Complementary and alternative therapies and osteoporosis 08286 5 Complementary aw.indd 2
Complementary and alternative therapies and osteoporosis 286 5 Complementary aw.indd 2 10/12/08 15:11:30 What is osteoporosis? Osteoporosis occurs when the struts which make up the mesh-like structure within bones become thin causing them to become fragile and break easily following a minor bump or fall. These broken bones are often referred to as fragility fractures. The terms ‘fracture’ and ‘broken bone’ mean the same thing. Although fractures can occur in different parts of the body, the wrists, hips and spine are most commonly affected. It is these broken bones or fractures which can lead to the pain associated with osteoporosis. Spinal fractures can also cause loss of height and curvature of the spine. Strong dense bone Fragile osteoporotic bone This leaflet covers specific information on complementary and alternative therapies. If you would like more general information on osteoporosis, please ask us for a copy of our publication All about Osteoporosis. New breast cancer pages JUNE 2012.indd 1 11/8/2012 12:37:35 PM Complementary and alternative therapies and osteoporosis Complementarytherapyisanareaofhealth carethatisgrowinginpopularityandmany peoplefindsuchtherapiesbeneficialin offeringrelieffrompainandimprovingtheir qualityoflife. Atpresentthereisnoevidencethat complementarytherapiesincreasebone densityorreducetheriskofbrokenbones. Mostofthesetherapieshavenotundergone thevigoroustestingandtrialsexpectedof conventionalmedicinesoyouareunlikely tofindproofthattheyworktoreduce pain.However,for thosepeoplewho havesustained fractures as a result of osteoporosis, thisapproachmay offeradditionalrelief frompainandother symptoms. 286 5 Complementary aw.indd 4 10/12/08 15:11:33 Complementarytherapyisincreasinglybeing usedalongsideconventionalmedicineas partofaperson’spainmanagementplanand manyhospitalsrunpainclinicswhichoffer awiderangeoftreatmentoptionsincluding complementaryapproaches.Inallsituations, itisimportantthatthetherapistismadefully awareofanindividual’smedicalhistorybefore commencingtreatmentanditisimportant thatyouexplainthatyouhaveosteoporosis and may be at a higher risk of breaking bones. Some of the most commonly used therapies are described on the following pages. A list of useful organisations and their contact details is included at the back of this leaflet. 286 5 Complementary aw.indd 5 10/12/08 15:11:37 Acupuncture The word acupuncture comes from the Latin acus meaning ‘needle’ and punctura meaning ‘to prick’. Certain strategic areas on the body are pierced with fine needles or stimulated with massage, heat or electricity, which can bring relief of symptoms both close to the needles and in distant parts of the body. Acupuncture has been found to be helpful in treating musculoskeletal disorders like rheumatoid arthritis, chronic pain and many other conditions. The needles used by acupuncturists are often disposable and, if not, should be carefully sterilised before use to avoid the risk of HIV or hepatitis. Most people feel no pain with acupuncture, although some may experience a heavy, dull, aching sensation. Symptoms may be relieved immediately or over a period of time. However, others experience no relief with this therapy. Acupuncture may, for some people, relieve the pain associated with spinal fractures but this may only last while treatment is undertaken and can reoccur once treatment has stopped. The cost of acupuncture and the number of sessions needed will vary according to the condition being treated. Your own doctor may offer acupuncture or may be able to refer you to a physiotherapist, nurse or other 53621_NOS_ Complementary amended pages.indd 6 17/02/2010 15:53 health professional who offers this service. Acupuncture can also be performed by nonmedically qualified acupuncturists and by lay practitioners. When choosing an acupuncturist it is recommended that you find out about the practitioner’s qualifications and experience, and to ask whether they are certified with a recognised body. A doctor qualified in acupuncture will be registered with the British Medical Acupuncture Society, and physiotherapists with the Acupuncture Association of Chartered Physiotherapists. The British Acupuncture Council represent the largest group of practitioners and hold a nationwide register. At present, the practice of acupuncture is not statutorily regulated; however, there are proposals for both acupuncture and herbal medicine to have statutory status in the near future. The National Institute for Health and Clinical Excellence (NICE), the independent body that advises NHS doctors on best clinical practice, has released evidence-based guidelines regarding the management of persistent, non-specific low back pain. The guidelines recommend acupuncture among the first line treatments for those with back pain that has lasted more than six weeks. 53621_NOS_ Complementary amended pages.indd 7 17/02/2010 15:54 Massage therapy Thepracticeofmassagetherapyisan ancientformofphysicalmedicineand continuestobeusedwidelyandinmany settings.Massagecanhelptoincrease relaxation,alleviateanxietyandstress associatedwithillnessandimproves generalwell-being. Massageinvolvesthestroking,pressing, kneadingandwarmingoftheskinand muscles.Themasseurwillusuallyusebare handsandmayuseoilstomakeiteasierto slidetheirhandsacrosstheskin. Researchstudieshavesofarnotgivena clearpicturehowmassageworksbutitis thoughtthatitcanstimulatethebloodand lymphaticcirculationandhelptoremove toxinsandwasteproductsfromthebody. (Thelymphaticsystemdrainswateryfluid fromtissuesofthebodyandreturnsittothe blood.)Massagecancontributetotherelief ofpainthroughthestrokingactionofthe massageonthenerveendingsintheskin, >> Massage can help to alleviate anxiety and stress associated with illness. 286 5 Complementary aw.indd 8 10/12/08 15:11:40 whichmayhelptolessenthesensationof painduetothereleaseofendorphins–the body’snaturalpain-reducingchemicals. There are many different massage techniques. Some therapies are more rigorous than others andmaynotbesuitableforthosepeopleat riskofbrokenbonesduetoosteoporosis. 286 5 Complementary aw.indd 9 10/12/08 15:11:43 Aromatherapy and aromatherapy massage Aromatherapyaimstocreateasenseofwellbeingbyusingtheessentialoilsofplants. Theycanbeinhaledasavapouror,indiluted form,massagedintotheskin.Essentialoils havebeenusedmedicinallyforcenturies andclinicaltrialshaveindicatedeffectiveness forbowelconditions,woundhealingand relievinganxiety.Oilswhichareassociated withhavingapain-relievingeffectinclude camomile,lavenderandrosemary,while bergamotandrosecanhelpdepression andirritabilityalongwithvaporisedessential oilsoflavender,orange,geranium,lemon andgrapefruit. Remember,oilsshouldneverbetaken internallyorappliedundilutedtotheskin. Gentlemassagewithdilutedoilscanhelp easemusclespasmandpain.Aromatherapy asatreatmentisusuallyarrangedprivately butsomedoctor’spracticesandhospital trustsdoreferwithintheNHSsystem.Ifyou aretakingregularmedication,checkwith yourdoctorortheAromatherapyCouncil. 286 5 Complementary aw.indd 10 10/12/08 15:11:43 Reflexology Reflexologyfocusesonthefeetandhasbeen adoptedfromeasternmedicine.Itworks onthetheorythatcertainareasonthefeet correspondtodifferentpartsofthebodyand thehealthandwell-beingofanindividual dependsuponfree-flowingenergywithin thebody.Ifthisflowisimpeded,ill-health willfollow.Bymassagingthecorresponding pointsonthefeet,theenergyisallowedto flowfreelyagain. Reflexology canbeusedfor relaxationthat,in turn,allowsforthe uninterruptedflow ofenergywhich may,inturn,help reducepain. Reflexologymay alsoincreasebloodandlymphaticcirculation, helpdigestionandalsotheimmunesystem. Thefeetaremassaged,usingoilsin somecases,bythetherapistwho,after consultationwiththeclient,willconcentrate ontheappropriateareasofthefeet. 286 5 Complementary aw.indd 11 10/12/08 15:11:46 Ifyouhavehadbrokenbonesinyourfeet duetoosteoporosis,informthetherapist accordinglyatthefirstappointmentandthey willthendecideiftreatmentisappropriate. Themassageuseddoesnothavetobe vigorousordeep,andgentlemassagemay bemorehelpfulinaidingrelaxation. Homeopathy Homeopathyisthoughttobeameans ofstimulatingthebody’sownhealing mechanism.Itwasestablishedinthelate 18thcenturyandthenamehomeopathyis derivedfromtheGreekhomoiosmeaning ‘like’andpathosmeaning‘suffering’.Itis baseduponthetheorythatsubstances which,inhighdosescauseoverdose,in smalldoseswillcure.Homeopathyaimsto stimulateourbody’snaturaldefencesystem. Itmaybeusefulforbothchronicand acutepain. Homeopathyshouldonlybeundertaken withtheadviceofaqualified,registered homeopath,particularlyinthecasesof pregnantwomenandyoungchildren. Pleaseconsultyourpharmacistbefore purchasingover-the-counterproducts andlethim/herknowifyouaretaking anyprescribedmedicines. 286 5 Complementary aw.indd 12 10/12/08 15:11:46 Herbs such as lemon balm may have an anti-spasmodic effect on the muscles. Herbal medicine Herbalmedicineisoneoftheoldestforms ofmedicine,havingbeenusedinallcultures andcivilisationsforcenturies.Herbal preparationsformthebasisformanyofour moderndrugs:aspirinisbaseduponan extractofwillow,whichwasusedbythe AmericanIndiansforthereliefofpain,and theheartdrugdigoxinisderivedfromextract offoxglove. Devil’sclawandwillowbarkmayhave anti-inflammatoryandpain-relieving properties,andherbssuchaslemonbalm, camomile,passionflowerandvalerian mayhaveananti-spasmodiceffectonthe muscles.Therearesomeplantsthatshould beavoidedbecausetheyarepotentially harmfulsoitisimportanttoseekexpert help.Medicinalherbalpreparationsshould be used with care during pregnancy or when taking other medications and only under the supervision of a herbalist. Further information and a list of practitioners can be obtainedfrom the National Institute of Medical Herbalists. 286 5 Complementary aw.indd 13 10/12/08 15:11:50 Natural progesterone Themainingredientinnaturalprogesterone creamcomesfromanextractfromwild yamsandisclaimedtobesimilartothe naturalhormone,progesterone,produced inthebody.Thisisthenmixedwithother ingredientstomakeitacreamthatcan berubbedintoskinandabsorbed.There areclaimsmadethatnaturalprogesterone creamscanbeusedtohelpwithmenopausal symptomsandtopreventosteoporosisand strengthenbones. Medicalresearchhasshownthatthe hormoneoestrogen,giventopostmenopausalwomeninhormone replacementtherapy(HRT),reducesthe riskofosteoporosisandfracture.However, givenonitsowntowomenwhohadnot hadahysterectomy,itincreasedtheriskof endometrial(womb)cancer.Progestogen,a syntheticformofprogesteroneis,therefore, givenaswellasoestrogentoreducethisrisk ofcancer.Progesterone,inanaturalform, israrelyusedinHRTbecauseitisusedup quicklybythebodyand,atthedoseneeded toprotectthewomblining,seemstomake womensleepy. 286 5 Complementary aw.indd 14 10/12/08 15:11:51 Naturalprogesteronecreamwasdeveloped becauseitwasbelieved,bythosewho claimeditsbenefit,thatitwasprogesterone ratherthanoestrogenthatreduced menopausalsymptomsandprevented osteoporosisinpost-menopausalwomen. Itwasalsobelievedthatinthis‘natural’form itwouldnotcausesideeffectsorharm. Historically,HRThasplayedakeyroleasa treatmentformenopausalsymptomsand topreventosteoporosis.However,with drugtreatmentsdevelopedspecificallyfor osteoporosisoverthelastdecadeorso andtheknowledgeofpotentialhealthrisks associatedwithlonger-termuseofHRT,itis nowmuchlesscommonlyused. Naturalprogesteronecreamisoften marketedasanaturalalternativeto HRTand,therefore,appealstowomen seekinganalternativeoptiontodrug treatmentsforosteoporosis. The main ingredient in natural progesterone cream comes from an extract from wild yams and is claimed to be similar to the natural hormone, progesterone. 286 5 Complementary aw.indd 15 10/12/08 15:11:53 Althoughtherearesomesideeffects associatedwiththeuseofthesynthetic progestogensinvariousHRTpreparations, asnaturalprogesteroneisanunlicensed product,anypossiblesideeffectsarenot officiallydocumented. Therehasbeensomescientificresearchinto theeffectofprogesteroneonbonedensity, althoughnoneofthesestudieshavelooked atwhetherornotitreducesaperson’s fracturerisk(likelihoodofbreakingabone). Furtherresearchisneeded. OneAmericanstudyinvestigatedtheeffects ofnaturalprogesteronecreamonboth menopausalsymptomsandbonedensity. Althoughitseemedeffectiveincontrolling hotflushes,therewasnoeffectonbone densityobservedinthefirstyear.Thishas beenconfirmedbyasmallBritishtrialwhich showednochangesinbonedensityover twoyears,butatrendtowardsimproved menopausalsymptoms.Thisstudyby SouthamptonUniversityhasbeenpresented atmajorosteoporosisconferencesbutis,as yet,unpublished. 286 5 Complementary aw.indd 16 10/12/08 15:11:53 Osteopathy and chiropractic Althoughosteopathyandchiropracticaretwo separate disciplines they have many similarities; both therapies consist of a number of different techniques, one of which includes manipulation ofthebonesoftheskeleton.Chiropractors tendtofocusonthejointsofthespineand nervoussystemandosteopathsplacemore emphasisonsofttissuesandmusclesand mobilisationofjoints.Theaimofthese therapiesistohelptoimprovethefunctionof joints,easepainandreducemusclespasm. Therehasbeensomeclinicalevidenceto suggestthatspinalmanipulationtechniques canhaveapositiveeffectonchroniclow backpain.Itisveryimportantthatpeople withosteoporosisdonotundergoany skeletalmanipulationduetotheriskof fracture. However, since both osteopathy and chiropractics use a wide range of approaches, theycanstillbeconsideredasasourceof painreliefaslongasthepractitionerismade fullyawareofanindividual’smedicalhistory beforecommencingtreatment. IntheUKbothpracticesarestatutorily regulated.Osteopathsmustberegistered withtheGeneralOsteopathicCouncil andchiropractorswiththeGeneral ChiropracticCouncil. 286 5 Complementary aw.indd 17 10/12/08 15:11:53 Exercise and movement therapies The Alexander Technique Thisisamethodofbreathingandexercise thatfocusesonimprovingpostureand mobility.FrederickMatthiasAlexanderfirst developedthetechniqueinthe1890s. Alexanderhadacareerinthetheatreandas ayoungactorkeptlosinghisvoiceduring stageperformances.Herealisedthatthe functioningofhisownvoicewasdependent onacorrectpostureandbalanceoftension inhisbody.Helaterwentontodevelophis methodsandteachothers. TheAlexander Techniqueaims toimprovethe alignmentofthe head,neckand back,toimprove co-ordinationand balanceandtohelp withbodyfunctions suchasbreathing anddigestion.Some peoplewithpostural changescausedby spinalfractureshave foundthisahelpful techniquetolearn. 286 5 Complementary aw.indd 18 10/12/08 15:11:56 Pilates Thisisanexercisetechniquewhichalso concentratesoncorrectbodyalignment.It wasoriginallydevelopedbyJosephPilates inthe1920sandpractisedbydancersto improvefitness. Pilatesconsistsofaspecificprogrammeof exercisestohelptoimproveflexibilityand strength;italsofocusesonusingthebody’s deepcoremusclesinthetrunkandpelvis. Thesearemusclesthathelptosupportthe body’sskeletalstructure. Thistypeofexercisemaybehelpfulfor peoplewhohavefracturesinthespine asaresultofosteoporosis.However,it isimportanttoavoidanymovementor stretchingexercisewhichinvolvesbending forwardortouchingyourtoesorundertaking neckexerciseswhereyourollyourhead backwardsorcircleyourhead,whichcould bepotentiallydangerousforthosepeopleat riskofbrokenbones. 286 5 Complementary aw.indd 19 10/12/08 15:11:56 Tai Chi TaiChiisanancientformofChinesemartial arts;itusestheprinciplesofdeepbreathing andrelaxationcombinedwithslowcontrolled movements. Tai Chi is good as an intervention tohelptoreducetheriskoffallingand, therefore,breakingaboneifyouhave osteoporosis.Thisisbecauseitimproves postureandbalanceinolderpeople. Yoga YogaoriginatesfromIndiaandhasbeen practisedforover5,000years.Itisbasedon Hinduphilosophyandfollowsasystemof exercisestoencouragephysicalandmental well-being.Itinvolveslearningaseriesof differentmovements,physicalpostures, breathingtechniquesandmeditation.There aremanydifferenttypesofyogabeing practised;however,themostcommonyoga techniqueisHathaYoga. Pilates,TaiChiandYogaareexercise methodswhichusecontrolledandfocused movementsandcanhelptoimproveposture anddevelopmusclestrength.Forsome peopletheymayactuallyhelptoalleviatepain symptomsresultingfromspinalfractures.As longasspecialcareisfollowedwithregard tothepotentiallydangerousmovements >> 286 5 Complementary aw.indd 20 10/12/08 15:11:56 whichhavealreadybeenmentioned,these approachesmayprovideanalternative exerciseactivityforolderpeopleandthose withosteoporosis. Itisalwaysrecommendedthatyoucheck withahealthcareprofessional(suchasyour GP)whohasaknowledgeofyourmedical historyandriskoffracturebeforetakingup anynewexercise.Additionally,aswithany organisedexerciseclass, itiswisetoinformyour instructorifyouhave osteoporosissohe/she canadaptthe movementsto suityou. 286 5 Complementary aw.indd 21 10/12/08 15:11:58 Factors which can help to maintain healthy bones are a well-balanced diet with adequate calcium-rich foods; regular weightbearing exercise; avoiding smoking and keeping alcohol consumption within the recommended limits. Join the National Osteoporosis Society today Become a member and support the only UK-wide charity dedicated to improving the diagnosis, prevention and treatment of osteoporosis. To join today, either call us or visit our website: 01761 473287 www.nos.org.uk Our publications are free of charge but we would welcome a donation You can support the work of the National Osteoporosis Society by making a single or regular donation: 01761 473111 www.nos.org.uk For osteoporosis information and support contact our Helpline: 0845 450 0230 nurses@nos.org.uk 53621_NOS_ Complementary amended pages.indd 1 9/19/2011 12:47:38 PM Useful contacts British Medical Acupuncture Society Royal London Hospital for Integrated Medicine 60 Great Ormond Street London WC1N 3HR Tel: 020 7713 9437 www.medical-acupuncture.co.uk The British Acupuncture Council 63 Jeddo Road London W12 9HQ Tel: 020 8735 0400 www.acupuncture.org.uk Aromatherapy Council www.aromatherapycouncil.co.uk The Society of Teachers of the Alexander Technique 1st Floor Linton House 39-51 Highgate Road London NW5 1RS Tel: 0207 482 5135 www.stat.org.uk General Chiropractic Council 44 Wicklow Street London WC1X 9HL Tel: 020 7713 5155 www.gcc-uk.org British Reflexology Association Monks Orchard Whitbourne Worcester WR6 5RB Tel: 01886 821207 www.britreflex.co.uk New breast cancer pages JUNE 2012.indd 3 11/8/2012 12:37:35 PM The Institute for Complementary Medicine and Natural Medicine ICNM Can-Mezzanine 32-36 Loman Street London SE1 OEH Tel: 020 7922 7980 www.i-c-m.org.uk British Homeopathic Association Hahnemann House 29 Park Street West Luton LU1 3BE Tel: 01582 408675 www.britishhomeopathic.org National Institute of Medical Herbalists Clover House, James Court, South Street, Exeter EX1 1EE Tel: 01392 426022 www.nimh.org.uk General Osteopathic Council 176 Tower Bridge Road London SE1 3LU Tel: 020 7357 6655 www.osteopathy.org.uk New breast cancer pages JUNE 2012.indd 4 11/8/2012 12:37:35 PM Other leaflets in this range: • Anorexia nervosa and osteoporosis • Anti-epileptic drugs and osteoporosis • Breast cancer treatments and osteoporosis • Clothing, body image and osteoporosis • Coeliac disease and osteoporosis • Complex regional pain syndrome and osteoporosis • The contraceptive injection (Depo Provera) and osteoporosis • Drug treatments for osteoporosis • Exercise and osteoporosis • Glucocorticoids and osteoporosis • Healthy bones – facts about food • Healthy living for strong bones • Hip protectors and osteoporosis • Hormone therapy in men and women and osteoporosis • Living with broken bones (includes information on welfare benefits) • Osteoarthritis and osteoporosis • Osteogenesis imperfecta and osteoporosis • Osteoporosis in children • Parathyroid disease and osteoporosis • Percutaneous vertebroplasty and balloon kyphoplasty and osteoporosis • Pregnancy and osteoporosis • Scans and tests and osteoporosis • Thyroid disease and osteoporosis • Transsexualism and osteoporosis • Vibration therapy and osteoporosis 0845 130 3076 (General Enquiries) 0845 450 0230 (Helpline) www.nos.org.uk Camerton, Bath BA2 0PJ President: HRH The Duchess of Cornwall National Osteoporosis Society is a registered charity no. 1102712 in England and Wales and no. SC039755 in Scotland. Registered as a company limited by guarantee in England and Wales no. 4995013 New breast cancer pages JUNE 2012.indd 2 Last updated November 2012 NOS/00200 11/8/2012 12:37:35 PM
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