Osteoporosis Flashcards
What is osteoporosis?
Osteoporosis is a thinning of the bones to where the bone mineral density (BMD) decreases to an extent which leaves the bone without sufficient strength to withstand normal force and can only be apparent when a fracture occurs despite minimal trauma and effects spongy bone of the spine (vertebrae), neck of femur and wrist.
What are the contributory factors to BMD loss?
- Lack of dietary calcium and vitamin D (=exposure to sunlight)
- Smoking
- Excess alcohol consumption
- Corticosteroid use
- Low levels of weight-bearing exercise
- Amenorrhoea (absence of periods)
- Nulliparity (no pregnancies)
What is the diagnosis of osteoporosis?
- Asymptomatic
- Loss of height
- Back pain (from vertebral compression fractures)
- Stress fractures (most commonly in lower extremities)
- Hip fracture
- Extreme kyphosis (extensive vertebral compression)
What are the key aims of exercise for osteoporosis?
- Maintain/Increase bone mineral density (BMD)
- Minimise age-related loss of BMD
- Prevent injuries (falls and fractures)
How to improve BMD?
- Early active lifestyle from early age associated with 50% risk reduction of osteoporosis compared with sedentary individuals
- Maximising and maintaining peak BMD throughout life
- Load-bearing activities- fast, high impact. high strain and diverse (i.e. squash and gymnastics) better less error rich activities such as cycling and swimming as it does not increase bone mineral density
- Weight training targets specific sites as activities such as running increases bone density in the legs and femur but not in other sites.
Why is exercise important to bone development?
Exercise influences the skeleton primarily by its direct impact on bone and by improving muscle mass and strength which exerts further strains on the skeleton.
Fitness testing considerations for osteoporosis?
- Cycle test vs Treadmill (if vertebral osteoporosis makes walking painful)
- Vertebral compression fractures leads to loss height and spinal deformation (kyphosis) which can compromise ventilatory ability and cause centre of gravity to be shifted forwards (balance may be compromised)
- Maximal muscle testing may be contraindication (due to high risk of fracture)
- If balance is an issue (kyphosis) cycle ergometry provides a safer alternative for the aerobic test
Exercise programming for osteoporosis?
Aerobic: Prescription= 40-70% HRpeak, METs/150 mins,week/20-30mins. Goals= Improve/maintain work capacity/Maintain bone mass (if load-bearing)
Strength: Prescription= 80% of 1RM, 3-10 reps/ 2 sets of 8-10 reps/2-3 days a week. Goals= Improve strength of arms, shoulders, legs and hips, improve posture
Flexibility: Prescription= 5-7 days a week. Goals= Increase/maintain ROM
Recommendations for exercise with osteoporosis?
Mode= Weight bearing endurance activities (stair climbing, jogging) Intensity= Moderate-high to achieve bone-loading forces Frequency= Weight bearing endurance activities 3-5 week/Resistance exercise 2-3x week Duration= 30/60 mins/day of a combination of weight bearing endurance .
Aerobic exercise- rationale and considerations?
Rationale:
Maintain bone mass (if bone loading is achieved)
Improves functional capacity
Lessens disability as ADLs performed more easily
Reduces risk of disease associated with low CRF/sedentary behaviour
Considerations:
Avoid high impact activities if severe osteoporosis is suspected
Strength exercise- rationale and considerations?
Rationale:
Decline in muscle strength of lower limbs is associated with increased incidence of falls.
Muscle weakness leads to reduced joint proprioception with consequent reduction in stability (improve strength = improved balance).
Improved muscle strength helps to conserve muscle mass.
Strength training provides specific loading to musculo-skeletal system.
Considerations:
High risk of fracture – proceed with caution.
Increase resistance & reduce repetitions – magnitude of strain important to promote BMD.
Adaptations in BMD likely to take 9 – 12 months (1 – 4% improvement associated with high resistance activity).
Avoid excessive spinal flexion & rotation – compressive forces could lead to fracture.
Flexibility exercise- rationale and considerations?
Rationale:
Counteracts shortening of pectorals associated with kyphosis of spine.
Useful to promote ROM in older population group.
Considerations:
Static stretches performed on muscles subject to adaptive shortening.
Functional / Balance / Motor Skills – Rationale & Considerations?
Rationale:
Prevents falls by improving proprioception and balance
Considerations:
Movements that challenges static and dynamic balance
Can be integrated with other fitness training or treated as a separate component
Exercise considerations for Osteoporosis?
1) Weight bearing but avoiding high impact
2) Strength training for vulnerable sites as the principle of specificity as these would experience the mechanical stress from the load bearing exercise
3) Forward flexion and rotation should be avoided by those with osteoporosis should be avoided to avoid the increase the risk of vertebral fractures
4) Emphasis on good posture to prevent compression fractures of the vertebrae
What barriers do older people face with osteoporosis and how can they be sorted?
1) Older people face the fear of falling and as a result injury (fracture)
2) As the condition is related to age there is an increase incidence of OP in an older population and as an consequence of disease include brittle bones
3) Inactivity (as lack of energy expenditure and increase age will increase weight gain i.e. obesity/ Increase in risk factor profile/ Functional decrements include loss of strength, power and flexibility
4) Additional disorders include dyslipidaemia, cardiovascular disease and also weight gain can place additional load bearing stress through the lower limb joints, furthering pain and degeneration
How to improve condition:
Implementing Osteoporosis management to slow down, stop or even reverse the effects of OP. With this however comes the education of exercise as keeping the patient mobile and active and utilising weight bearing exercises (mechanical loading which influences bone mass) would help decrease the effects of OP and even reverse them.
