise is stopped, so developing a lifelong habit of staying active is most effective.

Try to aim for a combination of weight-bearing, muscle-strengthening, and balance training exercises in 30- to 40-minute sessions four to six days a week, or 75-minute sessions twice a week.

Exercises for bone growth need to include variety. Some activities to try are:

• Walking, hiking, or jogging
• Tennis
• Dancing
• Aerobics, such as Zumba
  
• Strength/resistance training
• Tai chi
• Gentle yoga (some poses may need to be modified or avoided)
• Pilates
• Sit-to-stand exercises
• Wall sits
• Stair-climbing while holding the handrail

If it is safe for you to do so, you can add in some higher-impact activities, such as jumping rope.

Activities such as swimming, cycling, and other non-weight-bearing activities, do not promote bone growth, but have other health benefits.

Whether you have osteoporosis or not, always talk to your healthcare provider before starting a new activity or exercise routine.

Quit Smoking and Avoid or Limit Certain Substances

Some substances can increase the risk of developing osteoporosis, including:

• Smoking: Don't smoke. Smoking interferes with bone formation, affects estrogen metabolism (which may result in earlier menopause), and can slow the healing of fractures.
• Alcohol: Avoid alcohol or limit it to no more than one to two drinks per day (and at least two days a week without any alcohol). In addition to increasing the risk of osteoporosis, excessive alcohol also creates a fall risk.
• Caffeine: Avoid caffeine or limit caffeinated drinks to no more than two to three cups a day of coffee, tea, or cola. Caffeine can interfere with calcium absorption.
  

Avoiding Falls

About 1 in 4 people 65 and older in the United States report falling each year, and 37% of those who fall sustain an injury. Osteoporosis can put you at risk of fractures from even a minor fall.

Some measures you can take to reduce your risk of falling include:

• Under the guidance of a healthcare provider, regularly perform exercises that strengthen your balance, such as tai chi or yoga (swimming and cycling may also help).
• Check your home for fall hazards and address them, such as adding handrails on stairs and in the shower and toilet, removing loose rugs, making sure all areas of a room are well-lighted, checking for slippery and/or uneven surfaces, and managing other trip hazards like low furniture, small pets, cords, and clutter on the floor. Occupational therapists are experts in this area.
• If you wear vision aids like eyeglasses or contact lenses, ensure your prescription is current and wear your glasses or contacts as directed.
• Check that your footwear is flat-heeled, sturdy, and fits properly.
• Consider wearing a hip pad, which may protect your hip in a fall.

Medication

If you have or are at risk for osteoporosis, your healthcare provider may suggest taking medication to help slow bone loss and stimulate new bone formation, particularly if you have been through menopause. These may include:

• Bisphosphonates, including Fosamas (alendronate), Actonel (risedronate), Boniva (ibandronate), and Reclast (zoledronic acid)
• Prolia (denosumab)
• Evenity (romosozumab)
• Selective estrogen receptor modulators (SERMs), including Evista (raloxifene) and Duavee (bazedoxifene)

Hormone-based treatments may also be suggested, including:

• Calcitonin
• Estrogen hormone therapy/menopausal hormone therapy (MHT)
• Anabolic agents, such as Forteo (teriparatide) and Tymlos (abaloparatide)
• Testosterone therapy (for men with symptoms of testosterone deficiency and low testosterone levels)
  

Surgery

Those with recent vertebral fractures that are causing them pain and that are not responding to more conservative measures may be considered for treatments such as:

• Kyphoplasty: Using a needle, a balloon is inserted into the bone and inflated to restore the height of the vertebrae, followed by an injection of cement to prevent it from collapsing again.
• Vertebroplasty: Using a needle, cement is inserted into the broken spine bone (similar to kyphoplasty, but does not use a balloon).
  

Summary

There isn't enough evidence to support chiropractic care as a treatment for osteoporosis, but some chiropractors promote it as a way to help people with osteoporosis manage their symptoms.

People with osteoporosis may be advised to avoid chiropractic care. If their healthcare provider says it is safe, modified chiropractic care may be done. Chiropractors should screen clients for risk factors of osteoporosis before providing treatment.

Measures that can help treat or prevent osteoporosis include getting enough calcium and vitamin D, engaging in weight-bearing and balance exercises, reducing fall risks, avoiding smoking, avoiding or limiting alcohol and caffeine, and in some cases, medicine and/or surgery.

People with osteoporosis should consult their healthcare provider before beginning chiropractic care, an exercise program, or any other treatment.