2. A systemic skeletal
disease characterized by
low bone mass and
micro architectural
deterioration of bone
tissue lead to:
bone fragility
susceptibility to fracture
4. PRIMARY OSTEOPOROSIS:
TYPE 1 –mainly affects women, hormone
related and due to overactive osteoclasts .bone
loss is most rapid in 10 yrs after menopause.
TYPE2:affecting both sexes, age related and
due to underactive osteoblasts.
IDIOPATHIC: less common, affects young.
SECONDARY OSTEOPOROSIS: this is
associated with factors which predispose
individual to reduced bone density e.g.. Nutrition,
hormones, drugs, disease, rheumatologic
conditions.
6. Predictors of low bone mass
Female
Advanced age
Gonadal hormone deficiency ( estrogen or
testosterone )
White race
Low body weight & BMI(<19kg/m^2)
Family history of osteoporosis
Low calcium intake
Smoking / excessive alcohol intake
Low level of physical activity
Chronic glucocorticoid use
History of fracture
National Osteoporosis Foundation 1998
7. Pain D-L spine
Development of kyphotic hump-
dowager’s/bison’s hump
Generalized rarefaction of bone
Loss of vertebral height
Early fatigue
Skin creases around abdomen
Fractures : vertebral ,femoral
neck(elderly),distal forearms(young)
8.
9. Rate of Resorption > formation
Bone becomes weak and brittle & loss of
bone mass
Bone mineral density is decrease due to
deficiency of Ca and Vitamin D.
Since there is Ca deficiency it stimulates
parathyroid gland.
PTH desorbs Ca from bones to meet
bodily requirement of Ca.
10. Physical examination
Measurement of bone mineral content
Dual X-ray absorptiometry (DXA)
Ultrasonic measurement of bone
CT scan
Radiography
13. Bone densitometry by DEXA (dual energy x-
ray absorptiometry ):
• Is more precise and can detect osteoporosis
early.
National Osteoporosis Foundation 1998
14. X-ray : thinning of
bone trabaculae +
generalized
rarefaction
• In spinal column:
osteoporotic
compression
fracture may be
seen in vertebrae
18. Exercises can prevent osteoporosis
Exercise effect
Adolescent - Increased peak bone mass
Elderly - Small increase in BMD
Fitness may prevent falling
Evidence-based data :Reduction of hip & leg
fractures in observational studies
19. Treat predisposing factors
Fall prevention
Correct visual impairment
Avoid drugs - BZs, hypnotics,
antidepressant, drugs cause hypotension,
Extrinsic factors
External hip protector
Decrease the risk of hip fracture by
50%
20. Age of the patient. Current health status
Family history and past medical history
Cardio-pulmonary status of the patient
The lung capacity and whether the patient gets
out of breath”
Depends upon:
21. a. Reduce pain
b. Reduce disability
c. Preventing fracture
d. Muscle strengthening
Occupational therapy :
modification of home environment -
handrails, non slippery environment, night
lights, non skid rugs in washroom.
22. Lumbosacral support :or
a more rigid type of
brace provides localized
support, decreased
pain, limit motion and
attempt to realign the
vertebrae
Collars: useful in
supporting head
upwards, a soft collar
may make sleep
comfortable.
CASH brace
23. Body Mechanics
Avoid forward bending
•Carry loads close to the body
•Tighten your stomach when you lift items
•Never twist with a load
•Sit up straight with knees level to hips
•Change positions every 30 min
•Sleep with back straight
24. Fracture cases
acute vertebral fracture : bed rest ,pain relief-
TENS/IFT , patient should be mobilized as early as
possible , gentle exercises in hydrotherapy pool to
promote relaxation , extension exercises.
Other types of fracture : colles #- ROM
increase after plaster removal, pelvic#-
mobilization within limits of pain, rib #-TENS,
relaxed deep breathing & forced expiratory
technique rather than coughing
25. EXERCISE:
There are three essential areas that are prone to
osteoporosis - the hip, forearms and spine
for Spine :simple spine isometric exercises on a
mat would help.
For the Hips - walking and half squats help
For Forearms - standing or normal push ups
are beneficial.
One can also use a theraband or resistance
band for building muscle mass
26. Walking, low impact aerobics, weight training
using free weights or 1-2kg dumbbells and
barbells (The Wolff’s Law states that when
stress or mechanical load is applied to the
bone via the muscle and tendons, it has a
direct effect on bone formation and
remodelling.), resistance training with the
help of rubber tubes and swimming are
helpful. Also exercises which improve ones
postures, balance and body strength are
recommended.”
27. Exercises
Balancing exercise: Stand straight and lift one leg up by
bending at your knee and taking support. Stand on one leg
for 2-3minutes.
28. Cycling: On an exercise mat, lie on your back.
Raise your legs and move them slowly in a cycling
movement.
29. Knee bending: Lie down on your back. Lift
both your legs and bend them at the knees.
Hold the position for 15 counts.
30. Leg raises: Lie down on your back. Keep one leg
straight and one bent. Slowly raise the straight leg as
high as you can without lifting your hip from the floor.
Practice this 10 times before switching over to the
other leg.
31. Steps climbing: On a low grade/less high bench,
climb up and down 15 times slowly with the
support of a railing
32. Exercises to avoid:
A person with osteoporosis has weakened
bones which are prone to fracturing. Hence,
there are certain activities they ought to avoid.
These include:
High impact aerobics or running or jogging
Any exercise that requires sudden, forceful
movement
Abdominal sit-ups
Any exercise that requires a twisting motion,
such as a golf swing
Any exercise requiring sudden jolts, stops and
starts, such as tennis or squash.
33.
34. PT Set back:
Physiotherapy in the form of short wave
diathermy cannot be done for more than a
certain number of sittings, as this modality in
turn can cause mobilisation of calcium from the
bones.
35. Q
u i ck Ti m e ™ an d a T I
F F ( U
n co m p r
e ss ed ) d ec om pr es so r a r e ne ed ed t
o se e t hi s p i
c t ur e.
