Osteoporosis

Question 1

Define osteoporosis

Answer 1

• BMD 2n5 standard deviation below normal for age 30
• peak bone mass is at 30 years old

Question 2

Causes of osteoporosis

Answer 2

• estrogen loss
• corticosteroids
• loss of weight bearing, bed rest
• hyperparathyroidism, hyperthyroidism, & chronic renal failure

Question 3

Pathogenesis of osteoporosis

Answer 3

• combination of increased bone reabsorption & decreased bone formation
• imbalance between osteoclastic & osteoblastic function
• greatest effect on trabecular bone (vertebrae) & metaphysis of long bones

Question 4

Most common causes & risk factors of osteoporosis

Answer 4

• vitamin D insufficiency
• high salt intake
• smoking
• alcohol abuse
• low calcium intake
• athletic amenorrhea
• chronic obstructive lung disease (COPD)
• congestive heart failure
• depression
• idiopathic scoliosis
• weight loss

Question 5

Describe secondary fractures

Answer 5

• a fragility fracture patient is at elevated risk of subsequent fracture especially in the year or two following the first fracture
• fragility fractures & secondary fractures have broad implications for independence & life expectancy
• there are many opportunities to lower secondary fracture risk in these patients

Question 6

Describe fracture liaison services (FLS)

Answer 6

• a model for optimizing recognition of osteoporosis & initiating proper care
• associated with lower healthcare expenditures, improved outcomes, & positive changes in patient lifestyle choices
• some fracture types (ex: hip) still carry relatively poor prognosis

Question 7

Exercise goals for osteoporosis patients

Answer 7

• avoid injury during exercise
• reduce injury risk in general
• prevent falls
• slow BMD loss
• gain BMD?
• enjoy all the other benefits of exercise, mobility, & health

Question 8

Describe different exercises for postmenopausal women

Answer 8

• Static WB exercise: good for slowing hip BMD loss (ex: single leg standing)
• Dynamic WB low force: good for slowing lumbar BMD loss (ex: walking or yoga)
• Dynamic WB high force: no recommendation based on evidence (ex: jogging, dancing, vibration plates)
• Non-weight bearing low force: no recommendation based on evidence (ex: seated, low load, high rep exercises)
• Non-weight bearing high force: good for slowing femoral neck BMD loss (ex: seated, open chain, weights)
• Combo of exercises: good for general bone health (ex: small circuits or cross-modal training, axial loading, some resistance)

Question 9

Describe the different exercises for premenopausal women

Answer 9

• Static WBE: no evidence
• Dynamic WBE: no evidence
• Dynamic WBE high force: good for slowing lumbar BMD loss
• Non-WBE low force: no evidence
• Non-WBE high force: good for slowing lumbar BMD loss
• Combo: good for slowing lumbar & femoral neck BMD loss

Question 10

Describe exercise recommendation for osteoporotic men

Answer 10

• no evidence to support any specific exercise recommendations for prevention of BMD loss

Question 11

General considerations regarding the CPG

Answer 11

• the above exercise recommendations don’t consider fall risk
• the duration required to elicit a measurable training response is long (months to years)
• comparative effectiveness between different regimens remains unclear

Question 12

Effects of whole body vibration mechanism

Answer 12

• mechanical effect: literally applying a load directly to the bone
• neuromuscular effect: reflexive muscular co-activation, possible in response to a perceived “threat”

Question 13

Variables/setting that may affect outcome of whole body vibration

Answer 13

• patient population
• extent of BMD loss
• distribution of BMD loss
• acute variables of administration: frequency, magnitude, mode of vibration, or concurrent activity