Low Back Pathologies 3 Flashcards
key characteristics of the skeleton
metabolically active
continuous remodeling throughout life with annual bone turn over
remodeling is necessary to maintain structure integrity of skeleton and to serve a metabolic function as a storehouse of calcium and phosphorus
bone mass peaks between 25-35
osteoporosis is a persistent progressive metabolic disease characterized by what
low bone mass
impaired bone health
decreased bone strength
enhanced risk of fx
types of osteoporosis
primary is most common; associated with ARJC, hormone, and calcium levels and PA
secondary is because of disease or meds
describe the incidence of osteoporosis
not often presenting
70% undiagnosed
increasing in number and expected to keep going up
MOST common metabolic disease
highest in post-menopausal women with estrogen deficit and Scandinavian ancestry
precursor to osteoporosis
osteopenia (low bone mass)
% of men/women who have osteoporosis
33% women and 20% men over 50 will suffer from osteoporosis
risk factors for osteoporosis
lower hormone levels; specifically estrogen and testosterone
genetics
social habits
how do estrogen and testosterone levels affect osteoporosis
estrogen limits bone resorption and aids in calcium absorption
associated with menopause and abnormal menses
testosterone also limits resorption
how can genetics affect osteoporosis
family hx
also plays a role with parathyroid hormone for calcium balance and smaller bone stature
what social habits can affect osteoporosis
> 2 beers or > 1 glass of wine or > 1 liquor shot or > 3 cups caffeine per day
risk factors for osteoporosis
physical inactivity
depression alters hormones
meds (>3 months corticosteroids)
tobacco
dietary dysfunction with vit D and calcium levels associated with eating disorders, low protein, SAD, or conditions that alter absorption of nutrients
when should pts get a DEXA scan
women at 65
men at 70
pathogenesis of osteoporosis
metabolic disorder
osteoclastic > osteoblastic activity
endocrine disorder that limit calcium regulating and sex hormones
loss of inner cancellous bone
wedging, compression, and fx of vertebral body most often in lower thoracic and upper lumbar regions
where are fxs most common
femurs, ribs, radius = common areas
nontraumatic > traumatic
objective changes that may indicate asymptomatic osteoporosis
FHP
loss of height
increased thoracic and lumbar kyphosis
fulcrums
rounded/slouched posture
when is it common for fxs to occur with osteoporosis
often with seemingly benign flexion activity
i.e. bending or sneezing
S&S of osteoporotic fx
fx S&S plus
severe back pain mid thoracic/upper lumbar (especially with flx, compression, and valsalva stresses)
pain may refer to flanks/abdominal
ROM and resisted testing for osteoporosis
ROM = pain and limits with flx but possibly all direction
resisted = pain and weakness, primarily with flx but possibly with all directions
stress tests and neuro finding for osteoporosis
pain with compression and likely relief with distraction
pain with PA pressure
most often neuro is neg
special tests for osteoporosis
percussion
supine sign (not able to lie flat without pain)
common hx for those with osteoporosis
> 52
no LE pain
BMI <22
no regular exercise
female
referral for osteoporosis
if a fx is suspected, possibly urgent
emergency if neuro symptoms or inability to walk
PT rx for osteoporosis
even if there is a fx, pt is usually stable and able to tolerate R xdue to ligamentous structure
proceed based on symptoms
minimize ertebral compression
position/directional preferences with edu, treatments, and activite=ies
bracing/assistive devices i.e. cane/reacher
MET focus for osteoporosis
bone integrity (maintenance or improving density)
balance
walking/resistance
MT for osteoporosis pt
caution with JM (especially higher grades may be contraindicated) if advanced level of disease or more than 3 months of corticosteroid use
can use JM to normalize motion and stresses through spine
prognosis for osteoporosis fx
majority will heal after 8-12 weeks of conservative treatment with subsequent decline in pain
MT for osteoporosis pt
caution with JM (especially higher grades may be contraindicated) if advanced level of disease or more than 3 months of corticosteroid use
can use JM to normalize motion and stresses through spine
MD Rx for osteoporosis
percutaneous vertebroplasty
good treatment for some pts with acute/subacute pain
addition of exercises vs none provided better subjective outcomes startign at 6 months and lasting out to 2 years following sx
what is osteomalacia
bone softening without loss of bone mass or brittleness as with osteoporosis
etiology factors for osteomalacia
insufficient intestinal calcium absorption due to lack of calcium or more likely low vitamin D
increased kidney phosphate loss (i.e. due to kidney conditions, long term antacid use, or hyperparathyroidism disorders that alter clacium levels)
risk factors for osteomalacia
lack of dietary or sunlit vit D
malabsorption conditions including age that affect digestive and metabolic fxns
meds that alter vit D, calcium, or phosphate
pathogenesis of osteomalacia
lack of calcium salts
structure unchanged as mentioned but still weakens the bone with possible fx
primarily affects vertebra and femurs
clinical manifestations and S&S of osteomalacia
difficult and delayed S&S due to diffuse achiness and fatigue with wt loss
LBP and pelvic and LE pain aggrevated when WB
myalgia/arthalgia
proximal muscle weakness and polyneuropathy
altered gait
increased falls
progresses to deformities like increased kyphosis and genu varum (bow legged)
