Low Back Pathologies 3

Question 1

key characteristics of the skeleton

Answer 1

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

Question 2

osteoporosis is a persistent progressive metabolic disease characterized by what

Answer 2

low bone mass

impaired bone health

decreased bone strength

enhanced risk of fx

Question 3

types of osteoporosis

Answer 3

primary is most common; associated with ARJC, hormone, and calcium levels and PA

secondary is because of disease or meds

Question 4

describe the incidence of osteoporosis

Answer 4

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

Question 5

precursor to osteoporosis

Answer 5

osteopenia (low bone mass)

Question 6

% of men/women who have osteoporosis

Answer 6

33% women and 20% men over 50 will suffer from osteoporosis

Question 7

risk factors for osteoporosis

Answer 7

lower hormone levels; specifically estrogen and testosterone

genetics

social habits

Question 8

how do estrogen and testosterone levels affect osteoporosis

Answer 8

estrogen limits bone resorption and aids in calcium absorption

associated with menopause and abnormal menses

testosterone also limits resorption

Question 9

how can genetics affect osteoporosis

Answer 9

family hx

also plays a role with parathyroid hormone for calcium balance and smaller bone stature

Question 10

what social habits can affect osteoporosis

Answer 10

> 2 beers or > 1 glass of wine or > 1 liquor shot or > 3 cups caffeine per day

Question 11

risk factors for osteoporosis

Answer 11

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

Question 12

when should pts get a DEXA scan

Answer 12

women at 65
men at 70

Question 13

pathogenesis of osteoporosis

Answer 13

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

Question 14

where are fxs most common

Answer 14

femurs, ribs, radius = common areas

nontraumatic > traumatic

Question 15

objective changes that may indicate asymptomatic osteoporosis

Answer 15

FHP

loss of height

increased thoracic and lumbar kyphosis

fulcrums

rounded/slouched posture

Question 16

when is it common for fxs to occur with osteoporosis

Answer 16

often with seemingly benign flexion activity

i.e. bending or sneezing

Question 17

S&S of osteoporotic fx

Answer 17

fx S&S plus

severe back pain mid thoracic/upper lumbar (especially with flx, compression, and valsalva stresses)

pain may refer to flanks/abdominal

Question 18

ROM and resisted testing for osteoporosis

Answer 18

ROM = pain and limits with flx but possibly all direction

resisted = pain and weakness, primarily with flx but possibly with all directions

Question 19

stress tests and neuro finding for osteoporosis

Answer 19

pain with compression and likely relief with distraction

pain with PA pressure

most often neuro is neg

Question 20

special tests for osteoporosis

Answer 20

percussion

supine sign (not able to lie flat without pain)

Question 21

common hx for those with osteoporosis

Answer 21

> 52

no LE pain

BMI <22

no regular exercise

female

Question 22

referral for osteoporosis

Answer 22

if a fx is suspected, possibly urgent

emergency if neuro symptoms or inability to walk

Question 23

PT rx for osteoporosis

Answer 23

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

Question 24

MET focus for osteoporosis

Answer 24

bone integrity (maintenance or improving density)

balance

walking/resistance

Question 25

MT for osteoporosis pt

Answer 25

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

Question 26

prognosis for osteoporosis fx

Answer 26

majority will heal after 8-12 weeks of conservative treatment with subsequent decline in pain

Question 27

MT for osteoporosis pt

Answer 27

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

Question 28

MD Rx for osteoporosis

Answer 28

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

Question 29

what is osteomalacia

Answer 29

bone softening without loss of bone mass or brittleness as with osteoporosis

Question 30

etiology factors for osteomalacia

Answer 30

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)

Question 31

risk factors for osteomalacia

Answer 31

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

Question 32

pathogenesis of osteomalacia

Answer 32

lack of calcium salts

structure unchanged as mentioned but still weakens the bone with possible fx

primarily affects vertebra and femurs

Question 33

clinical manifestations and S&S of osteomalacia

Answer 33

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)