Osteoporosis slides

OSTEOPOROSIS-What it is and what you can do

about it-

A musculoskeletal disorder with compromised bone

strength that predisposes an individual to increased

fracture risk

NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and

Therapy. JAMA 2001: 285:785-795

In other words….

Reduction of bone mass, both quantity AND quality so thatbones become fragile and easily

fracturePEAK BONE MASS

The amount of bone we accumulate as a young adult (generally age 30-35)

About 90-98% is accumulated by age 18-20

www.niams.nih.gov/Health_Info/Bone/Osteoporosis/bone-mass.asp

Normal Bone

Osteoporotic

Bone

Also in childhood—babies are being born with it Affects all populations—women, men, young

adults, the elderly, patients in the clinic, and anyone here in this room today

Knows no boundaries regarding age, gender, lifestyle or ethnicity or any other factor

Affects over 55% of persons aged 50+ men & women

(Reference National Osteoporosis Foundation 2002) Total # of people estimated to have the condition

in the US—44 million Is more prevalent than coronary heart disease

(12.5 million,) heart attack (1.1 million,) or diabetes (17 million.) (Ref: Surgeon General’s Report 2004

Is more common than breast, uterine and ovarian cancer, combined

Patterns Of Postural Change

DETERMINANTS OFPEAK BONE MASS

Heredity – up to 75% *

Physical Activity

Nutrition

Hormonal Status Ethnicity Lifestyle Factors

http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/bone_mass.asp#aAccessed October 21, 2011

TESTS

FOR

OSTEOPOROSIS

The Only Current Non-Invasive

Diagnostic Test Available forClinical Use

BONE DENSITY SCAN

Bone Mineral Density (BMD) NowConsidered a Risk Factor

For Fracture and Not the Primary Diagnostic Tool it has Been

GOLD STANDARD

•LUMBAR SPINE•HIP

T Score

O to -1………………Normal Bone

-1 to -2.4…………….Osteopenia

-2.5 & Below………..Osteoporosis

Below -2.5 in presence of fracture…

……Severe Osteoporosis

MOST COMMON FRACTURES

WRIST HIP

VERTEBRAL BODY

OTHER COMMONFRACTURE SITES

RIBS PELVIS

ANY BONE IN THE BODY

HIP•Most disabling/life threatening•Older woman who falls backward

most likely to fracture her hip•1/2 women with hip fracture die

within one year of fracture•At 6 months following a hip

fracture, only 15% can walk across a room unaided.

CLINICAL CONSEQUENCES OF SPINE FRACTURES

SYMPTOMS SIGNS FUNCTION FUTURE RISKS

Back Pain (acute/chronic)Sleep DisturbanceAnxietyDepressionDecreased Self EsteemFear of future: Falls and FracturesReduced Quality of LifeEarly Satiety

Height LossKyphosisDecreased Lumbar LordosisProtuberant AbdomenReduced Lung FunctionWeight Loss

Impaired ADL’sDifficulty Fitting ClothesDifficulty Bending, Lifting, Descending Stairs, Cooking

Increased Risk of FractureIncreased Risk of Death

Source: Papaioannou et al. 2002. Reprinted from The American Journal of Medicine, Diagnosis and management of vertebral

fractures in elderly adults. 113(3):220-228 (2002)

Bone Health and OsteoporosisA Report of the Surgeon General October

2004

However more fractures occur in

women with normal bone or osteopenia

than in those with osteoporosis

Pasco JA, Seeman E, Henry MJ, et al. The population burden of fractures originates in women with osteopenia, not osteoporosis. Osteoporos Int (2006)17:1404Sornay-Rendu E, Munoz F, Garnero P, Duboeuf F, Delmas PD.. Identification of osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res. 2005 Oct;20(10):1813-9. Epub 2005 Jun 20.E. Siris & P. D. Delmas. Assessment of 10-year absolute fracture risk: a new paradigm with worldwide application. Osteoporosis International (2008);19:383-384

WHO Fracture Risk Assessment Tool

10 factors identified to increase fracture risk independent of bone mineral density

Age, sex, weight (under 125 lbs) & height, previous fractures, parental hip fracture history, smoking status, glucocorticoid use, rheumatoid arthritis, secondary disorders linked to osteoporosis such as diabetes, 3 or more alcoholic beverages per day

http://www.shef.ac.uk/FRAXhttp://www.betterbones.com/bonefracture/

whowillfracture.pdf

TRIANGLE OF MANAGEMENT

EXERCISETHE

“E”PILL

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(including osteoporosis)and make you look and feel years younger…..

FRONT

OF

BACKBONE

Principles of The Meeks MethodSite-Specific Exercise

UN-LOAD the Vertebral Bodies

DECOMPRESSION

FRONT of the Backbone

Single Best Exercise for Most Back Pain

GLADYS

JAMES

Habitual Posture Best PostureBest Posture - 1

Hour Later

JOYCE

Before After (30 mins)

LUCILLE

Before After (1 hour)

“SURPRISE” THE BONESWalk backward, sideward, on uneven surfaces

The Single Best Exercise for MostPeople at almost Anytime

Promotes Weightbearing through the Hip Joints and the Bones

WALKING

Running

Jumping

REMEMBERPRINCIPLES

OFMOVEMENT

andAVOID OR USE

CAUTION WITH THE FOLLOWING

EXERCISES/ACTIVITIES

YOGAQI GONGT’AI CHI

AEROBICS BODY PUMP

KICK BOXING

PILATES GYROTONIC

GOLF TENNIS BOWLING

TAE BOSTOMP

POOL CLASSES and SWIMMING

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CARDIO

The World’s Osteoporosis

is

Ticking

Chan et al. Bulletin of the World Health Organization 2003, 81 (11)Reference #15—Appendix Reference List

!!TAKE ACTION NOW!!

Best way to diffuse the world’s

OSTEOPOROSIS TIME BOMB

is to

THERAPEUTIC EXERCISEEmphasis on:

Unloading/DecompressionStrengthening**

(Back Extensor, Lower Abdominal, Hip Support Musculature)

Weightbearing through the hip joint and

the entire skeletonALIGNMENT MOST IMPORTANT(Alignment is EVERYTHING)

**Huntoon EA, Schmidt CK, Sinaki M – Significantly fewer refractures after vertebroplasty in patients who engage in back-extensor-sternghening exercises.**Sinaki M, Itoi E, Wahner HW, Wollan P,Gelzcer R. Mullan BP, Collins DA, Hodgson SF – Stronger back muscles reduce the incidence of vertebral fractures: a prospective 10 year follow-up of post-menopausal women

PURPOSES OF BRACING

Support and protectionControl of motionPrevent fracture

Allow weight-bearing activities

Bracing usually associated with weakeningof body part it is designed to protect

SPINOMEDSpinal Orthosis for Osteoporosis

“The Spinomed orthosis is the single, most significant advancement in the

conservative management of osteoporosis and compression fracture

EVER.” Sara M. Meeks, PT, MS, GCS Backed up by a peer-reviewed research study - Michael Pfeifer, Bettina

Begerow, Helmut Minne 2004 Ordered by Physician and fitted by Orthotist Strengthens rather than weakens – even with more wear time; begin slowly and increase as

patients can experience muscle discomfort from muscle activation Can fit to very severe thoracic hyperkyphosis Can be worn under clothing – inconspicuous Combine with Meeks Method of exercises for optimum results Orthosis should be worn when up and active, can be worn when sitting but

patient will not get the benefit of it

Goal is to Prevent the Next Fracture

Supine is Best

Prone is OK Too!

Be Careful with Straight leg raises

Don’t Forget The Hip Hinge

THANK YOU!!!!

Questions? Interested in a class? Need more information? If you feel you may

benefit from physical therapy for osteoporosis and would like to schedule an appointment, please call the number below

dwyerm@fauquierhealth.org (540) 316-2680 FH Physical Medicine and

Rehabilitation at the MOB (Medical Office Building)

www.Therapy2bYourself.blogspot.com