Osteoporosis, Womenʼs Health, and Physical Therapy

Welcome to this special topic issue of the Journal of Women's Health Physical Therapy. In an ever continuing effort to remain atop the issues affecting the health and wellness of women, we are pleased to present this special topic issue on osteoporosis and more specifically, the role of physical therapy in osteoporosis. The epidemiological data on osteoporosis are simply staggering— greater than 10 million people diagnosed and an estimated 34 million undiagnosed, an estimated national cost of $18 billion for osteoporosis-related hip fractures in 2002 alone, and a projected 6-fold increase in the incidence of osteoporosis between the years 2002 and 2020.1,2 Because clinical findings and functional consequences of the disease process can take many years to manifest, osteoporosis is considered a latent or silent disease. However, these alarming data indicate that it is time for physical therapists to listen more carefully and claim their rightful place in the medical management of osteoporosis. The risk factors for developing osteoporosis are many and are not proprietary to any one specialty area within our practice. Thus patients with, or at risk for, the disease may present in any number of clinical settings. The majority of osteoporosis risk factors are common to all areas of our profession and recognition of these risk factors is critical. If we are, as a profession, to advance our role in the prevention and management of osteoporosis, better understanding and application of evidence-based knowledge are requisite. This special issue is a proactive step in this direction. The opening paper by Kyle Moylan, Dennis Villareal, and David Sinacore of Washington University provides an excellent primer and current update on development and physiology of normal healthy bone before progressing to the pathophysiology and disease process of osteoporosis. Discussion of bone health and physical activity throughout the lifespan is then presented by Maureen Ashe and Jennifer Davis, of the University of British Columbia's Bone Health Group. Ashe and Davis provide an excellent review regarding evidence-based recommendations for exercise and physical activity for optimal bone health. Bernadette Matthews and Kim Bennell of the Centre for Health, Exercise, and Sports Medicine at the University of Melbourne then further the discussion of age-specific considerations for bone health by presenting a comprehensive review of current evidence regarding bone development and maturation in adolescent females. By addressing current lifestyle factors specific to the younger population and the role of physical therapy in bone health in this age group, Matthews and Bennell provide considerable information of great clinical use. Following the presentation on adolescent females, Jill Boissonnault, Bill Boissonnault, and Trish Bartoli of the University of Wisconsin present a paper addressing transient osteoporosis during the childbearing years. This is accompanied by a reprinting of the paper “Transient Osteoporosis of the Hip Associated with Pregnancy” by Bill and Jill Boissonnault originally published in the Journal of Orthopaedic and Sports Physical Therapy in 2001. In their current review, the authors provide a thorough discussion of the etiology, diagnosis, and prognosis of transient osteoporosis including a discussion of the differential diagnosis and physical therapy management of transient osteoporosis. Kathy Shipp then offers a comprehensive look at osteoporosis in the older female addressing patient evaluation, differential diagnosis, and evidence-based medical management of the disease manifestations specific to the mature patient. Meena Sran and Karim Khan of the Osteoporosis Program, British Columbia Women's Health Centre, Vancouver, Canada, present the final review —a comprehensive look at the physical therapist's role in osteoporosis. From the standpoint of prevention and management of osteoporosis to community-based education regarding osteoporosis awareness, the authors present the need for the increased presence of physical therapists in osteoporosis that has not yet been realized in our profession. Rounding out this special topic issue, we asked recognized experts in the field of osteoporosis and/or physical therapy practice and research to share their thoughts with us. We posed a series of questions regarding the past, present, and future role of physical therapy in osteoporosis research, clinical care, and education. Their responses are enlightening, thought provoking, and maybe even controversial. But without doubt, the comments necessitate further discussion in our profession. We at the Journal of Women's Health Physical Therapy hope that you find this practical and encouraging as you continue in our wonderfully challenging and rewarding profession. James W. Bellew EdD, PT Guest Editor

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