Osteoporosis

Question 1

2 basic mechanisms responsible for development of primary osteoporosis are:

Answer 1

1. poor bone mass acquisition during growth and development triad syndrome?)
2. accelerated bone loss in the period after peak bone mass is achieved (menopause)

Both processes are modulated by environmental and genetic factors

Question 2

Main factor influencing peak bone mass is:

Answer 2

genetic make up

Question 3

About two thirds of the risk for fracture in postmenopausal women is determined by…

Answer 3

premenopausal peak bone mass

Question 4

After menopause, decreased estrogen →

Answer 4

increased osteoclast activity → accelerated bone loss (10x’s: 3-5%/yr for 5-7 years).

Question 5

The rate of bone loss in individuals is mainly determined by environmental factors:

Answer 5

1. Nutritional
2. Behavioral
3. Medications

Question 6

peak bone mass occurs at what age?

Answer 6

mid 20’s

Question 7

estrogen ______ osteoclast activity

Answer 7

inhibits

Question 8

treatment of osteoporosis

Answer 8

• prevention: good nutrition, flexibility, no alcohol, smoke, calcium
• WB exercises
• Resistance excercises (no crunches)

Question 9

In both men and women >_____ yo, osteoblast activity drops off

Answer 9

60

Question 10

classification of osteoporosis

Answer 10

• PRIMARY:
  
  • Idiopathic
  • Type I: post-menopause
  • Type II: senile >75 y/o
• SECONDARY:
  
  • endocrine disorders
  • prolonged use of meds
  • other disorders

Question 11

Which type of osteoporosis is associated with associated with vertebral crush fractures and
Colles (distal radius) fractures?

Answer 11

Type I (post-menopausal)

Question 12

Which type of osteoporosis is associated with fractures of trabecular and cortical bones:
femoral neck, vertebrae, wrist, proximal humerus and tibia and pelvis?

Answer 12

mostly type II (senile)

Question 13

true or false, SCI can lead to osteoporosis

Answer 13

true, due to non WB

Question 14

Aging postural changes shift the COM __(direction)____creating instability in standing and walking

Answer 14

forward

Question 15

3 types of PRIMARY OSTEORPOROSIS:

Answer 15

1. Idiopathic: children and young adults, women and men, uncommon
2. Type I: post postmenopausal
3. Type II: senile, >70 decline in osteblast activity

Question 16

Causes of SECONDARY OSTEOPOROSIS:

Answer 16

• Endocrine disorders.
• SE of prolonged use of drugs.
• Associated with other disorders.

Question 17

S & S of osteoporosis:

Answer 17

• 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

Question 19

what is the aprox percentage of women with osteoporosis that are undiagnosed/untreated?

Answer 19

Question 20

Related Conditions with osteoporosis

Answer 20

• Nerve entrapment syndromes (joint space decreases)
• Restrictive pulmonary disease (from poor posture)
• Increased risk for falls (displaced COM)

Question 22

Most commonly used and preferred technique for the diagnosis of osteoporosis

Answer 22

Central DXA/DEXA
Dual energy x-ray absorptiometry

Question 23

diagnosis of osteoporosis

Answer 23

• Medical Hx,
• physical exam,
• bone density test,
• FRAX score,
• laboratory test
• central DXA/DEXA (dual energy x-ray absometry)

Question 24

Central DXA/DEXA
Dual energy x-ray absorptiometry

Answer 24

• 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

Question 25

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.

Answer 25

2.5

Question 26

in osteoporosis diagnosis, X-ray cannot be diagnosed until what percentage of bone loss?

Answer 26

>30%

Question 27

osteoporosis T-scores diagnosis values

Answer 27

• Normal: T > -1 SD
• Osteopenia: T between -1 and -2.5 SD
• Osteoporosis: T < -2.5 SD

Question 28

Ultrasound use for the diagnosis of osteoporosis is done at _________, not possible to measure hip or spine

Answer 28

the calcaneus bone

Question 30

The World Health Organization (WHO) has based definitions on the osteoporosis T-score:

Answer 30

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

Question 32

FRAX Score WHO Fracture Risk Assessment Tool used to guide treatment decisions in people who meet the following three conditions:

Answer 32

1. Postmenopausal women or men age 50 and older
2. People with low bone density (osteopenia)
3. People who have not taken an osteoporosis medicine

Question 33

__________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.

Answer 33

FRAX score

WHO Fracture Risk Assessment Tool

Question 34

Treatment of osteoporosis:

Answer 34

• 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

Question 35

Precautions/contraindications in an exercise program for the treatment of osteoporosis:

Answer 35

Avoid forced spinal flexion and joint mobilization/manipulation

Question 36

goals of physical therapy in pt with osteoporosis

Answer 36

1. Build bone or lessen the amount of bone loss at areas most vulnerable to fracture through exercise—hip, spine, shoulder, arms
2. Improve dynamic balance
3. Improve posture
4. Avoid exercise that contribute to spinal compression: crunches or sit ups.

Question 37

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.

Answer 37

osteoporosis