EXAM3/CH25/33- Older Adults + Osteoporosis Flashcards
osteoporosis
a skeletal disorder characterized by compromised bone strength, predisposing individuals to an increased risk of fracture
bone mineral density for osteoporosis
T score 2.5 standard deviations below the mean
osteopenia
less severe form of disease
bone mineral density for osteopenia
T score between 1-2.5 standard deviations below mean
majority of bone mass is accured when
in childhood
peak bone mass is generally attained by ____ years old
20
bone development is influcned by what
-genetics
-physical activity
-diet
-hormone balance (estrogen inhibits bone resorption)
____ inhibits bone resoprtion
estrogen
when does prevention of osteoporosis begin
in childhood
bone remodeling
naturally occuring process
-bone resorption followed by bone formation
bone resorption
breakdown of bone by osteoclasts
bone formation
production + mineralization of bone by osteoblasts
osteo
bone
clast
break
blast
develop
osteoclasts
responsible for bone resorption/breakdown
osteoblasts
responsible for bone development/formation
what is required to have good bone health
equal amounts of bone resportion + formation
bone loss occurs when
bone resorption exceeds formation
osteoporosis is symptomatic/asymptomatic
asymptomatic
first sign of osteoporosis
often a fracture
possible risk factors for osteoporosis
-sedentary
-diet
-post-menopause
what may be a red flag in determining osteoporosis
-abnormally-caused fracture (fall from standing height)
-vertebral fractures (height loss, protruding abdomen, hyperkyphosis, or other postural changes; may not be noticeable until multiple vertebral fractures have occurred)
what helps to strengthen bones
physical activity
history + physical exam
-medical history, medications, comorbid conditions, + contraindications to exercise
-fracture risk (FRAX)
-fall risk
-physical performance
-standing posture
-barriers to + facilitators of physical activity
long term use of ____ is detrimental to bone health
corticosteroid
-causes bone to break down
osteoporosis affects which part of spine
cervical spine
-do a postural assessment for osteoporosis
fracture risk assessment (FRAX)
-extends beyond BMD by looking at other patient risk factors
-age, gender, oral glucocorticoids, history of fracture
-ten-year probability of fracture is calculated based on algorithms from large populations
-risk of fracture is emphasized over the use of terms osteoporosis or osteopenia
downfall of FRAX
only for ages 40-90
if patient is sedentary, what do we click yes for on FRAX
secondary osteoporosis
bone mineral density (BMD)
-most common measure for diagostic testing
-uses dual-energy absorptiometry (DXA)
-femoral hip BMD is used for diagnosis of osteoporosis + determination of 10 yr risk
-lumbar spine measures can assist with diagnosis
does DXA provide a T-score
yes
____ can help increase or maintain bone mass
exercise
nonpharmacologic + pharmacologic agents are available to increase bone mass or slow loss
-calcium supplementation
-vitamin D supplementation
-bisphosphonates (decrease osteoclast activity)
-parathyroid hormone (increased bone turnover)
-calcitonin (decrease osteoclast activity)
-estrogen (or hormone) replacement therapy (decrease osteoclast activity)
exercise testing considerations
-determine an appropriate exercise prescription
-make certain that any potential benefits outweigh the risks
exercise testing contraindications
-ACSM does not view osteoporosis as an absolute or relative contraindication
-osteoporosis + osteopenia: avoid exercise testing that involves high-impact skeletal loading such as jumping/stepping/running
what mode is good for osteoporosis/osteopenia patients
cycle ergometer or arm ergometer
-fall prevention
goals of exercise prescription
-reduction of fractures (via prevention of falls)
-reduction of bone loss
-promotion of spine-sparing strategies (proper form)
current experimental knowledge indicates that an osteogenic exercise regimen should include what
load-bearing activities at high magnitude with few repetitions
fall prevention
- reducing base of support (feet together, stand on one foot)
- shifting your weight within your limits of stability (leaning forward + back, shifting weight heel to toe)
- reducing contact with support objects (if holding on to an assistive device while standing or doing exercises, reduce that contact gradually)
- changing sensory input (closing eyes)
where/when can fall prevention exercise be done
anywhere + as often as you want
Dr. Gardner’s take aways
-NO TWO CLINICAL PATIENTS ARE EXACTLY ALIKE!!
-start with program that is doable for patient + then progress
-at the absolute minimum, program should include
-cardiorespiratory
*10 minutes per bout of exercise
*2-3 days per week
-resistance training
*2-3 days per week
-flexibility + balance
*as often as possible
gerontology
study of the aging process
geriatrics
the branch of clinical medicine that encompasses the diagnosis + management of older individuals
older adults- signs + symptoms
-dependent primarily on specific physical conditions + chronic disease
-pain (arthritis), dyspnea (deconditioning, heart or lung disease)
older adults- history + physical examination
-general H&P should be performed
-pay careful attention to typical conditions of aging (e.g., heart disease, arthritis, lung disease)
-always assess medications for proper use
-assess gait disorders
-assess cognitive deficits
exercise testing for HEALTHY older adults (controlled BP + HR, no CV events)
can begin low- to moderate-intensity exercise without a stress test
when is a stress test needed for older adults
if high risk or desiring to do high intensity exercise (greater than 60% peak VO2)
what tests should be performed if older adult desires to begin resistance training
strength + ROM
just because someone is an older adult doesn’t mean we have to do exercise testing
polypharmacy
taking many medications
44% of older men + 57% of older women take ____ prescription medications
5+
-this leads to confusion on what to take + the timing of when to take it
what is crucial for CEP to understand for older adults
medication interactions + effect(s) of medication on exercise measures (i.e. HR, BP, respiration)
exercise program should be tailored to what
individual’s ability + desires
why should a warm-up be performed
to optimize chronotropic responses, increase perfusion to muscles, + maximize vessel responses
why should a cool-down be performed
may assist to attenuate vascular pooling, decreasing hypotension, + to lessen arrhythmias
