Shahnai Basharat et al.

Int. j. med. appl. health. Vol. 1, No. 2, 2013

COMBINATION THERAPY OF DIET AND PHYSICAL THERAPY IS HANDY TO COMBAT THE OSTEOPOROSIS 1*

2

Shahnai Basharat , Muhammad Mustafa Qamar*, Akhtar Rasul* and Ayesha Basharat 1 Institute of Diet & Nutritional Sciences, University of Lahore 2 Department of Physical Therapy, Sargodha Medical College Campus, University of Sargodha Corresponding author e-mail: [email protected] ABSTRACT Osteoporosis is a skeletal disorder, frequently common especially in postmenopausal women above age of 50 years. Evidence suggests that life modification can prevent or delay development of osteoporosis. A study was carried out in order to determine the effects of diet along with physical therapy in female patients with osteoporosis. In this causal comparative study, an osteoporosis knowledge based assessment questionnaire including diet frequency, anthropometric measurements, clinical signs and symptoms, including the prevalence of pain and intensity of pain in joints, biochemical evaluation and physical activity record were taken from sample of 50 female patients of osteoporosis between age ranges of 50-60 years. These subjects were randomly assigned st two groups. The 1 group consists of osteoporotic female patients who were on diet along with physical therapy nd and 2 group consists of other osteoporotic female patients who were on estrogen hormone replacement therapy. Chi-square was used to determine the effects of two treatments. Current study results indicated that diet along with physical therapy is more effective in the management of osteoporosis than the hormone replacement therapy. There was a significant improvement in the BMI, BMD-t score, the relief of pain and decrease in the intensity of pain, improved level of serum calcium, vitamin D and phosphorous level in the patients group who were seeking diet along with physical therapy treatment as compare to the group receiving hormone replacement therapy. We concluded that the patients having balanced intake of appropriate diet, caloric intake ranging from 1801-2200 KCals, supplementary calcium intake 1400 mg/day, including dairy products, green leafy vegetables, fruits and soybeans and the supplementation of vitamin D, soy-isoflavon along with physical therapy is best nonpharmacological interventional strategy to prevent, manage or treat the osteoporosis. KEY WORDS: Balanced diet, Physiotherapy, Hormone replacement therapy, Osteoporosis INTRODUCTION

lead a sedentary lifestyle, and vitamin D and calcium deficiency among Pakistani women has been reported to be as high as 83% which place them at a higher risk of having and developing osteoporosis (Fatima et al, 2009). A low calcium intake during the growing years limits the bone’s ability to achieve an optimal mass and density. Most people achieve a peak bone mass by their late 20’s and dense bones best protect against age-related bone loss and fractures. All adults lose bone as they grow older, it begins before they are 40 (Whitney & Rolfes, 2002; Heaney, 2009).

Osteoporosis is a “silent” condition in which the rate of bone loss exceeds the rate of new bone formation (Misner & Vanessa, 2006; Bauman, et al, 2008). It affects approximately 200 million women throughout the world. Osteoporosis affects an estimated 75 million people in Europe, US and Japan. In the US about 8 million women and 2 million men have osteopenia over the age of 50, are at greatest risk of developing osteoporosis and suffering related fractures with ratio of One in every two women and one in every six men will suffer an osteoporosis related fracture at some point in their life (Adachi, et al., 2001). In developed countries the spinal osteoporosis is about 4-6 times, and hip fractures 2-3 times more common in women than in men (Garnerov et al. 2000 ; Hough, 2006). According to the statistics from the International Osteoporosis Foundation, 30 to 50% of women and 15-30% of men in Pakistan were likely to suffer a fracture related to osteoporosis in their lifetime (AtKinson et al., 2004). According to one survey, 72% of people

Optimum balanced nutritional practices in the youth is required to achieve high peak bone mass. Bone health is influenced by three major interacting factors; diet, exercise, and estrogen. It is neither too early nor too late to prevent the onset and severity of osteoporosis by ensuring adequate intake of vitamin D, engaging in regular weight-bearing exercises (Miggiano & Gagliardi, 2005; Mahan & Stump, 2008; Farrell, et al., 2009). Weight-bearing and strengthening exercises are essential in the 36

Shahnai Basharat et al.

Int. j. med. appl. health. Vol. 1, No. 2, 2013

prevention and treatment of osteoporosis (Bonaiuti, et al., 2002). Sufficient amount of calcium, vitamin D, and protein intake is important in helping to maintain the bone density (Nieves, 2005). Diet that is rich in calcium, vitamin D, Omega-3, Omega-6 fatty acids, soy isoflavons, zinc, foliate, vitamin B6, B12, magnesium, phosphorous has played a significant role. According to one study, diet rich in soy (tofu, soy milk, and soybeans) has a tremendous effect on bone health, and increase bone mineral density. Soy isoflavons are phytoestrogen, having same effect as estrogen. So, it protects and stop bone loss, and increase bone mineral density. Exercise helps to relieve pain associated with osteoporosis as well as plays an integral role in maintaining bone mass (Arjmandi, 2001; Atkinson, 2004 ; Mahan & Stump, 2008).

MATERIAL AND METHODS A total of 50 osteoporotic female patients aged between 50-60 years were selected from the orthopedic OPD and general OPD of Shifa international & Holy family hospital Islamabad. The subjects were randomly assigned into two equal st groups. 1 group consists of subjects who were taken recommended diet along with physical nd therapy for 12 weeks and the subjects in 2 group were recommended to take hormone replacement therapy alone for 12 weeks. A formal written and oral consent was taken from all participants prior to the study according to Helsinki declaration. All data was demonstrated in percentage form. The Chi square test was used to evaluate the effectiveness of combination therapy including diet and physical therapy. The data collected was statistically analyzed by using SPSS software version-16 (SPSS Inc, Chicago). P value less than 0.05 was considered as statistical significant.

At present hormone replacement therapy (HRT) is used as a treatment for osteoporosis. Researches show that this therapy has a large number of hazardous side effects, as it increases the risk of heart diseases, breast cancer, and thrombosis. Many researches show diet as alternative to HRT because hazardous harms related to HRT can be prevented (Harvey & Cooper, 2006 ; Beral et al., 2002).

RESULTS The comparative research approach was used in st conducting this study with two groups. 1 group consisted of subjects who had combination therapy nd of diet and physical therapy and in 2 group the subject had taking hormonal replacement therapy for 12 weeks. All the subjects followed standardized diet, physical therapy and hormonal replacement therapy program under expert’s supervision. In HRT group, the subjects were taking the same regular diet or physical activity during the study as they were taking before the study. In Combination therapy group subjects performed whole body weight bearing exercise 3 day/week. The diet protocol in combination group was fellows as given in Table 1. Purposive sampling technique was used to collect samples. Structured questionnaire containing both open ended and closed ended questions was used for collecting the relevant data. It included nutritional assessment comprising of Anthropometric Measurements, Body Mass Index (BMI), Clinical data including clinical signs and symptoms related to osteoporosis, Biochemical evaluation and Dietary intake was also recorded.

The available literature on comparative effect of diet, physical therapy and replacement therapy among female patients with osteoporosis is very limited in developing countries and there are only a few studies related to this issue in Pakistan. The prevalence of osteoporosis in Pakistan is very high. World health organization has declared osteoporosis as a great threat to women calling it a silent killer due to non-presence of any primary sign and symptoms. According to statistics from International Osteoporosis Foundation (IOF) 30-50% of women in Pakistan suffer from fractures related to osteoporosis. Thus, this study will help in providing basis for planning nutritional education programs and policies. It will also create awareness in relation to effectiveness of diet along with physical therapy in the management of osteoporosis. The aim of the study is to find out the effects of diet along with physical therapy in comparison with HRT in female patients with osteoporosis. This study will be helpful to compare the effects of diet along with physical therapy and hormone replacement therapy amongst the female patients with osteoporosis.

Effect of combination therapy on BMI: There was a significant effect of combination therapy on BMI from the data it looks that combination therapy helps in normalizing BMI while in hormonal replacement therapy group, no significant changes were seen in BMI (Table-2). 37

Shahnai Basharat et al.

Int. j. med. appl. health. Vol. 1, No. 2, 2013

Effect of combination therapy on Pain: There was a significant effect of combination therapy on reduction of pain related to osteoporosis. On the other hand, hormonal replacement therapy group does not show positive impact in pain management in osteoporotic patients (Table 3).

comparison with baseline values. On the other hand, hormonal replacement therapy group does not show any significant impact on these biochemical variables in osteoporotic patients (Table-3). Effect of combination therapy on Bone Mass Density (BMD): Combination therapy of diet and physical therapy showed significant improvement in bone mass density (BMD) in osteoporotic subjects. However, hormonal replacement therapy fails to show any improvement in bone mass density (Table 3).

Effect of combination therapy on Biochemical Parameters: Similar to the findings coated above, there was a significant effect of combination therapy on serum; phosphorous, Vitamin D, Alkaline Phosphatase and calcium concentration in st

Table-1: Diet protocol in combination therapy in 1 Group (diet and physiotherapy group) Taken Diet with Physical Therapy Day Spinach (n=25) Turnip Green (n=25) Pumpkin (n=25) Fruits (n=25) No % No % No % No % 0 0 0 0 0 1 2% 0 0 1 1 2% 0 0 1 2% 2 4% 2 2 4% 0 0 19 38% 4 8% 3 21 42% 1 2% 4 8% 15 30% 4 1 2% 23 46% 0 0 1 2% 5 0 0 1 2% 0 0 2 4% 6 0 0 0 0 0 0 1 2% 7 0 0 0 0 0 0 0 0 Table-2: The number of subjects in different ranges in two different BMI ranges in two different groups st nd BMI Baseline Post- study subjects in 1 group Post- study subjects in 2 group ranges Subjects (Combination therapy) (HRT) 15-18 10 5 5 18-25 20 13 7 26-30 16 7 9 30-33 4 0 4 Table-3: Effect of interventions on Pain & Biochemical parameters in different groups Post-intervention st nd Parameter Status No. of Patients 1 Group 2 Group (Diet+ Physical therapy) (HRT) Pain 85 5 14 Yes No 15 45* 36 Phosphorous 45 48* 22 Normal low 55 02 28 Vitamin D 20 48* 06 Normal 80 2 44 low Alkaline 88 48 43 Normal phosphatase 12 02 07 low Calcium 85 07 17 Hypo-calcemic 15 43* 33 Normal BMD score 35 45* 20 Normal 65 05 30 low (Data demonstrated in percentage * significant