Osteoporosis By Amanda Neilson

Overview

• Definition

• Epidemiology

• Clinical Aspects

• Treatments

• Effects on Exercise

• Exercise Testing

• Exercise Prescription

• Summary and Conclusion

• References

Definition

Breakdown

Osteo- means to do with bones

Porosis- means a porous condition

Osteoporosis- Means ‘’Porous Bones’’

Definition

Osteoporosis- is a systemic

skeletal disease

characterized by low bone

mass and

microarchitectural

deterioration of bone

tissue leading to bone

fragility and increased risk

of fracture

Definition

Video

Epidemiology

Estimated 10 million Americans have

osteoporosis

• 80% Woman

• 20% Men

Most common in Post menopausal woman

34 million Americans have low bone mass

Likelihood of having an Osteoporotic fracture

in lifetime after age 50:

• 1 in 2 woman 50%

• 1 in 4 men 25%

Clinical Aspects

Symptoms• Pain/ Joint pain

• Swelling

• Falling

• Poor posture

•Loss of Height

People may not know they have

Osteoporosis until they fall

Risk Factors

• Gender (female)

• Older Age

• Family History

• Low Estrogen Levels in Woman

• History of Fractures

• Inadequate physical activity

• Smoking

• Alcohol consumption

• Low dietary calcium intake

• Vitamin D insufficiency

• Certain medications

•Certain Diseases and Conditions

Diagnosis • Bone Densitometry

•Bone Mineral Density (BMD) measured by Central

Dual- Energy X-ray

• Ultra Sound

• Quantitative Computed Tomography (qCT Scan)

Central Dual Energy Xray Video

T- score >-1 BMD is normal

T-score -1 to -2.5 BMD low bone mass

T-score -2.5 or less osteoporosis

Treatment

• Therapeutic Options

• Hormone therapies (HT)

•Medications

•Antiresorptive Medications:

Bisphosphates-

•Bone Forming Medications

•For high fracture risk

• Wear brace for support

No cure for low bone mass or

osteoporosis– but successful

management is possible!

Effects on Exercise

Limitations •Orthopedic Limitations

• Limited locomotor abilities

• Poor Balance

• Fear of falling

• More prone to fall

• Deconditioned

• Pain in joints

Effects on Exercise

Effects of Exercise Training

• up to 1 year walking programs have

shown preservation of BMD

• Jumping exercise increase hip BMD

while HT in premenopausal woman

• exercise can improve and maintain

BMD in men

• exercise reduces risk of falling

Exercise Testing Aerobic Testing •Cycle testing: 3 Min Stage

•Treadmill : can be unsafe

• Measure: BP, RPE (6-20),

METs, 12-lead ECG, HR

Strength

• Weight machines

• Free weights

• Handheld Dynamometer

Neuromuscular

• Gait test

• Balance Test

Endpoint: Pain or fatigue

Exercise TestingFunctional• 6 minute walk: Distance

• Tandem gait speed: Speed

• Step Test: Count

•Timed Chair sit to Stand: Try

without use of arms

ADL/ Functional Performance

Tests

• ADL- activities of daily living

Posture

• Flexicurve to determine index

of kyphosis (IK) (hump on

back)

Endpoint: pain or fatigue

Exercise Prescription

Aerobic

Mode

• Large muscle activity:

walking, cycling, swimming,

water walking

Goal- Maintain bone mass

Improve and maintain

work capacity

Intensity/Frequency/Duration

• 40-70% peak HR

• 3-5 days/ week

• 30-60 min/sessions

Exercise PrescriptionStrength

Mode

• Dumbbells

• Weight machines

• Cuff weights

• Floor calisthenics

•Vibrating machines

Goals

• Improve strength

•Improve posture

•Maintain Bone Mass

•Decrease fall Risk

Intensity/

Frequency/Duration

• 75% of 1RM, 8-12

reps

• 2 sets of 8-10 reps

• 2-3 days/week

• 20-40 min

Exercise Prescription

Flexibility

Mode

• Stretching

• Chair exercises

Goals

• Increase ROM

Intensity/Frequency/ Duration

• 5-7 days a week

Functional

Mode

• Activity Specific exercises

• Brisk Walking

• chair sit to stand

• Balancing Exercises

Goals

• Increase Maintain ADLs

•Improve Balance

•Decrease fall Risk

Duration

• 3-5 days/week

• 2-3 days/week

Summary • Osteoporosis means “Porous Bones”

• Estimated 10 million Americans have Osteoporosis

• 80 % woman 20% men

• 34 million Americans have low bone density

• Risk Factors can be age, gender, Family History, History

of falls, low estrogen levels in woman, smoking, alcohol

consumption.. Etc

• BMD diagnoses is based from T- scores

T- score >-1 BMD is normal

T-score -1 to -2.5 BMD low bone mass

T-score -2.5 or less osteoporosis

• Medication is the usual treatment

• Exercise has shown to maintain bone mineral density

Test

Senior Fitness Test

References

Looker AC, Melton LJ, Harris TB, Borrud LG, Shepherd JA. (2010). Prevalence and

Trends in Low Femur Bone Density Among Older US Adults. NHANES. 20:64-71

MacLaughlin, E. J. (2010). Improving osteoporosis screening, risk assessment, diagnosis,

and treatment initiation: Role of the health-system pharmacist in closing the

gap. American Journal of Health-System Pharmacy, 67S4-S8.

doi:10.2146/ajhp100075

Olszynski, W. P., Shawn Davison, K. K., Adachi, J. D., Brown, J. P., Cummings, S. R.,

Hanley, D. A., & ... Yuen, C. (2004). Osteoporosis in men: Epidemiology,

diagnosis, prevention, and treatment. Clinical Therapeutics, 26(1), 15.

Retrieved from EBSCOhost.

Shiel, William C Jr.(2009). Osteoporosis. EmedicalHealth.

http://www.emedicalhealth.com/osteoporosis/page14.htm

Durstine, Larry J, Moore, Geoffrey E, Painter, Patricia L, Roberts, Scott O. (2009).

ACSMs Exercise Management for Persons with Chronic Diseases and

Disabilities. American College of Sports Medicine. Third Edition. Pages 270-

279

American College of Sports Medicine. 2004. Position stand. Physical Activity and

Bone Health. Med. Sci. Exercise. 36 (11): 1895-1996