Which two substances mainly get reabsorbed by the body as we age which makes bone tissue weaker and leads to osteoporosis?

a) Calcium and phosphorusb) Calcium and potassiumc) Calcium and sodiumd) Calcium and iron

Most common type of bone disease “thin bones” Body fails to form enough new bone or too

much old bone absorbed by osteoclasts or both

As we age, calcium and phosphorus reabsorbed into body making bone tissue weaker

Results in brittle, fragile bones prone to fracture even without injury

Most commonly in wrist, neck of femur, vertebrae of lower spine

Causes: › drop in estrogen in menopause and drop in testosterone in

men› Being confined to a bed› Chronic RA, kidney disease, eating disorders› Corticosteroids› Vitamin D deficiency

Risk Factors: › women over 50› men over 70› Large amounts of alcohol› Family history› Hormone treatment history for prostate/breast cancer› Smoking › Too little calcium in diet

Patient History› General demographics› Social History› Employment/Hobbies› Growth and Development› Living Environment› General Health Status

BMI- lower BMI is at greater risk (especially BMI of 21 or below) › Social/Health Habits› Family History› Medical/Surgical History › Current Conditions/Chief Complaint› Functional Status › Medications› Other Clinical Tests

Bone Mineral Density Test X-ray (Typically DEXA scan)

Why is the neurological part of the systems review important for patients with osteoporosis?

a) Sensation is a major concernb) Want to know their ability to balance to

prevent fallsc) They have problems with motor

learningd) Concerned with motor control

Systems Review areas of special concern › Musculoskeletal

Gross ROM Gross strength Gross symmetry Posture

› Neuromuscular Gross coordinated movements (balance, gait,

locomotion, transfers) Motor Function (motor control and learning)

Special Tests › Berg Balance Scale› Tinetti › TUG› MMTs- find specific muscles to target if

weak

Things to keep in mind:› Clinical findings› Extent of loss of function› Chronicity or severity of problem

Do they have broken bones or have they fallen?› Multisite involvement?› Preexisting conditions

Broken bones in the past?› Potential discharge destination

Can affect which interventions they can do on their own› Social considerations› Physical function› Overall health status

Severely poor diet, low weight, more elderly, broken bones, and doesn’t exercise you would treat differently than someone without these conditions

Want to identify primary dysfunction in order to direct intervention

For osteoporosis it could be:› Lack of education› Strength› Posture› Lifestyle factors

According to the APTA, the range of visits for skeletal demineralization is 3-18

Factors that modify frequency of visits:› Accessibility/availability of resources› Adherence to intervention program› Age› anatomical/physiological changes› Caregiver consistency/expertise› Chronicity/severity of current condition› Cognitive status› Comorbidities, secondary impairments › Decline in functional status› Living environment› Multisite involvement› Nutritional status › Psychological/socioeconomic factors› Social support› Stability of condition

General Plan of Care: Patient/Client will reduce the risk of skeletal demineralization through strength-training and weight bearing therapeutic exercise programs and through lifestyle modifications.

General Goals of InterventionAbility to perform physical actions, tasks, or activities is improved.Awareness and use of community resources are improved.Behaviors that foster healthy habits, wellness, and prevention are acquired.Decision making is enhanced regarding patient/client health and the use of health care resources by patient/client, family, significant others, and caregivers. Health status is improved.Patient/client, family, significant other, and caregiver knowledge and awareness of the diagnosis, prognosis, interventions, and anticipated goals and expected outcomes are increased. Patient/client knowledge of personal and environmental factors associated with the condition is increased.Performance levels in self-care, home management, work (job/school/play), community, or leisure actions, tasks, or activities are improved. Physical function is improved.Risk of recurrence of condition is reduced.Safety of patient/client, family, significant others, and caregivers is improved.Utilization and cost of health care services are decreased.

• Aerobic capacity/endurance conditioning or reconditioning

• Balance, coordination, and agility training

• Body mechanics and postural stabilization Flexibility exercises Gait and locomotion training Relaxation Strength, power, and endurance

training for head, neck, limb, pelvic-floor, trunk, and ventilatory muscles

Barrier accommodations or modifications Injury prevention or reduction

How many times per week are weight bearing endurance activities preferred by the ACSM for bone health?

a) 1-2b) 2-3c) 3-5d) 5-7

ModeWeight-bearing endurance activitiesJumpingResistance ExerciseIntensityModerate to high intensity required for bone loadingFrequencyWeight-bearing endurance activities 3-5 times a week at least, 5-7 times preferredResistance exercise at least 2 times/weekDuration30-60 min combined weight-bearing endurance activities, jumping, and resistance training that targets all major muscle groups

Which is the most common and most accurate way to determine Bone Mineral Density testing:

a) densitometry scaleb) Spine CTc) Dual-energy x-ray absorptiometryd) x-ray

A bone mineral density (BMD) test measures how much calcium and other types of minerals are present in a section of your bone. Your health care provider uses this test, along with other risk factors, to predict your risk of bone fractures in the future and detect osteoporosis.

Bone fracture risk is highest in people with osteoporosis.

Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. › Your health care provider uses this test to predict your risk for

bone fractures in the future. A special type of spine CT that can show loss of bone

mineral density, quantitative computed tomography (QCT), may be used in rare cases.

In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones. › However, simple x-rays of bones are not very accurate in

predicting whether someone is likely to have osteoporosis. You may need other blood and urine tests if your

osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age.

Kyphosis is common in a person with Osteoporosis and often associated with the term:

a) Milwaukee humpb) Cobb’s humpc) Postural humpd) Dowagers hump

Bone pain or tenderness Fractures with little or no trauma Loss of height (as much as 6 inches) over time Low back pain due to fractures of the spinal

bones Neck pain due to fractures of the spinal bones Stooped posture or kyphosis-"dowager's hump”

***There are no symptoms in the early stages of the disease!!!***

Orthopedic Center of Central Virginia Osteoporosis Center

http://www.nof.org/node/57 Support & Nationwide events!!

Which food is lowest in calcium?

a) sardinesb) figsc) tofud) yogurt

Get at least 1,200 milligrams per day of calcium and 800 - 1,000 international units of vitamin D3. › Vitamin D helps your body absorb calcium.› Your doctor may recommend a supplement

to give you the calcium and vitamin D you need.

Follow a diet that provides the proper amount of calcium, vitamin D, and protein. › While this will not completely stop bone loss, it

will guarantee that a supply of the materials the body uses to form and maintain bones is available.

Caffeine:› Caffeine in high amounts can cause bone loss. It

interferes with calcium absorption and causes a slight increase in the amount of calcium in the urine.

Phosphoric Acid:› Some studies suggest that too much phosphorous

can reduce the amount of calcium that the body absorbs.

› Be careful not to substitute caffeinated drinks for milk and calcium-fortified juices. When drinks that have caffeine take the place of milk and other sources of calcium, bone health may be affected.

Which of the following activities would be contraindicated for an individual with osteoporosis?

A. reaching up in the cupboard B. bending over to tie a shoe C. arm exercises with a 3 lb. weight D. swimming

Consult physician prior to beginning a program

Weight Bearing Flexibility Balance (decrease falls) Resistance Whole Body

Dynamic abdominal exercises like sit-ups and excessive trunk flexion can cause vertebral crush fractures.

Twisting movements such as a golf swing can also cause fractures

Exercises that involve abrupt or explosive loading, or high-impact loading, are contraindicated.

If you participate in Yoga or Pilates inform the instructor so that positions can be modified

Bending can cause vertebral fracture and should be avoided

Some exercises are not suitable for people with osteoporosis because they exert very strong force on relatively weak bones

Avoid high impact: running, jogging Medical Conditions: Obesity, High

Blood, Pressure , Heart Disease may affect participation

Hiking Walking (outside, treadmill) Dancing (good warm up) Stair climbing Elliptical training machines Low-impact aerobics: step

aerobics Stair-step machines Cycling Volleyball Tennis

Free weights or weight machines at home or in the gym

Resistance tubing that comes in a variety of strengths

Water exercises

Lead a healthy lifestyle/ diet Online discussions and forums Healthtalkonline: share experiences National Osteoporosis Society Family involvement and activity http://www.wellness.com/find/psychiatri

st/va/lynchburg http://www.centralvamd.com/internal.h

tm

Which of the following is not a treatment for Osteoporosis?

A. parathyroid hormones B. estrogen supplement C. biophosphates D. corticosteroids

Estrogen- associated with cancer Evista- estrogen effects Calcitonin-slows bone loss Parathyroid hormone-increase bone

production Biophosphates- Boniva,Fosamax,

Actonel, Reclast› Given to reduce risk of fracture, increase

bone density, and stop bone loss

Corticosteroids (steroid hormones) Thyroid medications Blood thinners Diuretics (water pills) Antibiotics Immune system suppressants Aluminum containing antacids Vitamin A- over the recommended daily

dosage

APTA Guide to PT Practice American College of Sports Medicine http://www.acsm.org/ Pubmedhttp://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001400/ http://www.webmd.com/osteoporosis/guide/osteoporosis-exercise http://www.webmd.com/osteoporosis/features/exercise-for-

osteoporosis http://weighttraining.about.com/od/weighttrainingforhealth/a/

osteo.htm http://www.iofbonehealth.org/health-professionals/special-topics/

exercise-recommendations.html http://www.recovercisesforwellness.com/articles.htm http://www.nos.org.uk/page.aspx?pid=265&srcid=234 http://www.iofbonehealth.org/patients-public/about-osteoporosis/

prevention/nutrition/calcium-rich-foods.html