OSTEOPOROSIS

Dr. Punita Adajania

Osteon is bone and porosis is hole in Greek.

Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro architectural deterioration of bone tissue leading to bone fragility , and consequent increase in fracture risk .

WHAT IS OSTEOPOROSIS?

It leads to abnormally porous bone that is compressible , like a sponge.

The spine , hips and wrists are common areas of bone fractures from osteoporosis.

NORMAL MODERATE

SEVERE

•Osteoporosis is the most prevalent bone disease in the world.

• According to the International Osteoporosis Foundation, 1 in 3 women over 50 may experience osteoporotic fractures, and 1 in 5 men .

• Female to male ratio 1 : 6

PREVALENCE

2 TYPES :-a) PRIMARY OSTEOPOROSIS

I. Type-1 : Postmenopausal osteoporosisII. Type-2 : Age – associated osteoporosisb) SECONDARY OSTEOPOROSIS

Loss of bone is caused by an identifiable agent or disease process such as inflammatory disorder , bone marrow cellularity disorder and corticosteroid use.

TYPES OF OSTEOPOROSIS

SECONDARY OSTEOPOROSIS

• Fractures caused by osteoporosis are often painful.

• Osteoporosis is often called the ‘Silent disease’ as

many people don’t recognize they have it until a

fracture occurs.

• Back pain: Episodic, acute , low thoracic/high lumbar

pain

• Compression fracture of the spine

CLINICAL SIGNS AND SYMPTOMS

• Bone fractures

• Decrease in height

• Kyphosis

• Dowager’s hump

• Decreased activity tolerance

Rheumatologic disorders

• Rheumatoid arthritis, • Ankylosing spondylitis

Inherited Disorders• Osteogenesis imperfecta• Glycogen storage diseases

CAUSES

Nutritional And Gastro-intestinal Disorders • malnutrition, • parenteral nutrition, • gastrectomy,

Endocrine Disorders

• hyperparathyroidism• insulin-dependent diabetes mellitus, • adrenal insufficiency

RISK FACTORS

• Height loss• Body weight• Kyphosis• Humped back• Tooth loss• Skinfold thickness• Grip strength

PHYSICAL EXAMINATION

In case of vertebral fracture:

• Wall- occiput distance• Rib-pelvis distance

• FRAX is a fracture risk assessment tool used to evaluate the 10-year probability of hip and major osteoporotic fracture risk that integrates clinical risk factors and bone mineral density at the femoral neck.

FRACTURE RISK ASSESSMENT TOOL (FRAX)

• A simple clinical screening tool, based on age and weight, Osteoporosis.

• OSTA was developed for postmenopausal Asian women.

• Women in the high risk category and those in the moderate risk category with additional risk factors (e.g. glucocorticoid use, hypogonadism, immobilisation) for osteoporosis should be recommended for DXA

SELF-ASSESSMENT TOOL FOR ASIANS (OSTA)

• Bone Mineral Density (BMD) test :- The most common test.

Results are reported using T-scores.

T-scores are relative to how much higher or

lower your bone density is compared to that of a

healthy adult.

DIAGNOSIS

• Initial investigations include:1. ESR2. Bone profile: serum calcium, phosphate, albumin3. Alkaline phosphatase4. Renal function5. Plain X-rays - lateral thoraco-lumbar spine or hip

LABORATORY TESTS

• GOALS :-1) To educate proper posture.2) Teach safe ways of moving and lifting.3) To prevent a decline in bone mass and prevent fractures.4) To increase the strength in bones.5) To maintain or improve balance.6) To improve flexibility.7) To help decrease the stress placed on the bones by tight

muscles. 8) To improve overall mobility. 9) To control pain and gradually returning back to regular

activities.

PHYSIOTHERAPY MANAGEMENT

• If patient has fracture related to osteoporosis, treatment

will start with focus on decreasing pain.

• For that modalities like,

I. Ice

II. Heat

III.Ultrasound

IV.Electric current

After that , start with more advanced exercises involving

strengthening ,balance, weight bearing and flexibility

exercises.

EXERCISES

1) Extension exercises2) Chin tucks3) Scapular retractions4) Thoracic extensions5) Hip extension

These all exercises will improve posture , balance and strength.

NOTE :- Flexion exercises are CONTRAINDICATED.

Anterior compressive forces to the vertebra can contribute to compression fractures.

Orthoses is also used in osteoporotic spine .It promote extension of spine.

Hip protectors :- Hip protectors are an external hip protection

system that aims to reduce the hip facture.

Non-strenuous exercises for patient with severe osteoporosis

• Upper back and shoulder extension exercises perform with spine supported.

• Back extension exercise in sitting position. This position avoids or minimizes pain in patient with severe osteoporosis.

Maintain Posture

• Goal :- To get body lined up from head to toe,

with weight going through hips.

• Physical therapist role :- Give instruction that

all times to try to “ BE TALL “.

CORRECT LIFTING POSTURE

CORRECT SLEEPING POSTURE

STRENGTHENING EXERCISE

• Gentle weighted exercises , using either elastics or weights for upper and lower extremities.

• These exercises help to improve the individuals overall physical function and postural control.

• Exercise for improving strength in lumbar extensors and gluteus maximus muscles.

WEIGHT BEARING EXERCISES

• Walking outdoors or on a treadmill

• Gentle non-pounding forms of dance

• Stair climbing

• These all are useful activities to put weight through

the bones and encourage an upright posture while also

improving cardiovascular health.

• High impact activities such as running, jumping, and

pounding forms of dance should be strictly avoided.

• Arm press :-

Stand facing a wall, about 50cm away from it, with your feet slightly apart, arms bent at the elbows and hands at shoulder height.

Lean your body forwards towards the wall by bending your elbows in a controlled movement.

Push your body back to the starting position.

Balance Poor balance can lead to a fall which can

easily fracture an osteoporotic bone.

Exercises to improve balance:• Standing with feet close together• Standing on one foot, or standing with

one foot in front of the other. • Closing eyes can make any of these

activities even more difficult.• Safe environment is most important.• As balance gets better, more challenging

exercises should be provided.

FLEXIBILITY EXERCISE :- By improving and maintaining flexibility, the

stress put on bones by tight muscles will decrease and the ability to practice good posture and body mechanics will be improved.

Good flexibility also improves your mobility, which in turn improves you balance and decreases your risk of falls.

Stretching for upper back and chest will be prescribed to decrease the developing a stooped posture.

Stretches for hips, calf, and neck are also important.

• Pectoral stretching exercise performed in standing position. This is used to reduced kyphotic posture.

ALTERNATIVE/HOLISTIC MANAGEMENT • Alternative management of osteoporosis includes diet,

vitamin supplementation, and herbal supplementation. • Diet has a direct correlation to bone growth and as an

individual ages, he/she may not be absorbing the adequate amount of calcium.

• By using calcium-rich foods, such as milk, cheese,

almonds, broccoli, and cauliflower.

• Leafy green vegetables are a great addition to the diet with osteoporosis it has been shown that oxalate acid that is found in spinach prevents absorption of calcium in the stomach.

• Vitamin supplements may also be necessary when managing osteoporosis.

• According to the University of Maryland Medical Center (UMMC), 1,500 milligrams of calcium, taken in 3 doses of 500 milligrams per day, is an effective supplement to strengthen the bones and prevent further bone loss.

• Other vitamins that are recommended to retain bone strength are vitamins D and K.

YOGA • Yoga can stimulate the bones to

retain calcium.

DO’S AND DON’TIt is important not to rush into unaccustomed exercise

too quickly.

Exercise must be done regularly to have benefit.

Avoid combining flexion and rotation of the trunk to

reduce stress on vertebra.

Think carefully about undertaking activities that may

increase the chance of a fall.

Always maintain an upright posture.

THANK YOU