Osteoporosis

Question 1

Osteoporosis: chronic or acute?

Answer 1

CHRONIC, PROGRESSIVE DISEASE

Question 2

Osteoporosis characteristics

Answer 2

• low bone mass
• impaired bone quality
• decreased bone strength
• enhanced risk of fractures

Question 3

Osteomalasia

Answer 3

soft bone

Question 4

osteopenia

Answer 4

low bone mass

Question 5

What does osteoporosis translate to?

Answer 5

“porous bone”

Question 6

Incidence of osteoporotic fracture increases with?

Answer 6

AGE

Question 7

Osteoporosis and women

Answer 7

• more common
• estrogen deficient women
• postmenopausal women have higher risk

Question 8

Osteoporosis and men

Answer 8

• less common
• under diagnosed
• under treated
• underreported
• higher morbidity and mortality than women
• major public health problem

Question 9

What is bone composed of?

Answer 9

• mostly collagen
• collagen = protein
• calcium phosphate

Question 10

Two types of bone

Answer 10

1. Compact cortical bone – outer shell, shaft, 80%

2. Cancellous/ spongy– inner parts of bone, 20%

Question 11

Bone remodeling

Answer 11

resorption and formation of bone

occurs from the interaction of:

• osteocytes
• osteoclasts
• osteroblasts

Question 12

Osteoclasts

Answer 12

cells that break down bone

life span of about 3 weeks

Question 13

Osteoblasts

Answer 13

cells that form new bone

life span of about 3 months

Question 14

Osteocytes

Answer 14

cells buried in bone, comprise 95% of bone cells

sense mechanical strain by sending signals to osteoblasts to increase bone formation or osteoclast to remove existing bone

Question 15

Normal bone remodeling

Answer 15

Activation of osteoclasts
Bone breakdown by osteoclasts
Transition phase
Bone formation by osteoblasts
New bone matches amount broken down, hardens via MINERALIZATION PROCESS

Question 16

How does osteoporosis occur?

Answer 16

mismatch between osteoclast and osteoblast activity

commonly a result of:

• aging
• change in hormones post menopause
• diets low in calcium and vitamin D

Question 17

The more active you are…

Answer 17

the more DENSE your bones are

Question 18

Peak bone mass

Answer 18

largest amount of bone tissue a person has at any point in their life

most people reach by the age of 30

Question 19

Peak bone mass (girls)

Answer 19

Attained at age 18

Question 20

Peak bone mass (boys)

Answer 20

Attained at age 19-20

Question 21

Growth spurt ages

Answer 21

Girls: 11-14
Boy: 13-17

Adult bone mass is accumulated in this period of rapid growth

Build strong bones during this window of time!

Question 22

Determinants of peak bone mass

Answer 22

Physical Activity
Hormones
Risk Factors
Genetics 60-80%
Nutrition: Calcium, Vitamin D

Question 23

Two types of osteoporosis

Answer 23

primary

secondary

Question 24

Three types of osteoporsis

Answer 24

Generalized– whole skeleton

Regional– limb/ region

Localized– only focal areas of bone (cast)

Question 25

Primary osteoporosis

Answer 25

Due to biological changes: 1. menopause 2. aging

Question 26

Secondary osteoporosis

Answer 26

Can occur at any age, M=W - medical conditions - metabolic/ nutritional disorders - medications - immobilization with loss of function

Question 27

RISK FACTORS

Answer 27

ACCESS: leads to osteoporosis - Alcohol use - corticosteroid use - calcium low - estrogen low - smoking - sedentary lifestyle

Question 28

FRAX

Answer 28

evaluates fracture risk: 10 year probability

Question 29

FORE

Answer 29

10 year fracture risk calculator -- post menopausal women and men 45 and older, NOT receiving treatment for osteoporosis

Question 30

Bone mineral density

Answer 30

Average concentration of mineral in a define section of bone correlates with bone strength predicts future fracture risk

Question 31

Gold standard for diagnosing osteoporosis

Answer 31

DEXA: Dual energy x ray - assesses BMD - hip and spine - predicts fractures at other locations as well

Question 32

Can x rays detect osteoporosis?

Answer 32

YES, but cannot determine BMD and 30% loss of bone mass

Question 33

Most common osteoporotic fracture

Answer 33

``` vertebral hip rib radius femur ```

Question 34

Are vertebral factors often recognized?

Answer 34

NOPE, often silent increases likelihood of subsequent fractures

Question 35

Role of PT

Answer 35

``` Comprehensive evaluation Counsel Check for secondary causes Advise on adequate calcium and vitamin D Advise avoiding smoking/ alcohol consumption ```

Question 36

RED FLAGS you may see during a PT assessment

Answer 36

Height loss of more than 1" Previous fracture Family history Presence of kyphosis

Question 37

Top Tests for Assessment

Answer 37

``` Balance Standing height occiput to wall distance rib to pelvis distance kypholordosis prone hip extension supine to sit floor to stand SLS Hip hinge/ alignment SIT TO STAND ```

Question 38

PT Treatment goals

Answer 38

REDUCE FRACTURE RISK! ``` Decrease pain and increase mobility Increase bone density via joint reaction forces/ ground reaction forces Strengthen areas at risk Optimize posture Home modification-- reduce fall risk Promote overall fitness ```

Question 39

Intervention focus

Answer 39

``` FRACTURE PREVENTION leg strength balance thoracic extension hip extension thoracic mobilization ```

Question 40

T/F: People with osteoporosis are encouraged to perform trunk flexion.

Answer 40

FALSE!! Trunk flexion is CONTRAINDICATED Avoid flexion and rotation (crunches) Do not test spine mobility

Question 41

Optimal position

Answer 41

EXTENSION Increase length of spine and strength of stabilizers alignment is key

Question 42

Sara Meeks

Answer 42

Realignment routine exercises for postural correction, specific to patients with osteoporosis