OSTEOPOROSIS
 
Kim Bennell from School of Physio at Melbourne Uni gave the address.  Additional information is included from articles in the latest edition of Polio Network News from the International Polio Network USA.  This includes a study undertaken in NZ by Dr John Delahunt at the Wellington School of Medicine and Dr Liz Faulkner, Medical Advisor for the Post Polio Support Society NZ.
 
Osteoporosis costs the Australian community $800 million annually.  In Australia today 1 in 2 women and 1 in 3 men, over the age of 65, will develop a fracture due to osteoporosis before they die.
 
The NZ study involved 38 polios with residual weakness in 1 or more limbs.  Their research shows that polio weakened limbs are indeed relatively osteoporotic - even if the rest of the bones are not.  Polio affected limbs have lower bone mineral content in proportion to the reduction in muscle bulk.
 
 
In other words, the more muscle lost due to polio, the greater the degree of osteoporosis.
 
In fact Kim Bennell quotes that, "at bed rest, the rate of bone loss equals 1% per week!"
 
WHAT CAN WE DO ABOUT IT
Unfortunately the types of activity that ideally might be chosen to load bone areas are not necessarily going to be suitable for polios.  Bone responds best to exercise that places high loads on the skeleton and is different to what we normally do.  So weight bearing exercise like aerobics, gym, sprinting, tennis, basketball and weight lifting are better than swimming, cycling and walking.  As well, using extra bone loading for poor bone density in an area that has already been found to be very low, (eg in polio affected limbs) can result in exercise induced fractures!

So your physio needs to realise that often compromise and modification are required in setting out a program.  Consideration must be made of different muscle groups' strength due to polio, (which may affect bone strength), when considering both muscle strengthening exercise and bone loading exercises.
 
It is not known whether current medications for osteoporosis will help bone loss in weak polio limbs.  It is suspected that there will be limited benefit because of the direct relationship between muscle usage and bone maintenance.
 
HRT purports to slow bone loss but carries certain risks, most notably, the increased risk of breast cancer.  (Boron supplementation, which is gaining in popularity as a treatment for osteoporosis, also normalises hormone levels in both men and women without this risk.)
 
There is a warning in Post Polio News that too much calcium can flood the body's absorption sites, resulting in poor levels of iron, magnesium and zinc (which are already low in WA soil).
 
(The lastest from the Canadian Nurses' study shows that extra calcium doesn't prevent osteoporosis and that magnesium rather than calcium is required.)
 
TIPS
* So take care to minimise falls.
* Use aids to steady you where necessary.
* Watch where you put your feet.
* Install grab rails in bathrooms/toilets/stairs.
* Keep a flashlight beside the bed.
* Install touch battery lights for night trips to loo.   (polios may be more unbalanced in the dark)
* Get a portable phone to take from room to room so you don't need to rush to answer it and in case you fall
       and can't get up without help.
* Hide a key outside so others can get in to help.
* Arrange daily contact with family/friend if alone.
* Check side effects of medications you are on.

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Hip protectors are small plastic shields which fit over the bone in the upper outer part of the thigh below the hip.  They are held in place with modified underwear which has a pocket each side to hold the shield.  They are made of stiff but flexible plastic, are not in direct contact with skin, do not irritate and are comfortable to wear.  A Danish study in 1993 showed hip fracture risk reduced by 50%.
 
The incidence of hip fracture doubles for each 5 year increase in age over 65.  Twice as many women as men will have a hip fracture. The majority of falls do not result in major physical injury.  But if you are a polio who is prone to fall and have muscle wastage, the risk is greater and a hip protector may just save you from a fracture.
 

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