Osteoporosis Flashcards
2 basic mechanisms responsible for development of primary osteoporosis are:
- poor bone mass acquisition during growth and development triad syndrome?)
- accelerated bone loss in the period after peak bone mass is achieved (menopause)
Both processes are modulated by environmental and genetic factors
Main factor influencing peak bone mass is:
genetic make up
About two thirds of the risk for fracture in postmenopausal women is determined by…
premenopausal peak bone mass
After menopause, decreased estrogen →
increased osteoclast activity → accelerated bone loss (10x’s: 3-5%/yr for 5-7 years).
The rate of bone loss in individuals is mainly determined by environmental factors:
- Nutritional
- Behavioral
- Medications
peak bone mass occurs at what age?
mid 20’s
estrogen ______ osteoclast activity
inhibits
treatment of osteoporosis
- prevention: good nutrition, flexibility, no alcohol, smoke, calcium
- WB exercises
- Resistance excercises (no crunches)
In both men and women >_____ yo, osteoblast activity drops off
60
classification of osteoporosis
-
PRIMARY:
- Idiopathic
- Type I: post-menopause
- Type II: senile >75 y/o
-
SECONDARY:
- endocrine disorders
- prolonged use of meds
- other disorders
Which type of osteoporosis is associated with associated with vertebral crush fractures and
Colles (distal radius) fractures?
Type I (post-menopausal)
Which type of osteoporosis is associated with fractures of trabecular and cortical bones:
femoral neck, vertebrae, wrist, proximal humerus and tibia and pelvis?
mostly type II (senile)
true or false, SCI can lead to osteoporosis
true, due to non WB
Aging postural changes shift the COM __(direction)____creating instability in standing and walking
forward
3 types of PRIMARY OSTEORPOROSIS:
- Idiopathic: children and young adults, women and men, uncommon
- Type I: post postmenopausal
- Type II: senile, >70 decline in osteblast activity
Causes of SECONDARY OSTEOPOROSIS:
- Endocrine disorders.
- SE of prolonged use of drugs.
- Associated with other disorders.
S & S of osteoporosis:
- Loss of height: multiple spinal compression
- Asymptomatic
- May have muscle and bone pain
- Decrease muscle strenght
-
Vertebral compression/crush fractures:
- Minimal or not trauma
- Bellow WB vertebrae (T8)
- Usually pain does not radiate
what is the aprox percentage of women with osteoporosis that are undiagnosed/untreated?
Related Conditions with osteoporosis
- Nerve entrapment syndromes (joint space decreases)
- Restrictive pulmonary disease (from poor posture)
- Increased risk for falls (displaced COM)
Most commonly used and preferred technique for the diagnosis of osteoporosis
Central DXA/DEXA
Dual energy x-ray absorptiometry
diagnosis of osteoporosis
- Medical Hx,
- physical exam,
- bone density test,
- FRAX score,
- laboratory test
- central DXA/DEXA (dual energy x-ray absometry)
Central DXA/DEXA
Dual energy x-ray absorptiometry
- Most commonly used and preferred technique for the diagnosis of osteoporosis
- Usually measured at hip and spine
- May use radius in forearm if hip / spine cannot be measured
- Test results reported using T-scores
Osteoporosis is defined as having bone density more than______ standard deviations below that of a reference range for young women and leaves the older adult at risk for bone fracture.
2.5
in osteoporosis diagnosis, X-ray cannot be diagnosed until what percentage of bone loss?
>30%
osteoporosis T-scores diagnosis values
- Normal: T > -1 SD
- Osteopenia: T between -1 and -2.5 SD
- Osteoporosis: T < -2.5 SD
Ultrasound use for the diagnosis of osteoporosis is done at _________, not possible to measure hip or spine
the calcaneus bone
The World Health Organization (WHO) has based definitions on the osteoporosis T-score:
the number of standard deviations (SD) from the young adult (20 y.o. in same race and sex) mean value.
- Normal: T > -1 SD
- Osteopenia: T between -1 and -2.5 SD
- Osteoporosis: T < -2.5 SD
FRAX Score WHO Fracture Risk Assessment Tool used to guide treatment decisions in people who meet the following three conditions:
- Postmenopausal women or men age 50 and older
- People with low bone density (osteopenia)
- People who have not taken an osteoporosis medicine
__________score estimates the chance of breaking a hip as well as a combined chance of breaking a hip or other major bones over the next ten years. Other major bones include the spine, hip, forearm and shoulder.
FRAX score
WHO Fracture Risk Assessment Tool
Treatment of osteoporosis:
-
prevention mgmt:
- avoid alcohol, tobacco, caffeine
- well balance diet
- calcium
- assess risk for falls
-
Exercise programs
- WB
- strengthening
- flexibility and coordination
- aerobic
- NO FORCED FLEXION AND JOINT MOB/MANIP
Precautions/contraindications in an exercise program for the treatment of osteoporosis:
Avoid forced spinal flexion and joint mobilization/manipulation
goals of physical therapy in pt with osteoporosis
- Build bone or lessen the amount of bone loss at areas most vulnerable to fracture through exercise—hip, spine, shoulder, arms
- Improve dynamic balance
- Improve posture
- Avoid exercise that contribute to spinal compression: crunches or sit ups.
Bone densitometry, also called dual-energy x-ray absorptiometry or DEXA, uses a very small dose of ionizing radiation to produce pictures of the inside of the body (usually the lower spine and hips) to measure bone loss. It is commonly used to diagnose ________and to assess an individual’s risk for developing fractures.
osteoporosis
