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Safe physiotherapy with osteoporosis

Q What physiotherapy is safe for an osteoporotic patient? How soon can a patient return to high-impact sport after two years of etidronate (Didronel) therapy?

A Regular weight-bearing exercise is important for the prevention and treatment of osteoporosis. Physiotherapy can improve bone strength, reduce pain, improve posture, increase confidence and mobility, and reduce the risk of falling.

Unsupported, standing exercises are fine for someone with good balance, but may put someone with poor balance at risk of falling and breaking something else.

Jogging, skipping and high-impact aerobics should be avoided by people with established osteoporosis, whether or not they've ever fractured. Weight-bearing exercise improves bone density in the spine and hips, and crawling adds in weight-bearing through the wrists.

Mat exercises are great for stretching. Exercising with weights, which can be done sitting or lying, builds up stamina, bone and muscle strength.

Whatever exercise is being done it is important to start gradually and build up. If these simple rules are followed the exercises described should all be safe, as would brisk walking, cycling and swimming.

Two years of Didronel therapy will have increased bone strength but may not have restored it to normal. Beyond two years there is little further increase in bone density.

If a patient who has had osteoporosis wants to take up a high-impact sport it would be helpful to get a DEXA scan. If they are still osteoporotic, they should be advised against it.

Dr Theresa Allain is consultant physician at North Bristol NHS Trust department for care of the elderly, Westbury on Trym, Bristol

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