Ch. 21 - Osteoporosis

Question 1

How is osteoporosis defined?

Answer 1

As a disease that manifests in low bone density, deterioration of bone tissue, disruption of bone microarchitecture, and reduced bone strength, all of which may lead to bone fracture

Question 2

How is osteoporosis diagnosed?

Answer 2

Defined by the bone mineral density (BMD) at the hip or lumbar spine ≤2.5 standard deviations below the mean BMD of a young adult reference population (T-score calculated)

Question 3

How does the prevalence of osteoporosis differ between women and men and with age?

Answer 3

Prevalence higher in women than men, and higher in older ages

Question 4

What are some risk factors for osteoporosis?

Answer 4

• Having a thin or slender frame
• Having a parent with osteoporosis or hip fracture
• Having low levels of estrogen or testosterone
• Eating a diet low in calcium and vitamin D
• Consuming alcohol heavily for long periods of time
• Being physically inactive
• Having certain medical conditions and using prescription medications

Question 5

1. In 2019–2020, how many Canadians aged 40+ were living with diagnosed osteoporosis?
2. What percentage were women?

Answer 5

1. Almost 2.5 million
2. ~81%

Question 6

How does the risk of osteoporosis diagnosis change with age between 40 and 65?

Answer 6

The risk doubles every 5 years

Question 7

What was the mortality rate within a year of a hip fracture?

Answer 7

More than 1 in 5 Canadians with a hip fracture died of any cause within the following year

Question 7

In 2019–2020, what was the rate of hip fractures per 100,000 Canadians aged 40+?

Answer 7

156

Question 8

How did the likelihood of hip fracture differ between women and men?

Answer 8

Women were 2x more likely to fracture their hip compared to men

Question 9

How did mortality within a year of a hip fracture differ between men and women?

Answer 9

Men were 1.5x more likely to die of any cause within a year of a hip fracture compared to women

Question 10

How does bone mass typically change throughout adulthood?

Answer 10

Bone mass peaks in early adulthood and then declines during middle adult years

Question 11

When do women experience rapid bone loss?

Answer 11

Around the years of menopause (decline in estrogen levels)

Question 12

When do men tend to have fractures compared to women?

Answer 12

Later in life

Question 13

Why do women have a higher lifetime fracture risk?

Answer 13

Due to smaller bone size and increased fall risk

Question 14

What types of activities should preschool-aged children engage in for bone health?

Answer 14

Activities like:
* Hopping
* Skipping
* Jumping
* Tumbling

Question 15

What types of activities should school-aged youth engage in for bone health?

Answer 15

Muscle- and bone-strengthening activities in addition to aerobic exercise to maximize peak bone mass

Question 16

What is the focus regarding exercise and bone health in early adulthood?

Answer 16

Optimize bone mass with bone-loading activities

Question 17

What is the potential role of exercise in middle age and older adulthood regarding bone loss?

Answer 17

In slowing the rate of bone loss

Question 18

What types of exercise are recommended for bone health in middle and older adulthood?

Answer 18

• Weight-bearing physical activity
• Activities that involve jumping,
• Resistance training that targets all major muscles

Question 19

What modifications to exercise testing might be needed for individuals with osteoporosis?

Answer 19

• Modifications to test protocols for those with severe kyphosis that limits forward vision or balance
• Cycle ergometry rather than walking for those with compression fractures
• Maximal exertion and significant spinal flexion to be avoided in muscular fitness testing

Question 20

How should exercise training progress for individuals with osteoporosis?

Answer 20

Slowly

Question 21

What types of exercise should be worked towards for individuals with osteoporosis?

Answer 21

• Weight-bearing aerobic exercise 4 or 5 days per week
• Resistance exercise of 8 to 10 exercises on 1 or 2 days per week (may progress to 2 or 3 days per week of resistance exercise)
• Flexibility 5 to 7 days per week

Question 22

Are balance exercises valuable to individuals with osteoprosis?

Answer 22

Yes

Question 23

What activities should individuals with osteoporosis avoid?

Answer 23

• Activities with explosive movement
• High-impact loading
• Excessive twisting, bending, or compression of the spine

Question 24

How are individuals **categorized** in terms of low trauma fracture risk?

Answer 24

* Low risk * Moderate risk * High risk

Question 25

How is "**low risk**" of low trauma fracture defined?

Answer 25

As being asymptomatic of osteoporosis, with ‘**normal’ BMD (T-score above -1.0 SD)** and functional status, and no clinical risk factors for falls or fracture (e.g. children/ adolescents and healthy adults)

Question 26

How is "**moderate risk**" of low trauma fracture defined?

Answer 26

As having low bone mass (**T-score −1.0 to −2.5 SD**) and/or certain clinical or functional risk factors for fracture

Question 27

How is "**high risk**" of low trauma fracture defined?

Answer 27

As having osteoporosis (**T-score less than −2.5 SD**), previous fracture, and/or multiple risk factors for fracture

Question 28

What are the recommended FITT principles for **impact** exercise for **low-risk** individuals?

Answer 28

* **F:** 4-7 d/wk * **I:** high impact activities >4 x BW * **T:** 50 reps (3-5 sets x 10-20 reps); 1-2 min rest b/t sets * **T:** impact exercises ## Footnote Impact exercises include landings from exertional jumps such as high vertical jumps, star jumps, tuck jumps, and drop landings; including within sports such as volleyball, basketball, gymnastics, ballet, etc.

Question 29

Placeholder

Answer 29

* **F:** * **I:** * **T:** * **T:**

Question 30

What are the recommended FITT principles for **Resistance** exercise for **low-risk** individuals?

Answer 30

* **F:** 2 days/wk * **I:** 80-85% 1-RM (START WAY LOWER) * **T:** 2-3 sets x 6-8 reps * **T:** whole body RT exercises; consider high velocity-based movements to load bone ## Footnote Same as medium-risk and high-risk

Question 31

What are the recommended FITT principles for **balance** exercise for **low-risk** individuals?

Answer 31

* **F:** Incorporate balance activities where possible into strength and impact elements of the exercise program * **I:** Challenging activities * **T:** Incorporated into other exercises * **T:** Tasks performed with eyes closed should be done in proximity to a railing or other secure support

Question 32

What are the recommended FITT principles for **impact** exercise for **moderate-risk** individuals?

Answer 32

* **F:** 4-7 days/wk * **I:** Moderate-to-high impact activities **>2 BW** * **T:** 50 jumps per session (3–5 sets of 10–20 repetitions with 1–2 min rest between sets) * **T:** Impact exercises ## Footnote Impact exercises include running, stride jumps, jump rope, side steps, highland-type dancing, jump take offs and hops; including within sports such as, racquet sports, track events, most field sports and martial arts that include frequent jumps

Question 33

What are the recommended FITT principles for **resistance** exercise for **moderate-risk** individuals?

Answer 33

* **F:** 2 days/wk * **I:** 80-85% 1-RM (START WAY LOWER) * **T:** 2-3 sets x 6-8 reps * **T:** whole body RT exercises; consider high velocity-based movements to load bone ## Footnote Same as low-risk and high-risk

Question 34

What are the recommended FITT principles for **balance** exercise for **moderate-risk** individuals?

Answer 34

* **F:** 4 sessions/wk * **I:** challenging exercises * **T:** 30 min of a variety of balance exercises per session; at least 10 sec per balance exercise and at least 10 steps forward and back for mobility exercises, increasing as tolerated to longer durations * **T:** Balance exercises

Question 35

What are the recommended FITT principles for **impact** exercise for **high-risk** individuals?

Answer 35

* **F:** 4-7 days/wk * **I:** Moderate impact activities (2–3 BW), within the limits of pain, increasing as tolerated. Frail individuals will require a period of PRT * **T:** Aim to work up to 50 repetitions over time (5 sets of 10 repetitions with 1–2 min rest between sets) * **T:** Impact exercises ## Footnote Impact exercises include running, stride jumps, jump rope, side steps, highland-type dancing, jump take offs and hops; including within sports such as, racquet sports, track events, most field sports and martial arts that include frequent jumps

Question 36

What are the recommended FITT principles for **resistance** exercise for **high-risk** individuals?

Answer 36

* **F:** 2 days/wk * **I:** 80-85% 1-RM (START WAY LOWER) * **T:** 2-3 sets x 6-8 reps * **T:** whole body RT exercises; consider high velocity-based movements to load bone | Same as low-risk and medium-risk ## Footnote NOTE – gradually progress intensity for all levels of risk (low, moderate, and high); start at 50% 1-RM and gradually progress to 60%, 70%, 80% 1-RM as exercise technique is mastered

Question 37

What are the recommended FITT principles for **balance** exercise for **high-risk** individuals?

Answer 37

* **F:** 4 sessions/wk * **I:** challenging; use support if needed (eyes closed exercises); supervision recommended to reduce risk of falls * **T:** 30 min of a variety of balance exercises per session; at least 10 sec per balance exercise and at least 10 steps forward and back for mobility exercises * **T:** Balance exercises

Question 38

What types of trunk movements should individuals with osteoporosis avoid?

Answer 38

* Trunk flexion exercises as these increase risk of fracture * Also avoid powerful twisting movements of the trunk

Question 39

What should individuals with **spinal cord injury** and **osteoporosis** of the lower limbs avoid regarding electrical stimulation?

Answer 39

Maximal intensity physical activity (i.e., maximal strength testing) via electrical stimulation of the lower limbs

Question 40

What are some **safe** forms of physical activity for with **spinal cord injury** and **osteoporosis** of the lower limbs?

Answer 40

Progressive lower-limb resistance training, cycling, and ambulation (all assisted by electrical stimulation) or body-weight supported treadmill training

Question 41

What are the basic components of promoting bone health?

Answer 41

* Balanced nutrition, ideally starting from childhood * Adequate calcium and vitamin D intake * Physical activity and resistance training exercises * Avoid smoking and excessive alcohol intake