Unit 2 Bone Injury (fractures) and Osteoporosis Flashcards
what are the functions of bone?
support structures and provide shape to the body
protect vital structures
allow movement and anchors for muscle
provide mineral storage
contribute to blood cell formation in the red marrow
Bone is a highly specialized ___ tissue and is ___ vascular.
connective; highly
Bone is able to ___ and ___ without breaking and can ___ impact.
deform; adapt; absorb
Bone is a dynamic tissue that undergoes constant ___ in response to ___ and ___ stimulation.
remodeling; mechanical and physiological
what is wolf’s law?
bones are organized to resist the load placed on them. the more resistance, the more they are going to remodel.
what are the risk factors for fracture?
history of fall or trauma, advancing age, female, BMI<25, decreased BMD, nutrition, hormonal factors, neoplasm, low PA level, smoking
what diseases cause insufficiency or fragility fractures?
osteoporosis; osteomalacia; rickets; hyperparathyroidism; hypogonadism, osteogenesis imperfecta; scurvy; Marfans syndrome/Ehlers-Danos syndrome; Paget disease; medications (corticosteroids, antirheumatics, anti-seizures)
what is an insufficiency/ fragility fracture?
makes bones especially fragile due to some physiological mechanism or insufficient to take stress of normal activity
what are the 3 phases of repair in bone healing? what are the timeframes for each phase?
inflammatory (several days), reparative (3-6 weeks), and remodeling (months to years)
Bone has ___ potential to return to optimal function?
good
By end of the first week following a bone injury what has occurs?
most of the debris has been removed and fibrosis and revascularization have started
Bone remodels in response to ___.
mechanical stresses
The end of the reparative phase is indicated by what?
stability on an x-ray: the fracture lines begin to disappear
what is occurring during the inflammatory phase of bone healing? what are the signs and symptoms of this phase?
hematoma formation and angiogenesis; fibrous union
pain, swelling, heat
what is occurring during the reparative phase of bone healing?
soft cartilage formation including calcification then cartilage removal and bone formation
what does the clinical presentation of a fracture include?
unusual pain after trauma
deformity of alignment
pain with WB or leading and/or tenderness at bone region
dull, deep ache; sharp and severe
edema and ecchymosis
if displaces, complete or large will see major loss of function
crepitus that is atypical, unusual, or unexpected
fractures may not show on a radiograph due to ___.
swelling
what signs and symptoms should a PT be suspicious of in relation to a fracture?
negative initial radiograph then no progression with therapy and history includes considerable trauma
pain response to US and/or tuning fork
what is included in primary fracture management?
ORIF
closed reduction internal fixation
external fixator (complicated fractures)
traction for realignment (halo)
bone lengthening procedures
what is included in secondary fracture management?
no intervention: activity restriction, brace, crutch, boot, sling
closed reduction and casting
what are some PT interventions done during an immobilization phase of the fracture?
transfer training, ADL’s, gait per MD order (WB status)
After immobilization mobility is important. What should a PT start with once cast/immobilizer is removed?
stretch/mobilize with short level ROM and joint mobilizations
what are the signs of infection following a bone injury?
redness, swelling, fever, hotness, loss of appetite, nausea
what are some negative predictors for normal bone healing? other complications?
smoking, diabetes, corticosteroids, EtOH, renal and vascular insufficiency
poor stabilization, damage to blood supply, infection
what is the healing prognosis for bone injuries in children?
4-5 weeks
what is the healing prognosis for bone injuries in adolescents?
6-8 weeks
what is the healing prognosis for bone injuries in adults?
10-18 weeks
what are stress fractures caused by?
crepe in the bone that results from cyclic or sustained loading
what are some risk factors that may lead to stress fractures?
repetitive high intensity exercise, history of amenorrhea, family history of osteoporosis
what are the most common bones to see stress fractures in?
tibia, 2nd metacarpal, femoral neck, par interarticularis
what is the clinical presentation of a stress fracture?
history-insidious onset with microtrauma
pain - cortical-local, trabecular-diffuse
does not improve with activity
tenderness to palpation
what are some interventions for stress fractures?
rest/immobilization (NWB)
correct muscle imbalances and gait deviations
graduated return to training
promote shock absorption (shoes, modify surface)
orthotics PRN
train muscle endurance
what is osteoporosis?
a chronic, progressive disease characterized by low bone mass and microarchitectural deterioration of bone tissue leading to decreased bone strength enhanced bone fragility and a consequent increase in fracture incidence
what are the two types of osteoporosis?
primary: most common; most often in postmenopausal women
secondary: associated with other medical conditions or medications
what does the World Health Organization classify osteoporosis as?
BMD T-score of -2.5 SD or less
Bone strength is related to:
bone mass and other factors =, such as remodeling frequency, bone size and area, bone microarchitecture and degree of bone mineralization
Cortical bone makes up __% of the resistance to compression.
75%
why does osteoporosis occur?
imbalance of remodeling.
high bone turnover rate leads to weakening due to weaker trabecular/cancellous bone
new bone formation falls behind resorption due to declining osteoblast function
at what age does bone mass peak?
mid-30s
risk of fracture increases with __.
BMD loss
what are the non-modifiable risk factors for osteoporosis?
> 50 y.o.
caucasian/asian
menopausal
family history of osteoporosis
depression
lactose intolerance
what are the modifiable risk factors for osteoporosis?
inactivity, immobilization, sedentary lifestyle
excess EtOH, tabacco, caffeine
medications (steroids, immunosuppressants, anticoagulants)
low BMI, small body frame
diet (deficiency of Ca, Mg, Vitamin D, vitamin C)
eating disorders
what are the secondary causes of osteoporosis?
renal insufficiency, cushing’s, hyperthyroid/hyperparathyroidism, type II DM, multiple myeloma, osteomalacia, Paget’s dz/osetogenesis imperfecta, GI malabsorption/celiac, mets to bone, SCI, stroke
what are the major risk factors for osteoporotic falls?
body weight <70kg or BMI<21
corticosteroids
personal history of fractures as adult
first-degree relative with fragility fracture
current smoking
what are the major risk factors for osteoporotic falls?
early menopause
nutrition
decreased activity
ETOH
impaired vision
dementia
poor health
recent falls
what is osteomalacia?
softening of bones
disorder of mineralization of newly formed bone; causes weakness in bone and more prone to fracture.
caused by vitamin D deficiency and low blood phosphate
what is osteopenia?
low bone mass
bone loss is not as severe
what is osteoporosis?
decreased bone density (strength)
includes osteopenia but also includes a deterioration of bone tissue and decreased bone strength
who should be getting BMD testing?
all women 65+
men >/= 70
younger postmenopausal women and men 50-70 with clinical RF’s
adults with fracture after age 50
adults with a condition or a medication a/w low bone mass
perimenopausal women with high-risk risk factors
how often does medicare permit BMD testing?
every 2 years
what is included in a general nutrition treatment for osteoporosis?
calcium, vitamin D (800-1000 IU), vitamin K, vitamin A (RDA of 700 micrograms), magnesium
how can caffeine effect osteoporosis?
may reduce calcium absorption
some association with increased bone loss and fracture rates
how does ETOH affect osteoporosis?
can suppress osteoblasts
moderate intake in women 65+ is associated with lower BMD and increased risk of hip fracture
heavy intake increases risks of falls and hip fractures
what is included in pharmacological management for osteoporosis?
-antiresorptive: decreases the amount of bone that is lost (estrogrens/HRT, selective-estrogen receptor modulators, calcitonin, biphosphonates)
-anabolic PTH: builds up bone mass
what are the effects of estrogens/HRT on osteoporosis?
-recommended for prevention only
-increases BMD
-decrease in hip, vertebral, and other osteoporotic fracture rates
-increased risk of CV events, venous thromboembolism, and breast CA
-decrease in colon CA
what are SERMS (selective estrogen receptor modulators)?
-prevention and treatment of postmenopausal OP vertebral fracture risk
-daily oral dosing
-modest increase in BD of spine and hip; decreases bone turnover
what are the side effects of SERMs?
hot flashes, leg cramps, increased VTE
what is calcitonin used for? what are the side effects?
-treatment of postmenopausal only
-minimally inhibits bone resorption: possible analgesic effect for acute vertebral fx (acts directly on the osteoclasts which break down bone)
-nasal irritation, nausea, local inflammation and flushing
how do bisphosphonates effect osteoporosis?
decreases risk of vertebral fractures or hip fractures with side effects that are not a major as other pharmacological treatments
what is alendronate (fosamax) used for? what does it do?
prevention and treatment of male and postmenopausal OP
treatment of glucocorticoid-induced OP
inhibits osteoclasts, increased BMD
what is risedronate (actonel) used for? what does it do?
prevention and treatment of glucocorticoid-induced, male, and postmenopausal OP
reduced risk of spine fracture by 41-49% and hip fractures by 36% over 3 years
what is ibandronate (boniva) used for? what does it do?
prevention and treatment of postmenopausal OP
decreases risk of vertebral facture by 50% over 3 years
what is zoledronate (reclast) used for? what does it do?
treatment of postmenopausal OP
reduced incidence of spine fracture by 70%, hip fracture by 41%, and non-vertebral fx by 25% over 3 years
what is PTH: teriparatide (forteo) used for? what does it do?
treatment of high risk postmenopausal and male OP
anabolic: stimulated osteoblast activity -> increased trabecular bone density
what are the non-pharmacologic intervention for osteoporsis?
exercise (strengthening muscles of back and legs), orthotics, gait training, pain management
what exercises should be done with a patient that has osteoporosis?
weight-bearing, flexibility, strengthening (spine extension, chin tucks, scapular retraction, thoracic extension, hip extension), postural (prevent structural changes), balance
what exercises would be contraindicated for osteoporosis?
spinal flexion exercises could lead to vertebral fractures
what patient education should be given to patients with osteoporosis?
body mechanics
-avoid forward bending
-carry loads close to the body
-never twist with load
-sit up straight with knees level to hips
-change position every 30 min
-sleep with back straight
-log roll when getting out of bed
what home environment adjustments are needed for safety with patient’s with osteoporosis?
non slip floors
lighting
nightlights
telephone access
electrical cords secured
grab bars
avoid rugs
clear walkways
handrails on stairs
what is conservative treatment for management of vertebral fractures?
oral pain management
physical therapy
what surgical treatment is done for management of vertebral fractures?
kyphoplasty and vertebroplasty (injecting cement which restores vertebral body height, can partially correct kyphosis, relieves pain)
