Cours 9 : Osteoporosis

Question 1

Can Osteoporosis occur in young adults?

Answer 1

Yes

Question 2

What is the relation between Osteoporosis and Physical Activity?

Answer 2

Exercise increases body mass density

Question 3

The use of which medications can lead to osteoporosis?

Answer 3

Corticosteroids (overtime, it cause osteoporosis)

Question 4

What is osteo?

Answer 4

Bone

Question 5

What is porosis?

Answer 5

Porous (cavities in the bone)

Question 6

What is the osteoporosis diagnosis?

Answer 6

The quantitative computed tomography measures BMD and produced a three-dimensional image that shows true volume density QCT. Can isolate an area of testing

The only method capable of distinguishing BMD level between the exterior cortical bone and the interior trabecular bone (trabecular bone = where bone loss begins)

CT Scan can measure BMD inside bones

Question 7

What is the T-score?

Answer 7

The deviation from the mean bone density of healthy young adults of the same gender and ethnicity
** Your BMD score is compared with the score of healthy young adults **

BMD is lower for someone who’s 50 than 20.

Question 8

What is a Z-score?

Answer 8

The deviation form the mean bone density of adults of the same age, gender and ethnicity
** Your BMD score us compared with the score of adults same age as you **

Question 9

The World Health Organization uses what?

Answer 9

Uses a T-score of -2.5 S.D (and below) to définie osteoporosis. A T-score between -1 S.D and -2.5 S.D indicates some bone loos (osteopenia) and a risk of osteoporosis

Question 10

What is the BMD of healthy young adults for the hip?

Answer 10

1000 +_ 100 (S.D) mg/cm2

Question 11

What is osteopenia BMD?

Answer 11

BMD of 900 to 750 mg/cm2

Question 12

What is the BMD of osteoporosis?

Answer 12

BMD of 750 and lower

Question 13

What is the established osteoporosis?

Answer 13

Preferred term for those with osteoporosis and having one or more fragility fractures

A Fragility Fracture is any fall from a standing height or less, that results in a fracture

The body should be able to sustain a fall from this height without a fracture unless there is an underlaying cause

Most common areas : hip, spine and wrist

Question 14

What are the common fractures?

Answer 14

Vertebra, Hip and Wrist
Over 60 years old : 18% fracture of vertebra
Over 50 years old : 15% hip fracture

Women aged 65-69 who break a hip are 3 times more likely to die within a year than women of the same age who don’t break a hip

Question 15

What is the trend of Normal people (WHO categories)?

Answer 15

Decreases

Question 16

What is the trend of osteopenia (WHO categories)?

Answer 16

It increases and then decrease, because people are going from osteopenia to osteoporosis.

Question 17

What is the trend of osteoporosis (WHO categories)?

Answer 17

It increases

Question 18

What is the trend of Established Osteoporosis (WHO categories)?

Answer 18

It increases

Question 19

What is bone metabolism?

Answer 19

Bone = living tissue
Every 3 to 4 months = bone remodeling (old bone is removed and replaced by the new bone)

Bone eroding cells (osteoclasts) = dissolve the mineral and cause small cavities

Décalcification = bone resorption

Bone forming cells (osteoblasts) fill in the cavities until it is restored

Calcification = bone formation

End product = new mineralized bones

Question 20

What are the aging effects?

Answer 20

1. Unbalance in bone remodeling process :
   - loss of 1% of total bone mass each year after the age of 20 (- peak)
   - loss of 2 to 3% of total bone mass each year in women after menopause (first 5 years)
2. Calcium is less efficiently absorbed

Aging Effect on Bone Mineral Density

Question 21

How can we positively change/influence the BMD slope?

Answer 21

With nutrition, physical activity and hormones in post menopausal

Question 22

What is the bone remodeling process?

Answer 22

1. Hormones (parathyroid hormone, estrogen, testosterone)
   - Role = to maintain the appropriate level of calcium in the bone
   - The calcium controls the activity of bone cells
   - Lack of hormones = bone atrophy and general response of the skeletal system
2. Mechanical loading
   - Required to maintain adequate bone density
   - Loading —≥ Activation of bone cells —≥ BMD
   - Absence of loading = bone atrophy
   - This why exercise is so important in middle-aged females + males
   - Local response of the skeletal system

Question 23

What is the postmenopausal Osteoporosis (type 1)?

Answer 23

Decrease in estrogen
Most common
Only women
Mid sixties ( = 15 years post menopause)
Vertebral and hip fractures

Question 24

What is the Senile Osteoporosis (type 2)?

Answer 24

Over 80 years
30% are men
Forearm, pelvic, hip fractures

Question 25

What is secondary osteoporosis?

Answer 25

Associated with calcitonin imbalance, malabsorption conditions (ex : celiac disease, cystic fibrosis, lactose intolerant), alcoholism, smoking and the use of certain medications (ex : glucosteroids in arthritis)

Question 26

What is the prevention of osteoporosis?

Answer 26

Hormone replacement therapy
Pros : inhibit or slow down bone resorption
Decrease effects of menopause pause (Ex : hot flashes, nigh sweats)

Cons : increase of risk of blood clots, stroke and coronary heart disease, necessary or not?

Question 27

What is the best kind of physical activity?

Answer 27

Weight-bearing activities : walking, running, dancing + games and sports such as badminton, tennis, basketball, soccer, etc

Resistance exercise : weight training done with barbells or dumbbells or various apparatus (ex : nautilus)
+ special consideration : high intensities and few repetitions to increase bone pressure

Question 28

What are the effects of training ?

Answer 28

Increases the pressure on the bone = increase of bone mass (Site specific to the limbs used)

For clients with osteopenia or osteoporosis
- Avoid forward flexio of the spine
- Adapt equipment to decrease risk of falling (falls can cause fractures
- Aerobic dance exercise = low impact
- Resistance training = decrease load and increase repetitions