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70 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 24 Eighteen years ago, I wrote a column on osteoporosis, or bone thinning, for Massage & Bodywork magazine. Since then, I have entered the demographic most at risk for this disease, so it's now more meaningful to me. In addition, we have seen some significant changes in how this condition is discussed, especially in its prevention and treatment options. Osteoporosis and its precursor, osteopenia, remain important public health issues. The National Center for Health Statistics reported in 2017–2018 that more than 55 percent of adults in the US over age 50 have either osteoporosis or lower- than-optimal bone mass. About 1.5 million people over age 65 have an osteoporosis- related hip fracture each year, and a million compression fractures of the vertebrae are recorded annually. 1 Half of all females and one-quarter of all males will have a fracture related to osteoporosis at some point in their lives. This disease is also expensive; estimates say that by 2025, we will be spending $25.3 billion each year for treatment and other costs connected to 3 million yearly fractures. 2 I've been teaching about osteoporosis for many years, and it's been fascinating to observe how our understanding of the process of bone growth and degeneration has evolved. There are a million tangents I would love to share about this, like: Does milk make a difference? Why is the process accelerated during early perimenopause? What about all the contradictory data about vegetarian versus omnivore diets and osteoporosis risk? 70 m a s s a g e & b o d y wo r k m a rc h /a p r i l 2 0 24 No Bones About It Working Safely with Clients Who Have Osteoporosis By Ruth Werner Critical Thinking | Pathology Perspectives KEY POINT • Bone-thinning diseases like osteoporosis can present unique challenges for massage therapy and may require accommodations for pressure or client accessibility. However, I am limited by both word count and relevance, so although the interplay between age, childbirth history, diet, exercise, hormones, steroid use, and osteocyte, osteoblast, and osteoclast behavior is amazing to unpack, I can't make an argument that it is vital for massage therapists to understand it in full detail. If this piques your interest though, I strongly suggest looking at the resources provided at the end of this column. Following is a fresh look at osteoporosis, a common condition that is sometimes possible to prevent and always difficult to reverse. BONES ARE NOT INERT Bone growth and maintenance is a carefully coordinated dance between adding to our bone mass and subtracting from it. That balancing act is guided by our moment-to-moment needs. This is the essence of Wolff's Law: bones adapt according to mechanical loading. They become stronger with demand, and in the absence of mechanical stress, they demineralize and get weaker. Our bones start to grow before we are born. The cartilage scaffolding that provides the framework for the mineral deposits that become bone tissue begins to develop early in gestation. Calcium, phosphorus, and other minerals form around those cartilaginous structures in different patterns: porous trabecular bone in epiphyses and vertebral bodies, and denser cortical bone in the long bone shafts and in our small wrist and foot bones. Our f lat Normal trabecular bone (left) versus osteoporosis. 1

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