Osteoporosis Flashcards
What is Osteoporosis? Loãng xương
- Osteoporosis is a progressive disease in which the bones become gradually weaker and thinner, causing changes in posture and posing an increased risk of fractures
Osteoporosis is a potentially debilitating làm suy nhược condition affecting many Canadians
Bone is living tissue and it undergoes a continuous process whereby old bone breaks down and is then replaced by new bone
Osteoclast hủy cốt bào cells erode xói mòn the bone, creating cavities in it. Osteoblasts cells form bone and fill in the cavities
In a person with osteoporosis, there is an imbalance between the breaking down and restoring processes resulting in thinner, more porous xốp and brittle bones over time
It is often referred to as the “silent thief” because bone mass is lost continuously, over many years, often without the person experiencing any signs or symptoms until a fracture occurs
The pain, debility, deformity sự biến dạng and fractures that are common with osteoporosis are a major health concern
Causes and Risk Factors
The cause of osteoporosis is not related to any one problem, but certain risk factors have been identified:
- Gender: women almost twice as often as men
- Post-menopause
- Prolonged sex homrmone deficiencies
- Ovaries removed before the age of 45
- Family history of osteoporosis
- Caucasian or Eurasian ancestry
- Thin, small bones
- Primary hyperparathyroidism bệnh cường cận giáp , hyperthyroidism bệnh cường giáp, RA, liver or kidney disease, diabetes mellitus
- Excessive use of medications such as cortisone, prednisone, anticonvulsants thuốc chống co giật, thyroid hormone, heparin, aluminum in antacids nhôm trong thuốc kháng axit
- Calcium deficiency
- Limited exposure to sunlight or inadequate vitamin D intake
- Caffeine consumption of more than 3 cups/day
- Alcohol consumption of 2 drinks or more/day
- Limited exercise or weight bearing
- Cigarette smoking
Why Women are Affected More than Men
- Bone mass usually reaches a peak when a woman reaches the age of 30-35 years
- Normally a loss of bone occurs at a rate of 1% of bone/year after age 35
- By the time many women reach between 55-60 years of age, a 30-40% bone loss may be experienced
- Normally, the hormone estrogen slows the pace of bone breakdown
- While aging itself will result in some bone loss the change in estrogen levels accelerates tăng tốc this rate of loss
- Osteoporosis is less common in men. This lower risk is due to greater peak bone mass compared to women and a slow gradual decline of sex hormones rather than the relatively fast loss of sex hormones experienced by women in menopause mãn kinh
- Men with very low levels of male hormones knows as hypogonadism suy sinh dục, are at greater risk for osteoporosis
Disuse Osteoporosis
Disuse of the long bones, specifically the lower limbs, can lead to osteoporosis
This may be secondary to any trauma or musculoskeletal or neuromuscular pathologies that affect the person’s ability to weight bear
Those who experience prolonged immobilization, who have decreased use of limbs or who require a wheelchair are susceptible dễ bị tổn thương
This includes people with lower limb fractures, long-term rheumatoid arthritis, spinal cord injuries, cerebral palsy and advanced MS
Prevention & Medical Treatment
Standard x-ray will only reveal osteoporosis if at least ¼ of the bone density is lost. There is a specific x-ray which will most accurately reveal bone density problems but the technology is not always available in smaller communities
Low bone mass -sometimes called osteopenia, includes a low to moderate risk of fracture and may be treated with diet and lifestyle changes depending on the amount of bone loss and the person’s age
Osteoporosis-includes a moderate to high risk of fracture, medical treatment is advised through diet and lifestyle changes
Severe osteoporosis-includes a very high to extremely high risk of fracture, medical treatment is strongly recommended
Medical treatment focuses on ensuring adequate calcium and vitamin D levels, regular weight bearing exercises and resistance training and the use of medication
Drugs known as bisphosphonates prevent bone loss and help the rebuilding of bone
For many women, hormone therapy is recommended
Estrogen is the hormone needed to treat osteoporosis but if taken alone it can increase the chance of developing uterine cancer. To reduce the risk, progesterone is combined with estrogen
Contraindications
Overpressure testing procedures are best avoided with clients who are either at risk for or who have osteoporosis
Any mobilization technique that creates stress on the bones, such as rib springing, aggressive joint play and some rhythmic mobilization techniques, is CI’d for clients with osteoporosis
With severe osteoporosis, it is safest to avoid joint mobilization techniques
Avoid giving flexion exercises such as bending from a standing position or full sit ups if the client has a history of compression fractures
High impact exercises are used with extreme caution
Immobilization should be avoided if possible
Symptom Picture
Many women with osteoporosis do not experience any symptoms for years
Periodic định kỳ acute low thoracic or high lumbar pain may be present
Often women only become aware of the problem when a minor injury results in a fracture of a wrist or hip, even a strong cough or hug could cause a rib to crack or break
As the osteoporosis continues, vertebrae start to wedge cái nêm or fracture, this causes compression of the nerves and a loss of height of more than an inch. It can also result in hyperkyphosis and the “dowager’s hump” cái bướu của thái hậu often seen in women as they age
Health History Questions
What is your general health like?
Is there a family history of osteoporosis?
Are you menopausal or post-menopausal?
Have you ever experienced amenorrhea mất kinh over a period of time, especially in your teens and twenties?
Do you experience back pain in the mid-to lower spine?
Have you noticed a loss of height of more than one inch or increased stooping or rounding of the shoulders
Have you taken any of the following medications over a long period of time? Cortisone, prednisone, anticonvulsants thuốc chống co giật, thyroid hormone, heparin or antacids
Do you experience any pain?
Further Assessment
Testing:
Testing is performed to rule out other possible causes of back and joint pain. This includes testing for degenerative disc disease, osteoarthritis and RA. If any of these conditions are suspected, the client is referred to her physician for diagnosis
AF ROM and PR ROM resting as well as weight bearing are painful in the groin or hip region if a hip fracture is presente.
Massage
The client may not be aware that she is developing this condition, unless it has been diagnosed by a physician
The therapist may want to contact the client’s medical doctor, with the client’s permission to obtain more information about the client’s degree of osteoporosis
Positioning is for client comfort
In the prone position, a pillow should be placed lengthwise under the trunk if there is a pronounced humping of the back
In the supine position, the trunk may need to be supported by a few pillows under the trunk and C-spine so the spine is not stressed
The massage is performed in the context of a relaxation treatment, including the use of diaphragmatic breathing
Depending on the severity of the osteoporosis and the age of the client, a hyperkyphosis treatment may be performed with modifications to the pressure and the intensity of the massage techniques
Passive movement of the joints is incorporated throughout the massage to facilitate joint health
If a client is at risk for osteoporosis, the first clinical manifestations are often pain accompanied by skeletal fracture
Self-Care
Education about relaxation strategies will help those experiencing pain. Diaphragmatic breathing is encouraged
Referral to a naturopath or nutritionist is recommended for guidelines to appropriate levels of calcium and vitamin D
Exercise involves weight bearing exercises, strength building, activities to address balance and coordination
Weight bearing exercises are introduced gradually and maintained at a moderate level of intensity
Weight training or resistance exercises can be performed
