BSNC 1000 Module 6 Mobility Class 1

Module 6: Concept of Mobility

Class 1: Concept Introduction and Pathophysiology of Osteoporosis

Learning Outcomes

• Define the concept of mobility

• Describe the scope of mobility

• Describe the requirements for mobility and the function of neurologic and musculoskeletal structures related to mobility

• Identify conditions causing impaired mobility

• Identify risk factors for impaired mobility in older adults

• Describe the pathophysiology of osteoporosis

Concept of Mobility

• Mobility: The state or quality of being mobile or movable.

• Essential for performing Activities of Daily Living (ADLs) such as:

  • Eating

  • Dressing

  • Walking

Scope of Mobility

• Categories:

  • Full mobility

  • Impaired mobility

  • Immobility

• Impairment in mobility can include:

  • Limitation in physical movement

  • Inability to perform gross or fine movements and coordination

• Modifications in mobility can be:

  • Transient

  • Recurring

  • Permanent

• Common causes of immobility include:

  • Stroke

  • Fractures

  • Multiple sclerosis

  • Trauma

  • Morbid obesity

• Aging impacts mobility due to changes in skeletal, muscular, and nervous systems.

Requirements for Mobility

• Complete the concept triangle demonstrating relationships between:

  • Mobility

  • Perfusion

  • Gas exchange

Risk Factors for Impaired Mobility in Older Adults

• Age-related changes in:

  • Neurologic function

  • Musculoskeletal function

  • Other body systems (e.g., circulation, respiratory)

Factors that Impair Mobility

Impaired Mobility

• Caused by:

  • Neurologic conditions

    • Brain, spinal cord, nerves

  • Musculoskeletal conditions

    • Skeletal (cartilage, tendons, ligaments)

    • Muscle conditions

    • Joint conditions

Consequences of Impaired Mobility

• Common consequences can include:

  • Increased risk of falls

  • Muscle atrophy

  • Contractures

• Situations where immobility is beneficial should be considered (e.g., post-surgery for healing).

Review of Bone Structure and Function

Bone Tissue Organization

• Types of bone structures:

  • Concentric lamellae

  • Interstitial lamellae

  • Trabecular (spongy) bone

  • Osteons

• Components:

  • Periosteum, perforating canal, central canal, arteries, and veins.

Bone Remodeling

• Process: Bone resorption and deposition.

• Bone remodeling cycle relevant to maintaining bone health.

Factors Regulating Bone Growth and Remodeling

• Key regulators include:

  • Nutrients (minerals, vitamins)

  • Hormones (parathyroid hormone, Vitamin D, calcitonin)

  • Physical activity influences bone density and strength.

Calcium Homeostasis

• Role of PTH and Calcitonin:

  • PTH promotes Ca2+ release into blood and reabsorption from urine.

  • Calcitonin inhibits Ca2+ release by osteoclasts.

Peak Bone Mass

• Achieved by age 30 after a period of higher bone formation than resorption.

• Importance of building strong bones in childhood and adolescence to prevent osteoporosis.

Osteoporosis: Overview

• Multifactorial disease characterized by:

  • Absolute reduction in total bone mass

  • Imbalance in bone remodeling

• Risk factors: Aging, being female, genetic predisposition, lifestyle factors, hormonal changes.

Epidemiology of Osteoporosis

• Affects at least 1 in 3 women and 1 in 5 men.

• 2 million Canadians affected; over 80% of fractures in individuals 50+ are osteoporotic.

• Significant mortality risk (28% of women, 37% of men post-hip fracture).

Key Risk Factors for Osteoporosis

• Modifiable risk factors: Lifestyle choices affecting bone health.

• Non-modifiable risk factors: Age, gender, family history.

Bone Density and Age

• After age 30, resorption exceeds formation.

• Men generally start with higher bone mass and lose it more slowly than women.

Gender and Ethnic Differences in Bone Density

• Men typically have higher density due to hormonal factors.

• Ethnic variations exist in bone mass.

Age Related Changes

Primary Osteoporosis

• Post-menopausal and age-related factors contribute to increased bone loss.

• Osteopenia and subsequent osteoporosis can develop due to these factors.

Estrogen Deficiency

• Estrogen inhibits osteoclast activity, slowing bone resorption.

• Rapid loss during early menopause.

Osteoporosis Pathology

• Structural changes in both compact and spongy bone observed during osteoporosis.

Diagnosing Osteoporosis

• Based on Bone Mineral Density (BMD) measurements using T scores to assess risk.

Consequences of Osteoporosis

• Weakening of bones increases risk of fractures, especially in the spine, proximal femur, and distal radius.

Mobility Impairment due to Osteoporosis

• Osteoporosis directly affects mobility due to structural weakening and related fractures.

Questions and Comments

• Prepare for Class 2 on Friday with any questions or topics for discussion.