little bone mineral density brought on by changed bone microstructure is known as osteoporosis, which ultimately predisposes individuals to fragility fractures with little force. The quality of life is significantly reduced as a result of osteoporotic fractures, which also increase morbidity, mortality, and disability. Soon, a presentation on the management of osteoporosis with physical therapy will be made available.

1. OSTEOPOROSIS
BY: ANISHA D KATOLE
FINAL BPTH

2. OUTLINE
• DEFINITION
• PATHOPHYSIOLOGY
• TYPES
• CAUSES
• CLINICAL FEATURES
• INVESTIGATIONS
• DIAGNOSTIC FEATURES
• ICF

3. DEFINITION
• The most common metabolic bone disease.
• Osteoporosis is characterised by a diffuse reduction in the bone density due to decrease
in the bone mass.
• It occurs when the rate of bone resorption exceeds the rate of bone formation.
• The reduction of bone mass results in fragile skeleton associated with increased risk of
fractures and consequent pain and deformity.

6. PATHOPHYSIOLOGY
• Bone loss due to normal age related changes in bone remodelling as well as extrinsic and intrinsic factor that
exaggerated this process.
• Bone remodelling has two primary functions
1. To repair micro damage within the skeleton to maintain the skeletal strength.
2. To supply calcium to maintain calcium supply.
• After age 30- 40, the resorption and formation processes becomes imbalanced and resorption exceed
formation.
• Excessive bone loss can be loss due to an increase in osteoclastic activity and/or osteoblastic activity.

8. TYPES OF OSTEOPOROSIS
• PRIMARY OSTEOPOROSIS
• SECONDARY OSTEOPOROSIS

9. PRIMARY OSTEOPOROSIS
• Primary osteoporosis results without an underlying disease or medication
• It is further divided into 2 types: 1. Idiopathic type
2.Involutional type
• Idiopathic type is found in the young and juveniles and is less frequent.
• Involutional type is seen in postmenopausal women and ageing individuals and is more
common.
• In women, there is an accelerated phase of bone loss after the menopause due to
estrogen deficiency, which causes uncoupling of bone resorption and bone
formation, such that the amount of bone removed by osteoclasts exceeds the rate of
new bone formation by osteoblasts.

10. SECONDARY OSTEOPOROSIS
• It is attributed to number of factors and conditions.
• E.g : Immobilization, chronic anaemia, acromegaly, hepatic diseases,
hyperparathyroidism, hypogonadism and starvation.
• This can be an effect of medication.
• E.g : hypercortisonism, administration of anticonvulsants drugs and large dose of
heparin.

11. CAUSES
• Senility
• Post-immobilization e.g a bed ridden
patient
• Post-menopausal
• Protein deficiency
inadequate intake- old age, illness
malnutrition
excess protein loss (3rd degree burns)
mal-absorption
• Endocrinal :
Cushing’s disease
Hyperthyroid stage
• Drug induced:
Long term steroid therapy
phenobarbitone therapy
Chronic heparin therapy
• Rheumatological conditions :
RA
Ankylosing spondylosis

12. • Lack of calcium diet
• Lack of physical activity
• Family history
• Smoking
• Chronic obstructive pulmonary disorders
• Asthma
• Gastrointestinal diseases

13. CLINICAL FEATURES
• Asymptomatic until fracture occurs
• Fractures due to bone fragility are the most
common manifestations.
• Back pain
• Height loss
• Increased Kyphosis
• Decreased activity tolerance
• Osteoporotic fractures can affect any bone,
but the most common sites are the forearm
(Colle’s fracture), spine (vertebral fracture)
and hip. Of these, hip fractures are the most
serious.
• Immobility
• Loss of height

14. INVESTIGATIONS
1. X-RAY :
• In severe cases , a spine or hip x-ray may
show fracture or collapse of the spinal bones
• However , simple x-rays of bones are not
very accurate in predicting whether someone
is likely to have osteoporosis.

15. Biconcave fracture of L1 in an 86yrs old
woman with severe osteoporosis

16. 2. CT-SCAN :
• A special type of spine CT that can show loss
of bone mineral density, quantitative
computed tomography (QCT) may be used in
rare cases.

17. 3. DEXA (DEXA ENERGY XRAY
ABSORBTIOMETRY):
• A bone density is a low dose x-ray which
checks an area of the body such as the hip,
hand or foot for signs of mineral loss and
bone thinning

18. 4.NEUTRON ACTIVATION ANALYSIS:
In this method , calcium in the bone is activated
by neutron bombing , and its activity measured,
5. BONE BIOPSY

19. DIAGNOSTIC FEATURES
A medical evaluation to diagnose osteoporosis and estimate risk of breaking a bone may involve
one or more following steps:
1. Medical history
2. Physical examination
3. Bone density test
4. Laboratory test

20. ICF
1. Structures related to the nervous system
2. Structures related to eye, ear , voice and speech
3. Structures related to cardiovascular , immunological and respiratory systems.
4. Structures related to the digestive , metabolism and endocrine system.
5. Structures related to genito-urinal and reproductive system.
• STRUCTURAL INTEGRITY

21. • STRUCTURAL IMPAIRMENT:
IMPAIRMENT
1. Deterioration of bone tissue
2. Increased porosity of bone
3. Bone fractures
4. Increased bone fragility
5. Decreased bone mass
6. Increased bone resorption
CLINICAL REASONING
Reduced bone mineral density
Decreased Cortical thickness and
no. & size of trabeculae
Increased porosity or trauma
Low bone mass
Insufficient dietary intake of
calcium, phosphorus, Mg , vit D
Increased no. of osteoclasts
SOURCE OF
INFORMATION
X-RAY
X-RAY
History
Investigations
Investigations
Investigations

22. 7. Dorsal kyphosis (thorax)
8. Delicate medullary trabeculae
&thin cortices
9. Loss of vertical height of a
vertebrae
10. Reduced intrathoracic volume
Multiple thoracic compression
fractures
Demineralization of bone
Compression of vertebral bodies
Compression of vertebral bodies
Assessment and x-ray
X-ray
Investigations
Investigations

23. • FUNCTIONAL INTEGRITY
1. Mental functions
2. Voice and speech functions
3. Functions related to CVS , immunological systems.
4. Functions related to digestive , metabolic and endocrine systems.
5. Genito-urinary and reproductive functions.
6. Functions of the skin and related functions.

24. • FUNCTIONAL IMPAIRMENT
IMPAIRMENT
1. Pain in lower back
2. Shortness of breath
3. Loss of mobility
4. Stooped posture
CLINICAL REASONING
Abnormal stress on the spinal
muscles & ligaments
Due to reduced intrathoracic
volume or early satiety due to the
compression of the abdominal
cavity as the rib cage approaches
the pelvis
Weakening of the bones
Weakness of spine muscles
SOURCE OF
INFORMATION
History
Assessment
Assessment
Assessment

25.  ACTIVITY
LIMITAIONS
1. Climbing stairs
2. Long standing
3. Running
4. Bending from lower back
 PARTICIPATION
RESTRICTIONS
1. Occupational work
2. Outdoor activities
3. Social gatherings

26.  CONTEXTUAL FACTORS:
• PERSONAL FACTORS:
Facilitators:
Education
Family support
Self motivation
Barriers:
Age
Gender
Occupation
Socioeconomic status

27. • ENVIRONMENTAL FACTORS:
Facilitators:
hospital facilities
Social support
Barriers :
Transportations