Osteoporosis

Question 1

How many individuals have osteoporosis above the age of 50

Answer 1

10 million

Question 2

What is osteoporosis

Answer 2

Skeletal disease

Low bone mineral density

Changes in the microarchitecture of bone which increases chance of fracture

Question 3

Osteoporosis is often found in

Answer 3

Postmenopausal women and in men above 50

Question 4

osteoporosis is found when a bone mineral density T score of < -2.5 in the

Answer 4

Lumbar spine

Femoral neck

Forearm

Question 5

What is Type 1 primary osteoporosis

Answer 5

Most common in women after menopause

Question 6

What is type 2 primary osteoporosis

Answer 6

Decline in bone density and strength by aging (senile osteoporosis)

Question 7

What is secondary osteoporosis

Answer 7

Caused by something else (medical condition)

Question 8

A bone mineral density T score of -1 and -2.5 is considered to be

Answer 8

Osteopenia

Which is low bone density

Question 9

A bone mineral density T score of less than -2.5 is considered to be

Answer 9

Osteoporosis

Question 10

Risk factors of osteoporosis

Answer 10

So many…

Look on slide 19

Question 11

What are the two types of bone

Answer 11

Cortical

Trabecular

Question 12

What is cortical bone

Answer 12

Compact and solid

Dense deposits of mineral

Found in LONG bone

80% of bone mass

20% of bone surface area

Question 13

What is trabecular bone

Answer 13

Spongy or cancellous

Bone marrow fills the space between

Found in the ends of long bones, vertebral bodies and calcaneus

20% of bone mass

80% of bone surface area

Question 14

Cortical bone have _______ walls

Have more ________

Pores are developed in the _______

Answer 14

Thinner

Porous

Shaft walls

Question 15

There are _______ Trabecular bones

They are generally ________

They have ________

Answer 15

Fewer

Thinner

Vacant space

Question 16

What is the process of bone repair

Answer 16

Rest

Osteoclasts - bone resorption

Osteoblasts - bone formation

Rest - new bone

Question 17

Bone resorption vs bone formation in:

Osteoporosis
Normal bone
Osteopetrosis

Answer 17

Bone resorption > Bone formation

Bone resorption = Bone formation

Bone resorption < Bone formation

Question 18

What are the drugs used for treatment/prevention of osteoporosis

Answer 18

Antiresorptive medications

Anabolic drugs

Question 19

What do antiresorptive drugs do

Answer 19

Action on Osteoclasts
Bone loss slowed
New bone is still made at same pace

exampels:
Bisphosphonates, calcitonin, denosumab, estrogen and estrogen agonists/antagonists

Question 20

Anabolic drugs do what

Answer 20

Action of osteoblast

Increase the rate of bone formation

Teriparatide

Question 21

What does physical activity do for osteoporotic fractures

Answer 21

Reduce risk for fractures

Enhances the peak bone mass achieved during growth and development

Slowing the rate of bone loss with aging

Reducing the risk of falls via benefits on muscle strength and balance

Question 22

Physical activity plays a prominent role in primary and secondary prevention of osteoporosis

Answer 22

True

Question 23

Physical activity is _______ associated with risk of hip and spine fracture

Answer 23

Inversely

Question 24

Exercise training can ______ or ______ the decrease in spine and hip bone mineral density

Answer 24

Increase

Slow

Question 25

What is necessary to test people with osteoporosis

Answer 25

Use a cycle leg ergometry Especially for people with severe vertebral osteoporosis - walking is painful

Question 26

Vertebral compression fractures leading to a loss of height and spinal deformation can Therefore this can affect

Answer 26

Compromise ventilatory capacity and result in a forward shift in center of gravity Balance during treadmill walking and a handrail support would be required

Question 27

Max muscle strength testing may be ________ in patients with severe osteoporosis However, there are ______ for _________ for maximal muscle strength testing

Answer 27

Contraindicated No established guidelines Contraindications

Question 28

What are the FITT recommendations for individuals at risk for osteoporosis

Answer 28

Frequency: 3 - 5 days/wk for aerobic 2-3 days/wk for resistance Intensity: Aerobic = moderate to vigorous Resistance = moderate to vigorous Time: 30 - 60 mins/day Type: Weight bearing aerobic Jumping Resistance exercise

Question 29

What are the FITT recommendations for individuals with osteoporosis

Answer 29

Frequency: 4 - 5 days/wk for aerobic 2-3 days/wk for resistance 5-7 days/wk flexibility Intensity: Aerobic = moderate Resistance = adjust so that last 2 reps are challenging Time: Aerobic = Begin with 20 mins Progress to min 30mins, max 45-60mins Resistance = 1 set, 8-12 reps Increase to 2 sets after 2 weeks 8-10 exercises

Question 30

What are the special considerations for people with osteoporosis

Answer 30

Difficult to quantify exercise intensity due to bone loading forces Currently no established guidelines regarding contraindications for exercise For older women and men at increased risk of falls they should include activities that improve balance

Question 31

General recommendation is to prescribe

Answer 31

Moderate intensity exercise that does not cause exacerbate pain

Question 32

Exercises that cause ______________ of the spine should also be avoided

Answer 32

Twisting, bending or compression

Question 33

Should the frailest elderly people remain physically active

Answer 33

True

Question 34

What are some lifestyle modifications that can be done

Answer 34

Calcium and vit D Do weight bearing and resistance training Avoid tobacco Avoid alcohol DXA scan and take medications if recommended

Question 35

What is the bottom line

Answer 35

Physical activity is vital in primary and secondary osteoporosis prevention Weight bearing aerobic and resistance exercise is vital to help with risk for osteoporosis It is difficult to quantify the magnitude of bone loading forces but generally increase in parallel with exercise intensity

Question 36

Physical activity improves body composition by increasing lean body mass and decreasing fat mass in older adults

Answer 36

True

Question 37

Any modality that impose excessive orthopedic stress is recommended to improve aerobic capacity for older adults who have join problems

Answer 37

False

Question 38

Type 1 osteoporosis occurs commonly in postmenopausal women

Answer 38

True

Question 39

The bone mineral density range for osteoporosis is T-score between -1 and -2.5

Answer 39

False

Question 40

Osteoporosis occurs when activity of osteoclasts is greater than the activity of osteoblasts

Answer 40

True

Question 41

Bisphosphonates are the type of anti-resorptive medications which increase the rate of bone formation

Answer 41

False

Question 42

Vertebral compression fractures leading to a loss of height and spinal deformation can compromise ventilatory capacity and result in a forward shift in the center of gravity

Answer 42

True

Question 43

Exercises that involve high impact loading should be suggested for people with osteoporosis because it helps increase bone mineral density

Answer 43

False

Question 44

Trabecular bones compose about 80% of bone mass

Answer 44

False

Question 45

Type 2 osteoporosis is also called as _____ osteoporosis because bone density and strength are declined by aging

Answer 45

Senile