128. Osteoporosis Medications – What PTs Should Know

Now, today we're gonna cover more on osteoporosis and medications and the clinical. We're gonna cover today more on osteoporosis medications and implications for physical therapy. Now, while we're not the ones prescribing medications, I can't tell you how many patients I've seen recently who have just recently been diagnosed with osteoporosis. They are living active lifestyles.

They're doing everything that they can to be healthy but they're scared to death of falling or breaking their hip or things like that because you hear so much about, Hey, once you break your hip, it's over, or things like that. And that's terrifying. And a lot of times in healthcare, when we think of these patients.

Sometimes we can think of them as our more sedentary individuals, but this is not always the case.

So it is very important for us as healthcare providers who are oriented on exercise to one, understand the implications of these medications, things to screen out for but also to be able to incorporate this in a bone loading program that is safe for our patients and helps them to be successful. So with that.

We're gonna recap what an osteoporosis is, some common medications that you can, you should know and how they work, and then clinical implications for what that means for us as physical therapists. So just as a brief review, osteoporosis is a systemic skeletal disease, so it's more characterized by low bone mass and micro architectural deterioration of bone tissue.

So this can drastically increase someone's bone fragility and increase their frac root. Fracture risk, especially at the hip, spine and wrist in pt as PTs, physiotherapists,

physical therapists, we play a huge role in helping patients through exercise, fall prevention and education, giving them permission to move. 'cause we really want these patients to move, right? But to do that well, we need to understand how medications impact bone physiology and how they may interact with our plan. Now common medications that you should know.

Number one, bisphosphonates. So examples of bisphosphonates can be alendronate or ax, reigate or actonel, ibandronate or beneva and onic acid or reclass. So how these work, the mechanism is essentially that they inhibit osteoclast mediated bone resorption. Remember, osteoclast or the cell that resorb bone. So if they block this cell, it's gonna slow down bone resorption.

Now, sometimes patients will take dosage, orally daily, weekly, or monthly, or they can do it yearly by iv. So for PT considerations, they may need to be upright for 30 to 60 minutes post dose to prevent. Esophageal irritation or GI issues. And some rare side effects. It's not very common, but really good to have on your radar would be osteonecrosis of the jaw.

So if they're talking about they've had a recent dental surgery or they have jaw pain and they're on this medication. You wanna have your radar up, right? You and investigate that. Make sure that that is being monitored by someone. It is also atypical for femur fractures to occur with long-term use, but we do wanna assess if they're having thigh or groin pain.

Another one would be Umab or Prolia. It is a R-A-N-K-L inhibitor or monoclonal antibody. So essentially it prevents osteoclast formation or function, which again reduces bone resorption. It is usually a subcutaneous injection every six months. But a key note to keep in mind is that someone can have rebound bone loss if the therapy is stopped abruptly.

So fracture, fracture risk actually increases. So transitional plans are pretty essential. Sometimes our patients just decide to. Stop treatments when they've had enough, and this is probably not one that they should. So if they're talking to you about this, I would discourage it. Relax. Aine or Avista is a SCRM stands for selective estrogen receptor modulator.

Which is why we use the acronym it is used more for postmenopausal women because it mimics estrogen's effects on the bone. And the benefit is we can have modest bone preservation and reduce vertebral fractures which is pretty nice. And then teriparatide. Or Forteo and aide or TIMOs. These are PTH analogs.

So the cool thing about this one is it actually stimulates new bone formation by activating osteoblasts. Now remember, that's the cell that helps re put down bone, so that's more so reserved for severe osteoporosis or multiple fragility fractures. It's people are on it a max of two years just due to the risk of osteosarcoma

in animal studies. There's no confirmed human cases at clinical doses, but probably not something we wanna mess with for too long. So also, hence why it's reserved for more severe cases instead of putting it on everybody. So those are the only medications that build bone. We just don't want them to build the wrong type of bone.

Now for PTs, these are our clinical implications. I. In our exercise, exercise is so critical for these patients. Even if they're on medication medications, a lot of them slow down bone loss.

But exercise is meant to help rebuild bone density and also help these patients with balanced strength and posture which a lot of these patients remember, they're terrified of falling. A lot of times they come out hearing this diagnosis and they feel so fragile and so broken.

So the more that we can help them regain confidence and also improve their balance of the needs, improving the better. So a lot of times our prescriptions for this will be things that are in weight bearing resistance training and balance training. The important thing is that.

You don't just give everyone the same bone loading program, people are gonna start off at different levels of function. I have seen patients who they're already running and marching and doing these things and they need to just kind of bring it up a bit. And I've had patients where.

Walking is painful currently 'cause they've also got concurrent knee pain or maybe they're deconditioned from a recent illness or things like that. So we need to assess their readiness for exercise too. Don't, don't turn off that part of your brain please. The other component are, as I've already mentioned, as PTs, our role is to watch for side effects.

So watching for jaw or thigh pain, especially if they're on bisphosphonates. That way we can assess to see kinda. Have it on our radar if they are developing osteonecrosis or a atypical femur fracture.

Some medications like relax, aine or polypharmacy like ine or if they're having a lot of medications interacting with each other from polypharmacy would be dizziness and orthostatic hypotension. Which if they're experiencing dizziness, that does increase their fall risk. And we already mentioned. Poor bone density doesn't

mix well with high fall risk. So just keep that on your radar. And then if they actually just have really bad balance in general set them up for success. Especially if, if they have impaired mobility, you're assessing their gait, don't forget to assess vitals, balance, all that kind of stuff. And then patient education.

Medication adherence is important if they are trying to assess for positive results and if they're unhappy with their medications, I think it can be really helpful to also encourage these patients to. Actually have a conversation with their physician instead of assuming their physician doesn't want to talk to them. In my experience, they do.

So helping to reinforce the strength of having a medical team working around you, I think is very helpful. And then a lot of patients are asymptomatic too, so. Explaining the why behind the long-term exercise and medications can help improve compliance ideally in a way where we're not invoking fear as well. So that these patients ideally can work towards

building their bone density. So as a review, know the medications. Ask the right questions, screen for red flags until your, your treatment to the patient that is in front of you. Exercise is still our main tool, but layering it with our understanding of pharmacology can be an even better. So that's it for today, guys. I hope that you found this helpful.

But if you have any questions, you can feel free to reach out at pt Snacks podcast@gmail.com. If you are liking the show and you would like to support it, there is a link below. But also if you want to further your understanding in, in general, you're looking for CCUs that are flexible with you. Med Bridge is offering listeners a huge discount of.

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Where you can put together video exercises for your patient and give it to them. So super helpful. I've used it before myself, but definitely check out the promo code in the show notes if you're interested. And yeah, just go from there. So that's it for today, guys. I hope you have a great one and end the next time.