9) Osteoporosis Flashcards
Osteoporosis
Chronic, progressive disease characterized by low bone mass, decr bone strength, & incr fx risk
What is the most common metabolic bone disease?
Osteoporosis
What is OP the major cause of?
*Fx in elderly resulting in pain, disability, costly rehab, poor QOL, & premature death
True or False: OP occurs t/o the lifespan.
True
What happens to many pt’s w/OP-related fx’s?
Fx’s go un-dx’ed.
Qualities of OP in males:
- Less common
- Underdx’ed
- Underreported
- Higher m&m than women
- Major public health concern
Collagen
Protein that provides a soft framework
CaP
Adds strength to & hardens bone
Where is cortical bone located?
Shafts of long bones
Where is trabeculated bone located?
Spine, pelvis, & ends of long bones
Osteoblasts
Build up bone
Osteoclasts
Break down bone
Osteocytes
Sense mechanical strain & respond to this train by stimulating osteoblasts & osteoclasts to do their thing
What type of bone cell makes up about 95% of adult bone?
Osteocytes
Generalized OP
Involves the entire skeleton
Regional OP
Involves a limb or region
Localized OP
Involves only focal areas; Sometimes the result of prolonged immobilization
Primary OP
Bone loss associated w/biological changes that take place t/o the lifespan
*Type 1 & Type 2
Type 1 OP
Occurs in post-menopausal women bc of decr estrogen
Type 2 OP
Associated w/the aging process
Secondary OP
Occurs at any age 2° to medical conditions, metabolic/nutritional disorders, meds, & immobilization
When do females & males hit peak bone mass?
Females=18y/o
Males=20y/o
During the growth spurt, what % of total adult bone mass is acquired?
40%
What is the critical period for building bone mass?
Growth spurt during puberty
What influences peak bone mass?
- Genetics
- Nutrition
- Physical activity
- Hormones
- Risk factors
Non-modifiable risk factors of OP
- Gender
- Age
- Body size
- Ethnicity
- FHx
- Depression
- Lactose Intolerance
- Femoral Neck BMD
Modifiable risk factors of OP
- Sex hormones
- Anorexia
- Ca2+ & vitamin D intake
- Too much protein, Na, & caffeine intake
- Weight
- Physical activity
- Meds
- Alochol
- Smoking
Risk factors of OP for women
- White & Asian
- Post-menopause
- Early menopause/menstrual dysfxn
- FHx of OP &/or fx
- Lifestyle
- Prolonged exposure to certain meds
- Ca tx
- Thin/small boned
- Chronic diseases
Risk factors of OP for men
- White
- Age
- Lifestyle
- FHx
- Prostate CA w/bilateral orchiectomy
- Undx’ed low testosterone
- Hypogonadism
- Chronic diseases
FRAX
Evals 10-yr spine, UE, or hip fx risk
FORE Test
Estimates 10yr fx risk for post-menopausal women & men >45y/o who aren’t getting tx for OP
BMD
Avg concentration of mineral in a defined section of a bone; Correlates w/bone strength
What is an excellent predictor of future fx?
BMD
Who should have a BMD test?
Women >65y/o & men >70y/o
Who should not have a BMD test?
Kids, healthy young men, & premenopausal women
What is the gold standard for measuring BMD?
DEXA
What areas does DEXA focus on?
Hip & spine
Can an x-ray be used to determine BMD?
No
What is the most common site for OP fx’s to occur?
The spine
What are spine fx’s followed by?
Fx of the hip, rib, radius, & femur
Sx’s of vertebral fx
- Back pain
- Loss of height
- Postural change
- Fxnl impairment
- Disability
- QOL
What can be used to confirm vertebral fx?
Lateral spine x-ray & DEXA
Can PT help prevent future OP fx?
Yes
Medical & PT Management of OP
- Tx should be pt-specific
- Control pain w/moist heat, TENS, oral analgesics, positioning, & bracing
- Assess diet
- Postural education
- Vertebroplasty or kyphoplasty
- Meds
- Counsel on risk
- Check for 2° causes
- Advise on Ca2+ & vitamin D intake
- Design a regular exercise program
- Advise against smoking & alcohol
- Use guidelines
Red Flags for OP
- Height loss >1’’
- Previous Fx
- FHx
- Kyphosis
Top 11 Assessment Tests for OP
- Balance
- Standing Height
- Occiput to wall distance
- Flexibility
- Kypholordosis
- Prone Hip Extension
- Supine to sit
- STS
- Floor to stand
- Single leg stance
- Hip hinge/spinal alignment
- Slow gait speed (1m/s)
Tx goals for OP
- Decr fx risk
- Decr pain
- Incr mobility
- Incr bmd
- Strengthen
- Optimize posture–>Neutral spine
- Promote overall fitness
- Balance, hip extension, thoracic extension, & thoracic mobes
How is postural stabilization effective?
Via lengthening of the spine & contracting the deep stabilizers during abdominal & back exercises
Programs for OP should be:
- Population specific
- Site specific
- Novel
- Intermittent
- Progressive
- Agreeable
- Used in conjunction w/diet
- Incorporate rxn forces
Great activities for OP
- Line dancing
- Tai chi
- Aquatics
- Walking
- Resistance exercise
- High impact
- Resistive back strengthening
- Aerobics
- WBV
Strength training guidelines for OP
- 1RM
- Ideal intensity=70-80%
- 8-12 reps for temporary fatigue
- More reps is not as effective
- Decompression exercises
Other good interventions for OP
- Jt mobes–>Use your own clinical decision making
- Taping
- Bracing
Purpose of bracing
- Strengthens back extensors & abs
- Decr kyphosis
- Decr pain
- Decr sway
- Incr vital capacity
Exercise contraindications for OP
- Trunk flexion
- Trunk rotation
- Side bending
- Don’t test spine mobility
- Certain yoga poses
