Definition of osteoporosis, Types of osteoporosis, Primary osteoporosis, Secondary osteoporosis, Causes of osteoporosis, Risk factors of osteoporosis, Pathophysiology of osteoporosis, Clinical features of osteoporosis, Physical examination of osteoporosis, Bone mass density test, FRAX Investigation of osteoporosis, Physiotherapy management

1. HAPPY WORLD
OSTEOPOROSIS
DAY 20th OCT

2. OSTEOPOROSIS AND IT'S
PHYSIOTHERAPY MANAGEMENT
PRESENTED BY -
MR BHUNESHWAR MISHRA
WELCOME IN THE PERFECT PHYSIO TUTORIAL YOUTUBE CHANNEL

3. DEFINITION
Osteoporosis is made up of greek word Osteon + porosis
Osteon Means bone and porosis Means hole .
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 .
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.

5. INCIDENCE
Osteoporosis is the most prevalent bone
disease in the world.
• According to the International
Osteoporosis Foundation,
1 in 3 women over 50 Years may experience
osteoporotic fractures, and 1 in 5 men .
Male to Female ratio 1 : 6 .

6. TYPES OF OSTEOPOROSIS
TWO TYPES :-
a) PRIMARY OSTEOPOROSIS or Type-1 :
Postmenopausal osteoporosis .
b) Type-2 : Age – associated osteoporosis )
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.

7. Secondary Osteoporosis
Secondary Osteoporosis

9. ETIOLOGY OF OSTEOPOROSIS
Rheumatological disorders - Rheumatoid arthritis,
• Ankylosing spondylitis
• Inherited Disorders
• Osteogenesis imperfecta
• Glycogen storage diseases
Nutritional And Gastro-intestinal Disorders - malnutrition,
• parenteral nutrition,
• gastrectomy,
Endocrine Disorders -
• hyperparathyroidism
• insulin-dependent diabetes mellitus,
• adrenal insufficiency

10. Risk factors

11. Clinical features
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
• Bone fractures
• Decrease in height
• Kyphosis
•Decreased activity tolerance

13. Height loss.
• Body weight
• Kyphosis
• Humped back
• Tooth loss
• Skinfold thickness
• Grip strength .
In case of vertebral fracture:
• Wall- occiput distance
• Rib-pelvis distance
Physical examination

14. Fracture Risk assessment tools(FARX)
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.
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.
FRAX scale score -
Less than 10% - low Risk
10% to 20% - moderate
More than 20% - high Risk

15. 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.
BMD

16. Investigation
1. ESR
2. Bone profile: serum calcium,
phosphate, albumin
3. Alkaline phosphatase
4. Renal function
5. Plain X-rays - lateral thoraco-lumbar
spine or hip

17. PHYSIOTHERAPY
MANAGEMENT

18. Goals of Physiotherapist
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.

19. If patient has fracture related to osteoporosis,
treatment will start with focus on decreasing pain.
• For that modalities like,
1- Cryotherapy
2- Heat therapy
3- Ultrasoundtherapy
4- Electric current After that , start with more
advanced exercises involving strengthening
,balance, weight bearing and flexibility exercises.

20. Exercises
1)Extension exercises
2) Chin tucks
3) Scapular retractions
4) Thoracic extensions
5) Hip extension .
These all exercises will improve posture ,
balance and strength.

21. Facts
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.

23. 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.

27. • 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.

28. 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.

29. 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.

31. 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.

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

33. • 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.pplements

34. Thank you