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Topics in PT > Osteoporosis Management > Flashcards

Osteoporosis Management Flashcards

1
Q

Osteopenia

A
  • low bone mass
  • Bone mineral density (BMD) level between 1.0 and 2.5 standard deviations below the young adult mean as measured by DXA. [-2.5 < T-score < -1.0]
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2
Q

functional definition of osteoporosis

A

Skeletal disorder characterized by compromised
bone strength and increased fracture risk

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3
Q

Operational Definition of osteoporosis

A

Bone mineral density (BMD) level at or more than
2.5 standard deviations below the young adult mean as measured by DXA
(Dual energy X-ray absorptiometry). [T-score ≤ -2.5]

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4
Q

primary osteoporosis

A
  • Osteoporosis that is the result of aging or menopause, or both
  • Aging causes a decrease of osteoblastic activity, resulting in decreases in bone formation
  • Menopause causes an increase of osteoclastic activity, which results in increases in bone breakdown (resorption)
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5
Q

secondary osteoporosis

A

osteoporosis resulting from medication, disease or other condition

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6
Q

how many Americans aged 50 + years old have osteoporosis or osteopenia?

A

55%

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7
Q

prevalence

A

a. twice as common among women as men.
b. common among Caucasians and Asians than Hispanics.
These diseases are more common among Hispanics than African Americans

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8
Q

Most common fracture sites from osteoporosis

A
  • vertebrae
  • hips
  • wrists
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9
Q

common functional consequences

A

chronic pain, limited mobility,
respiratory dysfunction, fear of injury, and stigma

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10
Q

functional decline is particularly profound following….

A

hip fracture

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11
Q

functional decline after hip fracture

A

a. 50% of persons with hip fracture NEVER regain their pre-fracture function.
b. Among persons living at home prior to a hip fracture, 25% require long-term
nursing home care.
c. Up to 25% with hip fracture will die within one year

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12
Q

Non-modifiable risk factors for osteoporosis

A

a. Female
b. Older age
c. Caucasian or Asian background
d. Fair complexion and blue eyes
e. Thin, petite body build
f. Family history of osteoporosis
g. Early menopause
h. Lactose intolerance

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13
Q

Modifiable risk factors for osteoporosis

A

i. Low calcium and Vitamin D diet
ii. Smoking
iii. Chronic dieting
iv. Estrogen deficiency
v. Sedentary lifestyle
vi. high caffeine use
vii. excessive alcohol consumption

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14
Q

risk factors for osteoporotic fractures

A

a. History of falls
b. Poor physical condition
c. Dementia
d. Impaired vision
e. Environmental hazards
f. Current use of benzodiazepines or anticonvulsants
g. Resident of nursing home or other long term care facility

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14
Q

Vertebral Fracture Facts

A
  • Mortality increases after first year
  • Deformity
  • Neutral Fatigue
  • Ambulation issues
  • Issues with IADLs
  • Does not need to move to nursing home
  • social participation challenges
  • dependent
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15
Q

Hip Fracture Facts

A
  • Mortality increases during 1st year
  • No deformity
  • Neutral fatigue
  • Ambulation issues
  • IADL issues
  • Possibly needs to move to nursing home
  • social participation callenges
  • dependent
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16
Q

Wrist Fracture Facts

A
  • Mortality: unknown
  • Deformity not typically present
  • neutral fatigue
  • no ambulation issues
  • issues with IADLs
  • Does not need to move to nursing home
  • no social participation challenges typically present
  • no dependency
17
Q

Severe consequences of vertebral fractures

A
  • decreased lung function
  • decreased mobility
  • decreased strength
  • decreased endurance
  • decreased balance capacity
  • decreased ADLs
  • decreased IADLs
  • decreased social function
  • trouble sleeping
  • trouble finding clothes that fit
18
Q

History items specific to osteoporosis

A
  • Current medications associated with fall risk and bone loss
  • Bone health related comorbidities
  • History of fractures
  • Results from prior BMD assessment and imaging studies
19
Q

Tests and measures specific to osteoporosis

A
  • Quantification of thoracic kyphosis
20
Q

Education items specific to osteoporosis

A

Patient should demonstrate knowledge and application of:
* fracture prevention strategies including slowing the rate of bone loss
* An exercise program that emphasizes bone safe posture, as well as resistance, aerobic, balance, and flexibility exercises
* Safe and unsafe postures and movements

21
Q

Intervention items specific to osteoporosis

A
  • Education on posture, body mechanics, and activity modification to reduce fracture risk during daily activities including exercise
  • Bone-healthy (fracture preventative and BMD preserving) body mechanics patterns as exercises
22
Q

For patients with/at risk for osteoporosis, you should establish:

A

culturally sensitive standards for nutrition, exercise, fall prevention and bone health

23
Q

For patients with/at risk for osteoporosis, you should conduct programs designed to change….

A

the health behaviors of older adults related to
nutrition, exercise, fall prevention and bone health

24
Q

programs for patients with/at risk for osteoporosis should include…

A

i. Needs Assessment and Research
ii. Program development
iii. Group-specific marketing iv. Program implementation
v. Evaluation of program implementation and program outcomes

25
Q

Non-pharmacological strategies

A

interventions targeted at the individual’s specific problems related to nutrition, exercise, fall prevention, and bone health

26
Q

Pharmacological strategies:

A

i. Antiresorptive therapy to inhibit osteoclastic bone resorption
ii. Anabolic therapy to stimulate osteoblastic new bone formation

27
Q

FDA approved anti-resorptive therapy

A

bisphosphonates, estrogens, selective estrogen receptor modulators, calcitonin,
and denosumab

28
Q

FDA approved anabolic therapy

A

teriparatide and abaloparatide

29
Q

Two grade B recommendations from the USPSTF

A
  • The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent
    osteoporotic fractures in women 65 years and older
  • The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool
30
Q

frequency physical activity recommendations

A
  • adequate physical activity/exercise (100%)
  • weight-bearing exercises (95%)
  • muscle strengthening exercises (84%)
  • low impact weight-bearing [walking] (78%)
  • resistance exercises (58%)
  • balance training exercises (58%)
  • moderate impact weight-bearing [stair climbing] (44%
31
Q

Epidemiology recap

A

osteoporosis is most prevalent among persons who are thin, sedentary, and have a fair complexation, but old age, race, and gender are affected

32
Q

risk factors recap

A

risk factors for osteoporosis and osteoporotic fractures are different, and short-term physical therapy can more likely reduce the risk of hip fractures compared to vertebral compression fractures

33
Q

strategies to reduce risk recap

A

reducing risk if the responsibility of society, the community, clinicians, and individuals

34
Q

take home message - osteoporosis is…

A
  • common, costly, and disabling
  • Physical therapists should assess an older
    adult’s bone health during the initial evaluation
35
Q

take home message- osteoporosis precipitates impairments…

A
  • beyond the musculoskeletal system
  • Physical
    therapists should utilize knowledge of these potential impairments in prevention and
    intervention programs.
36
Q

take home message - osteoporosis directly and indirectly precipitates…

A
  • activity and participation limitations.
  • Physical therapists should address the activity and participation limitations as well as the osteoporosis precipitating these problems.
37
Q

take home message - osteoporosis should be treated by…

A

a team of health care professionals with an integrated and coordinated plan of care

38
Q

osteoporosis screening recommendations for men

A

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men

39
Q
A

Topics in PT (9 decks)

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