BO B BY PA R K E R

OSTEOPOROSIS

OVERVIEW

• Definitions• Epidemiology• Symptoms • Treatment• Effects of Exercise• Testing• Prescription• Conclusion• References

http://www.beautyhealthwomen.com/benefits-in-women

VIDEO

• http://www.youtube.com/watch?v=rHyeZhcoZcQ

DEFINITIONS

• Osteoporosis is a bone disease that thins skeletal bone tissue losing bone density over time• There is no cure for low bone mass and

osteoporosis, successful management is possible• Osteoporosis is directly related to Osteopenia

referring to bone mineral density (BMD) that is lower than normal peak BMD

EPIDEMIOLOGY

• Currently it is estimated that over 200 million people worldwide suffer from this disease • Researchers estimate that about 1 out of 5

American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine).• Women can lose up to 20% of their bone mass in

the five to seven years after menopause

EPIDEMIOLOGY

• Approximately 30% of all postmenopausal women have osteoporosis in the United States and in Europe• In 2005, the cost associated with osteoporosis-

related fractures was estimated at $19 billion• By 2025, the costs are expected to rise to

approximately $25.3 billion.

EPIDEMIOLOGY IMAGE

http://www.iofbonehealth.org/bonehealth/epidemiology

SYMPTOMS

• There are no symptoms in the early stages. You will not notice any pain or changes as the bones become thinner!• In the later stages, symptoms include bone

pain/tenderness, fractures, loss of height, low back/neck pain due to fractures of the spinal bones, Stooped posture (kyphosis)• Since your bones are getting thinner, there is an

increase risk of breaking a bone because the bone is less dense.

OSTEOPOROSIS IMAGES

Normal bone Matrix Osteoporosis

http://www.doctortipster.com/1333-osteoporosis.html

RISK FACTORS

• Older age• Gender (females have a higher percentage)• Family History• Smoking• Alcohol Consumption• Low Calcium and Vitamin D intake• Low lean body mass• Diseases (anorexia, bulimia, asthma, cystic

fibrosis, celiac disease, etc.)

DIAGNOSIS

• DEXA Scan (Dual X-ray Absorptiometry) is the most common• Quantitative computed tomography (QCT)• The World Health Organization (WHO) Fracture

Risk Assessment Tool (FRAXTM). It’s available online and can be used to determine the 10-year probability of a major osteoporotic fracture

IMAGES

http://www.gorhams.dk/html/what_is_dexa_scanning.html

PRESCRIPTION

The National Osteoporosis Foundation suggest the following five steps that together optimize bone health and help prevent osteoporosis• Obtain the recommended, age-related amount of

calcium and vitamin D per day• Engage in regular weight-bearing and muscle

strengthening exercises• Avoid Tobacco and excess alcohol• Education about bone health• Having a bone density examination/taking

medication when recommended

MEDICATION

• Antiresorptive medications:• Bisphosphonates (alendronate and alendronate plus

vitamin D3)

• Selective estrogen receptor modulators (SERMs) or estrogen agonists • Raloxifene, which is FDA approved for osteoporosis in

post menopausal women)

• Bone Forming (Anabolic) medications:• Teriparatide (Forteo which is a form of parathyroid

hormone)• Limited time on for postmenopausal women and men

with very low bone mineral density

EFFECTS ON EXERCISE

• Mechanical limitations imposed on respiratory muscle functions in individuals with severe thoracic kyphosis• For those who only complication is low bone

mass, standardized exercise testing with precautions to minimize the risk of falling during the test is recommended • Regular aerobic, weight-bearing, and resistance

exercise training has been shown to have a positive effect on the bone mineral density (BMD) of the spine in post menopausal women

EXERCISE TESTING

Methods Measures

Aerobic Cycle (ramp protocol 5-20 W/min; staged protocol 25-50 W/3min stage)Treadmill (1-2 METs/stage)

12-lead ECG, HRBPRPE (6-20)METs

StrengthWeight machinesFree WeightsHandheld dynamometer

PainFatigue

NeuromuscularGait analysisBalance

Pain Fatigue

EXERCISE TESTING (CONT.)

Methods Measure

Functional6 min walkTandem gait speedStep testTimed chair sit to stand testADL/functional performance testsPostureQuality of life Scales

DistanceSpeedCountTry without use of armsFlexicure to determine the index of kyphosis (IK)

EXERCISE PROGRAMMING

Modes Intensity/Frequency/Duration

AerobicLarge muscle activities (Walking, Cycling, Elliptical, Running, etc.

40-70% peak HR, METs3-5 days/week30-60 min/session

Strengthdumbbells, weight machines, etc.

75% of 1RM, 8-12 reps2 sets of 8-102-3 days/week for 20-40 min

FlexibilityStretching, Chair exercises

5-7 days/week with prolonged holding (30s as tolerated)

FunctionalActivity-specific exercise, brisk walk, chair sit, balancing exercises

3-5 days/week2-3 days/week

POSTMENOPAUSAL OSTEOPOROSIS

• http://www.youtube.com/watch?v=CluxTHfi-AE&feature=fvst

SUMMARY AND CONCLUSION

• Osteoporosis is the thinning of the bone tissue and loss of bone density over time• There is no symptoms in the early stages• There is no cure• Exercising and eliminating risk factors can help

prevent and manage Osteoporosis and Osteopenia

REFERENCES

• American College of Sports Medicine. (2009). L. Dustrine, P. Painter, G. Moore & S. Roberts (Eds.), Illinois : Human Kinetics.

• http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001400/• http://www.iofbonehealth.org/bonehealth/epidemiology• http://www.medscape.com/viewarticle/410461• http://www.medscape.org/viewarticle/502984_5• http://www.hazletonhealthandwellness.org  • http://www.webmd.com/osteoporosis/guide/osteoporosis-diagnosis-tests