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EXCI 455 > LECTURE NINE: Bones, Falls, & Fractures > Flashcards

LECTURE NINE: Bones, Falls, & Fractures Flashcards

1
Q

What are the 3 names for the interior of bone?

A
  • spongy
  • cancellous
  • trabecular
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2
Q

What is spongy bone surrounded by?

A

Compact bone

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3
Q

Describe the characteristics of spongy bone.

A

Spongy bone is porous, and contains red bone marrow, where RBCs are made.

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4
Q

What type of bone is easiest to fracture?

A

Spongy bone

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5
Q

Are there blood vessels in the bone marrow?

A

Yes.

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6
Q

What are the 3 factors that affect bone strength?

A

1) Bone Density (mass bone/unit volume)
2) Bone Quality (structural material of bones)
3) Bone Geometry (morphology: diameter of bone)

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7
Q

What percentage of bone’s resistance to fracture does Bone Density account for?

A

50-80%

*the more dense, the more solid.

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8
Q

What is the yearly estimated rate of bone loss (%) in the first decade post-menopause?

Yearly after the first decade?

A

1-2% yearly in first decade; 0.3-0.5%/year after that.

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9
Q

In women, active bone growth occurs until age __, then shows a slow loss between ages __-__, a rapid loss between ages __-__, and a less rapid loss after age __.

A

Approximately….

Active bone growth occurs until age 35 (approx); slow loss between 35-50; rapid loss 50-60; less rapid loss after 60.

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10
Q

What are the 2 major substances that increase the structural integrity of bone?

A

Minerals (ex: calcium), and Collagen

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11
Q

What are the 4 major minerals in bone (in order).

What do these minerals provide? (2)

A

Calcium, Magnesium, Sodium, Potassium.

They provide RIGIDITY and STRENGTH.

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12
Q

What happens to collagen and mineral tissues in bones when we age?

A

They are less resistant to mechanical loading.

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13
Q

For a bone with the same thickness, the one with a _____ (greater/smaller) diameter is more solid.

A

greater diameter = more solid

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14
Q

What is the process by which the loss of BMD is compensated in older adults?

What occurs in this process?

A

Periosteal Apposition: tissue is added along the outer surface of the bone; it’s trying to “patch” the bone to maintain solidity.

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15
Q

The geometry of bone depends on the bone’s framework; trusses and bridges. Describe what happens in an osteopenic bone? In a trained individual’s bone? A normal bone?

A 
In an osteopenic bone:
- decrease in size of bridges (thinner)
- decrease in number of bridges (trabeculae)
- increase space in cavities
= reduced bone strength
in a trained individual's bone
- increased in size of bridges (thicker)
- increase in number of bridges
- decrease space in cavities
= increased bone strength

Normal bone = somewhere in between: analogous with roof trusses.

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16
Q

Osteopenia: A (condition/disease) characterized by (very low/ lower than normal) BMD: may be (predictor/precursor) to osteoporosis.

A

A CONDITION characterized by LOWER THAN NORMAL BMD. May be a PRECURSOR to osteoporosis.

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17
Q

Osteoporosis: A disease where bone ____ and ______ decline to a point where there is a significant increase in ______ and ________ to fracture.

A

Osteoporosis: A disease where bone MASS and STRENGTH decline to a point where there is a significant increase in FRAGILITY and SUSCEPTIBILITY to fracture.

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18
Q

What is “Established Osteoporosis”?

A

Those with osteoporosis who have ONE OR MORE fragility fractures.

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19
Q

Osteopenia is characterized with a BMD of __ to ___ standard deviations below the mean value for young adults.

A

Osteopenia is characterized with a BMD of 1 to 2.5 standard deviations below the mean value for young adults.

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20
Q

Osteoporosis is characterized with a BMD of ____ standard deviations below the mean value for young adults.

A

Osteoporosis is characterized with a BMD of 2.5 or greater standard deviations below the mean value for young adults.

*Exactly 2.5 SD below is “on the fence”…won’t be asked to characterized as either on exam.

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21
Q

What proportion of OAs who suffer a hip fracture recover sufficiently to perform BADLs and IADLs? What does this cause?

A

LESS THAN 1/3!!!

Causes a loss of independence.

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22
Q

What (%) chance of sustaining a fracture in their lifetime do women have?

A

40%

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23
Q

what are the 3 most common sites of fragility fracture?

A
  • Spine
  • Hip
  • Wrist

(also common: knee, ankle, hand, forearm)

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24
Q

What is a Fragility fracture?

A

A fall from standing height or less that results in a fracture.

  • The body should be able to sustain this fall without fracture: FFs reveal an underlying cause for fragility.
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25
Q

What are the 7 Training Principles to maximize the influence of exercise on bones?

A

1) Bone adapts best to DYNAMIC rather than STATIC mechanical stimulation
2) If a bone is to respond to training, the stimulus must be at a SUPRA-THRESHOLD level.
3) The response of bone to exercise is improved by BRIEF but INTERMITTENT exercise.
4) Bone responds best when the exercise employs a pattern that DIFFERS from the usual loading pattern.
5) The response that any bone has to a mechanical stimulus such as exercise is proportional to the LOADING CYCLE.
6) For bone to adapt, it must have sufficient ENERGY to rebuild itself.
7) For exercise to work, there should be abundant CALCIUM and VITAMIN D availability.

26
Q

What “message” tells the bone to grow in response to mechanical loading?

A

Fluid flowing through the canalicular channels and around the bone trabeculae; this is where nutrient diffusion occurs

(Principle 1: dynamic > static)

27
Q

What amplifies hormonal responses promoting bone growth? (2)

A
  • Intensity of exercise

- Differences in exercise patterning (ex: change up exercises!)

28
Q

What is osteogenesis?

A

synonym for bone growth

29
Q

What is a change in posture we see in OAs with osteoporosis?

A

Kyphosis of the spine (cervical and thoracic)

30
Q

In terms of training modality, what has the greater effect on BMD:

High intensity resistance training, or, high impact aerobic training?

A

High intensity RESISTANCE TRAINING has the greater effect on BMD.

(Principle 2: stimulus must be at suprathreshold level)

31
Q

What happens after surpassing the supramaximal stimulus in RT?

A

“Failure Point”: stress above this point causes bone fracture.

32
Q

Dividing the total volume of work performed per week across more days vs. fewer days will have a (greater/lesser) osteogenic effect.

Ex: if goal is to reduce PA time, it would be better to (shorten/lengthen) each session rather than reduce the number of session performed.

A

A GREATER osteogenic effect- short, intense bouts build bone better than longer sessions.

Ex: Better to SHORTEN each session rather than reducing the total number of days performing the exercise.

(Principle 3: improved by brief but intermittent exercise)

33
Q

When challenged beyond the usual loading pattern, bone responds best. In terms of RT programming, it is therefore important to vary….(3).

A

1) vary the AMOUNT of resistance
(ex: increase the load to remain challenging)

2) vary the METHOD used to provide resistance
(ex: use free weights, resistance bands, machines, isokinetic specialty equipment)

3) vary the DIRECTIONS in which force is applied
(ex: stress bones from every angle)

(Principle 4: bone responds best when PA employs different patterns)

34
Q

What is the goal of “The Book Drill”?

What kind of training is it (what types of contractions)?

What variations are there?

How can you increase resistance?

A

Goal: Balance Training in ADLs

Training Type: Dynamic (concentric and eccentric)

Variations: Directions in which force is applied (forward, backward, sideways); change distance between books, pile them higher to make it easier, lower to make harder; heavier vs. light books…

Increase resistance with a weighted vest!

35
Q

What is the goal of a “Ladder Drill”?

What types of contractions?

Name some variations-

A

Goal: Agility training

Contractions: Dynamic (concentric and eccentric)

Variations: add jumps, change direction or pattern of movement…

36
Q

Is there a limit to the number of repetitions (i.e. loading cycle) that will elicit a positive BMD response?

If so, what is it per day?

A

Yes!

There is a positive effect up to about 40 loading cycles per day; after that, more cycles have little/no additional effect.

(Principle 5: loading cycles)

37
Q

The development of new bone = a _______ _______ requiring energy.

A

The development of new bone is a METABOLIC PROCESS requiring energy.

(Principle 6: sufficient energy)

38
Q

What are the 2 major dietary problems that OA may face having a deleterious effect on their bone health?

A

Low energy intake (especially low protein), and low calcium intake.

39
Q

True or False:

1) Exercise without sufficient calcium intake will show little improvement in BMD
2) No exercise with sufficient calcium intake will show little improvement in BMD.
3) Exercise and sufficient calcium intake is the best way to improve BMD.

A

ALL TRUE!

You really need both exercise and enough Ca to improve BMD. Without either piece of the puzzle, there BMD will suffer.

40
Q

What is the role of Vitamin D in the bones?

A

Vitamin D helps facilitates the absorption of minerals (ex: Ca, P, Mg) through the intestinal wall and into the blood stream- from the digestive system to the building sites in the bones.

41
Q

What are the ACSM guidelines to preserve bone health in adulthood?

Mode:
Intensity:
Frequency:
Duration:

A

Mode: weight bearing endurance activities (ex: tennis, stairs, jogging, jumping sports, resistance training)

Intensity: moderate to high

Frequency:

  • Weight bearing endurance: 3-5 x/week
  • RT: 2-3 x/week

Duration: 30-60 min/day combination weight bearing/jumping activities and RT targeting all major muscle groups.

TAKE HOME MESSAGE: STRESS YOUR BONES!

42
Q

What are the ACSM guidelines specifically for OAs diagnosed with osteoporosis?

A

Frequency:

  • 2-3 days per week RT:
  • 1-3 sets; 5-8 reps; 4-6 strength exercises (weight bearing, both UB and LB, using body weight as resistance)

Intensity: increased by adding resistance gradually (up to 10 lbs.) ex: weighted vest, therabands, tubing.

*AVOID: impact exercise, be careful of SPINE!!!
Avoid: spinal flexion against resistance, spinal extension, high compressive forces on spine, quick trunk rotation.

43
Q

YES/NO?

Are compression fractures likely to cause nerve or spinal cord damage in OA with osteoporosis?

A

NO.

Why? For most fractures, damage is limited to the front of the vertebral column, therefore rarely associated with SC damage.

44
Q

“If bone density is the problem, falls are the mechanism by which that problem is transformed into injury.”

A

“If bone density is the problem, falls are the mechanism by which that problem is transformed into injury.”

45
Q

What is the leading cause of injuries among Canadians over 65?

A

FALLS.

46
Q

What is the proportion of Canadian community-dwelling seniors who experience at least one fall per year?

a) 10-20%
b) 20-30%
c) 30-40%
d) 40-45%

A

b) 20-30%

47
Q

Falls are the direct cause of what % of hip fractures? What proportion of these hip fractures lead to death?

A

Falls are the direct cause of 95% of hip fractures, leading to death in 20% of cases.

48
Q

Falls account for what % of seniors’ injury-related hospitalizations?

A

85%.

Making this the leading cause of injury-related admissions for seniors.

49
Q

What is the yearly public health cost of seniors’ injuries?

What are the emotional/social costs?

A

> 2 billion$/year!

Emotional/social costs:

  • loss of independence
  • personal suffering
  • decreased quality of life
50
Q

Where are the 2 areas of the house where the majority of falls occur?

A

Stairs & Bathroom

51
Q

Describe the vicious cycle of the fear of falling.

A

Fear of falling causes many OAs to reduce their PA, which leads to a loss of muscle mass and strength, which increases their risk of falling, leading to falls. If they fall, their fear of falling intensifies… (Vicious Cycle!!!)

52
Q

Older adults may make more errors when they are required to move (faster/accurately), than their ability to move (faster/accurately).

A

Older adults may make more errors when they are required to move FASTER than their ability to move ACCURATELY.

53
Q

Age-related changes in sensory and motor function show a continuous and progressive decrease in… (3)

A
  • nerve conduction velocity (decrease by 10-15%)
  • proprioception (decreased response from muscle spindles)
  • vestibular function (dizziness)
54
Q

Two factors affecting incidence of falls in OA:

Impaired ________ ______ (orientation of body in space and position of body parts in relation to each other)

____ ________ awareness (low heels with thin, hard soles maximize _________).

A

1) Impaired POSITION SENSE (orientation of body in space and position of body parts in relation to each other)
2) FOOT POSITION awareness (footwear with low heels and thin, hard soles maximize PROPRIOCEPTION)

55
Q

What leads to age-related loss of vision and vision acuity.

A

Anatomical changes in visual system (cornea, lens, iris, vitreous humor, visual cortex)

56
Q

What are 4 aspects of vision loss that make it dangerous for night driving in OAs?

A
  • reduced peripheral vision
  • glare sensitivity
  • dark adaptation
  • depth perception
57
Q

Which are used for night vision: rods or cones?

A

RODS

58
Q

Describe 3 areas of hearing which are needed to interpret sounds, and decline with age? What can these be worsened by?

Considering this, how to we help OAs hear us better?

A
  • acuity
  • localization of sound
  • ability to mask extraneous sound
  • worsened by tinnitus
  • *Speak SLOWER and louder to help OAs with comprehension.
59
Q

Exercise area should be ____ to compensate for vision impairments in OA.

A

well lit

60
Q

Instructions should be spoken clearly and ______.

A

slowly

61
Q

Instructor should ____ participants and _____ their comprehension.

A

face and observe

62
Q

For participants with a history of frequent falls/postural instability, an _____ ______ can be helpful for safety/confidence.

A

external support (ex: chair, wall bars, walker).

EXCI 455 (13 decks)

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