Osteoporosis Flashcards
How many individuals have osteoporosis above the age of 50
10 million
What is osteoporosis
Skeletal disease
Low bone mineral density
Changes in the microarchitecture of bone which increases chance of fracture
Osteoporosis is often found in
Postmenopausal women and in men above 50
osteoporosis is found when a bone mineral density T score of < -2.5 in the
Lumbar spine
Femoral neck
Forearm
What is Type 1 primary osteoporosis
Most common in women after menopause
What is type 2 primary osteoporosis
Decline in bone density and strength by aging (senile osteoporosis)
What is secondary osteoporosis
Caused by something else (medical condition)
A bone mineral density T score of -1 and -2.5 is considered to be
Osteopenia
Which is low bone density
A bone mineral density T score of less than -2.5 is considered to be
Osteoporosis
Risk factors of osteoporosis
So many…
Look on slide 19
What are the two types of bone
Cortical
Trabecular
What is cortical bone
Compact and solid
Dense deposits of mineral
Found in LONG bone
80% of bone mass
20% of bone surface area
What is trabecular bone
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
Cortical bone have _______ walls
Have more ________
Pores are developed in the _______
Thinner
Porous
Shaft walls
There are _______ Trabecular bones
They are generally ________
They have ________
Fewer
Thinner
Vacant space
What is the process of bone repair
Rest
Osteoclasts - bone resorption
Osteoblasts - bone formation
Rest - new bone
Bone resorption vs bone formation in:
Osteoporosis
Normal bone
Osteopetrosis
Bone resorption > Bone formation
Bone resorption = Bone formation
Bone resorption < Bone formation
What are the drugs used for treatment/prevention of osteoporosis
Antiresorptive medications
Anabolic drugs
What do antiresorptive drugs do
Action on Osteoclasts
Bone loss slowed
New bone is still made at same pace
exampels:
Bisphosphonates, calcitonin, denosumab, estrogen and estrogen agonists/antagonists
Anabolic drugs do what
Action of osteoblast
Increase the rate of bone formation
Teriparatide
What does physical activity do for osteoporotic fractures
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
Physical activity plays a prominent role in primary and secondary prevention of osteoporosis
True
Physical activity is _______ associated with risk of hip and spine fracture
Inversely
Exercise training can ______ or ______ the decrease in spine and hip bone mineral density
Increase
Slow
What is necessary to test people with osteoporosis
Use a cycle leg ergometry
Especially for people with severe vertebral osteoporosis - walking is painful
Vertebral compression fractures leading to a loss of height and spinal deformation can
Therefore this can affect
Compromise ventilatory capacity and result in a forward shift in center of gravity
Balance during treadmill walking and a handrail support would be required
Max muscle strength testing may be ________ in patients with severe osteoporosis
However, there are ______ for _________ for maximal muscle strength testing
Contraindicated
No established guidelines
Contraindications
What are the FITT recommendations for individuals at risk for osteoporosis
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
What are the FITT recommendations for individuals with osteoporosis
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
What are the special considerations for people with osteoporosis
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
General recommendation is to prescribe
Moderate intensity exercise that does not cause exacerbate pain
Exercises that cause ______________ of the spine should also be avoided
Twisting, bending or compression
Should the frailest elderly people remain physically active
True
What are some lifestyle modifications that can be done
Calcium and vit D
Do weight bearing and resistance training
Avoid tobacco
Avoid alcohol
DXA scan and take medications if recommended
What is the bottom line
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
Physical activity improves body composition by increasing lean body mass and decreasing fat mass in older adults
True
Any modality that impose excessive orthopedic stress is recommended to improve aerobic capacity for older adults who have join problems
False
Type 1 osteoporosis occurs commonly in postmenopausal women
True
The bone mineral density range for osteoporosis is T-score between -1 and -2.5
False
Osteoporosis occurs when activity of osteoclasts is greater than the activity of osteoblasts
True
Bisphosphonates are the type of anti-resorptive medications which increase the rate of bone formation
False
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
True
Exercises that involve high impact loading should be suggested for people with osteoporosis because it helps increase bone mineral density
False
Trabecular bones compose about 80% of bone mass
False
Type 2 osteoporosis is also called as _____ osteoporosis because bone density and strength are declined by aging
Senile
