Chapter Eleven: Orthoses for Osteoporosis Flashcards
What is osteoporosis?
A disorder in which mineralized bone density is below normal, resulting in a bone structure that is vulnerable to fractures.
What is a compromised bone due to osteoporosis characterized by?
A reduction in bone mass that is related to an imbalance in bone formation and resorption.
What is the most common of the metabolic bone diseases?
Osteoporosis
What does osteopenia mean?
Too little bone
A decrease in bone mass normally begins when?
In a person’s early thirties and continues throughout their life
What are the different types of osteoporosis?
Type I
Type II
What is type I osteoporosis?
It affects women and is associated with estrogen deficiency occurring 5 to 10 years after menopause
What is primarily affected in Type I osteoporosis?
Trabecular osteogenesis which results in a diminished capacity to support compressive loads.
Where are the sites that are at greater risk in Type I osteoporosis?
Vertebral bodies,
Distal radius
Hips
What is Type II osteoporosis?
Affects both males and females
it is due to calcium deficiency and is associated with aging.
What are primarily affected in Type II osteoporosis?
Trabecular and cortical bone are affected
Cortical bone provides support, especially for bending and torsional loads.
What sites of the body are at greater risk with Type II osteoporosis?
Femoral neck Proximal tibia Humerus Pelvis Vertebral bodies
What is a common posutral deformity secondary to Vertebral Compression Fractures?
Hyperkyphosis
Hyperkyphosis can lead to what?
Ligamentous stretching Diminished functional vital capacity Inferior costal margin Pelvic rim contact Discomfort Chronic low back pain Abdominal crowding Depression Muscle imbalance Painful chronic intravertebral pseudarthrosis
What is sarcopenia?
Involutional muscle loss
The severity of the Vertebral compression fracture can lead to what?
Diminished function,
Decreased mobility
Physical deconditioning
Consequently accelerated bone loss
What are the clinical signs of Vertebral compression fracture?
Sudden onset of back pain Loss of height Spinal deformity Protuberant abdomen Diminished vital capacity Lung capacity is reduced
What are the drug therapies for osteoporosis?
Bisphosphonates to decrease bone resorption,
Estrogen/hormone replacement to counteract the postmenopausal increased rate of bone loss, and
Calcitonin to reduce osteoclastic bone resorption.
What are the nonpharmacologic treatments of osteoporosis?
Exercise
Physical management of pain
Orthotic treatment
Gait training
What are some drug therapies that can increase bone mass?
Sodium fluoride Anabolic steroids Testosterone Parathyroid hormone They may have side effects
What is a surgical treatment of vertebral compression fractures?
Augmentation of VCF with bone cement
It includes vertebroplasty: in which bone cement is percutaneously injected into the fractured vertebral body to stabilize it
And Kyphoplasty: in which bone cement is injected after percutaneous reduction of the vertebral body deformity using inflatable bone tamps.
What orthosis is usually not an option for vertebral compression fractures? Why?
Total contact TLSO
Because there may be large spinal deformities which can have an uncomfortable fit over bony prominences or restriction of pulmonary capacity.
What does PTS stand for?
Posture training support
What is a PTS?
A weighted kypho-orthosis provides a weight suspended just inferior to the scapulae.
When is a PTS indicated?
Cases of excess dorsal kyphosis possibly involving iliocostal contact or iliocostal friction syndrome.
What are the mechanisms that suggest PTS works?
Anterior compression forces on the spine are reduced by the countermoment produced by the posterior weight.
The device encourages active back extension through propioceptive input and helps increase back extensor strength.
Why might a lumbosacral corset and dorsolumbosacral corset be used?
They reduce pain by axial unloading,
Reduce muscle strain
and Improve standing balance by moving the position of the center of gravity posteriorly.
When should corsets not be used?
If there is severe respiratory condition present
When should a corset be used?
For patients with COPD
When are three-point hyperextension orthoses indicated?
For stable compression fractures in the lower thoracic/upper lumbar spine.
What is a clear disadvantage of the hyperextension orthosis?
It puts excessive pressure on the pubis and sternum and doesn’t correct the standing posture.
What are the orthotic goals of hyperextension orthoses?
Unloading of the fracture site to decreases pain and prevent excessive flexion.
What are the two orthoses that actually have scientific support for their efficacy on treating vertebral compression fractures?
PTS
Spinomed (TLSO-Sagittal plane control)
What does spinomed resemble?
Knight-Taylor orthosis
What are the orthotic goals of the spinomed?
Correcting the unbalanced anterior posture in the sagittal plane
Retracting the shoulders,
Increasing back extensor strength
Increase intracavity pressure
What are the advantages of the Spinomed?
High patient compliance Strengthening of the paraspinal muscles Device's light Ease of donning and doffing Hand moldability of the brace
What does the posterior shell TLSO consist of?
Plastic posterior shell, soft corset front
a system of straps
What makes the posterior shell TLSO different from Spinomed?
The plastic posterior shell is not designed to be in total contact at the superior portion in the initial phase of orthotic treatment, but it may achieve contact in the later phases.
What are the orthotic goals of the posterior shell TLSO?
Restoration of sagittal plane standing posture alignment,
reduction of internal rotation of the shoulders
Improvement of vital capacity
Restoration of heel-to-toe gait
Improvement of seated posture
What are the disadvantages of the posterior shell TLSO?
Difficulty in donning and doffing
Excessive weight.
Whta is an example of an inapporpriate device for patients with acute pain from VCF?
PTS
It is not deigned to immobilize the fracture site or provide stability. It is only intended for the rehabilitation of chronic pain.
What is an example of an inappropriate device for patients with chronic pain from VCF?
Hyperextension orthosis
Patient assessment of VCFs should include what?
Medical history Knowledge of the patient's living environment Patient ability to perform ADLs Previous/current fractures Previous/current treatment Other medical conditions occurrence of falls MMT ROM Visual/cognitive impairment Location of pain chronic/acute