Clinical ex. Phys CH. 25

what is osteoporosis

Skeletal disorder characterized by compromised bone strength, predisposing individuals to an increased risk of fracture

Osteoporosis mean bone mineral density (BMD) is..

2.5 standard deviations below the mean (T-score -2.5)

Osteopenia

less severe form of disease

in osteopenia, BMD score is

BMD T-score is between -1 and -2.5

Fracture risk assessment (FRAX) does not just look at ___. They also look at

BMD.

Age, gender, use of oral glucocorticoids (GCOP), history of fracture

what are utilized and calculated in a fracture risk assessment (FRAX)

Risk factors are utilized in an algorithm (with or without BMD) and a 10 year probability of fracture is calculated

FRAX is not validated for use under the age of

40

FRAX does not show to be a better predictor of fracture over, only...

give an example

BMD classifications of osteoporosis vs. osteopenia alone

ex. many with osteopenia will experience a fracture where not all with osteoporosis will

onset for osteoporosis is typically...

rate increases during..

after the age of 40 (.5-1% of loss per year after age 40)

rate increases during a 3-5 year period after menopause

Most often a results of age-related bone loss..

postmenopausal bone loss, or other secondary factors (immobility, medication side effects, RA, Chrons disease, etc.) - or a combo of any of these

since _/_ of every women will experience osteoporosis at some point in their life, it is thought of...

1/2, it is thought of as a "women's disease" - but prevalence in males is at least 15%

When do you reach peak bone mass

25-30 yrs

peak bone mass

highest amount of bone mass attained during life

influencers of peak bone mass

genetics, physical activity, diet, and hormonal balance

what will determine osteoporosis development throughout life

Amount of peak bone mass and extent of bone loss that occurs throughout life

first line of defense for prevention of osteoporosis

maximizing peak bone mass during childhood and adolescence

bone modeling

bone formation without prior bone resorption

bone remodeling

old bone is broken down and new bone is produced in its place to maintain bone strength repair and fatigue damage

bone remodeling involves

bone resorption (break down of bone by osteoclasts) followed by bone formation (production of bone by osteoblasts)

bone remodeling takes

several months

If resorption and formation are balanced then bone mass is..

maintained

if resorption is greater than formation, then bone loss occurs

hormonal influencers in pre puberty

primarily influenced by estrogen, growth hormone, and insulin-like growth factors

bone growth in length occurs

occurs at the growth plate and influenced by Indian hedgehog, parathyroid hormone related protein, estrogen, and thyroid hormone

during/after puberty and into adulthood:

bone mass changes are mostly influenced by estrogen

estrogen deficiency =

bone loss

estrogen deficiency occurs after menopause and is why osteoporosis

becomes extremely more common in women with age

Young amenorrheic women experience bone loss due to...

hormone disruption

(damage can be intense enough that they are unable to regain sufficient bone mass even with resumption of regular menstrual periods)

what can create estrogen deficiency and affect bone mass

surgical removal of ovaries

what in men can result in bone loss

testosterone deficiency

other factors affecting bone mass: energy deficiency

energy deficiency in men and women of all ages increases bone loss

calcium or vitamin D deficiencies:

hinder bone mass

If calcium intake is insufficient during childhood when bone modeling is still occurring, then the body will sacrifice increases in bone length to maintain bone strength!

other factors affecting bone mass: mechanical loading

looks to increase bone mass and strength depending on frequency and magnitude of load

vice versa will also occur with decreased loading (bone loss and reduced strength)

most common sites for osteoporotic fractures are

the wrist, spine, humerus, hip (femoral neck), rib, pelvis

Most common sites are typically due to load on osteoporotic load, but can be influenced by..

torsional or compressive loads as well (especially the spine)

symptoms of osteoporosis

typically none during periods of accelerated bone loss or unbalanced bone remodeling

what is typically the first sign of osteoporosis and why is that unfortunate?

Fracture, this is unfortunate because that means the damage has already occurred

diagnostic testing for osteoporosis

dual energy absoprtiometry (DEXA/DXA) is the most common technology to assess BMD

DEXA is not used for overall BMD but typically more specific of the

hip, spine, and less often the forearm

what is used for diagnosis and most often the determination of 10 year risk?

femoral hip BMD

T score compares your bone density to a..

young adult at peak bone strength. It is not used if a person is younger than 50 years old.

The reference graph compares your bone density to the...

young normal population (light blue) and a population of the same age, gender and race (dark blue). Your score is the circle.

Z score compares your bone density to

people of the same age.

A score of less than ___ implies less than average. If your T- score is less than __ or your Z score is less than __, you should contact your physician and have a comprehensive bone density DXA scan performed

-1, -1, -2

ACSM does not view osteoporosis as

an absolute or relative contraindication

For osteoporosis and osteopenia, best practice to avoid...

high-impact skeletal load testing such jumping/stepping

alternatives for exercise testing

cycling protocol, treadmill protocol (walking only)

consider fall risk and increased risk of fracture with a fall

treatment for osteoporosis

exercise, calcium supplementation, vitamin D supplementation, assessment of energy efficiency considerations

exercise alone for osteoporosis is...

not sufficient to prevent all bone loss, but is vital to bone health and reducing loss

Therapeutic goals include reducing fractures/risk of fractures with:

- Fall prevention protocols

- Promotion of spine-sparing strategies

Osteogenic exercise regimens that are currently supported (always with patient

specificity in mind - considering current risk of fracture with stress):

- Load-bearing activities at high magnitude with few reps

- Variable strain distributions throughout the bone structure

- Loading in a site-specific manner (hips, wrist, low back)

- Long-term and progressive exercise

- Dispersing loading activities throughout the day rather than all at one time

aerobic physical activity for osteoporosis

- 30-60 min of moderate activity each day

- 150-300 cumulative min/week

more exercise prescription for osteoporosis

- balance training (improves fall prevention)

- flexibility

- postural correction

what should all be considered when designing a program

Fall and fracture risk, medical history, physical function, goals, and

preferences

benefits of exercise needs to..

outweigh risk of fractures

what else should be prioritized in exercise program for patient with osteoporosis

balance, functional, and strength training