by amanda neilson
TRANSCRIPT
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
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
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
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