Final osteoporosis powerpoint


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  • Most important: previous fractures, age, diet, medications, risk factors
  • Bad postures such as hunch back put added pressure on weak bony areas such as the vertebrae Be careful when assessing strength to make sure you don’t cause an injury Balance is a major concern so they don’t fall and break their bones!
  • Balance test will just depend on their level of functioning which you’ll probably understand from the history and systems review
  • Lots of possible goals for intervention just focus on what is more important to your patient
  • Bone mineral density (BMD) tests are used to detect osteoporosis, the thinning of bone tissue and loss of bone density over time. A BMD test performed by a central DXA can: Tell if a person has low bone density before a fracture occurs Tell if a person’s bones are losing bone density or staying the same when the test is repeated at intervals of one year or more Predict the chances that a person will have a fracture in the future Help a person and his or her healthcare provider decide if treatment is needed Who should be tested: Postmenopausal woman generally every 2 years A man age 50-70 with one or more risk factors for osteoporosis A man age 70 or older, even without any risk factorsAnyone who has broken a bone with minimal trauma, such as a ground level fall People who have used certain medications long-term including steroids
  • milwaukee– one particular body brace that is often used to treat kyphosis in the US. Modern CAD / CAM braces are used in Europe to treat different types of kyphosis. These are much easier to wear and have better in-brace corrections than reported for the Milwaukee brace. Since there are different curve patterns (thoracic, thoracolumbar and lumbar) different types of braces are in use. Cobb angle- method of measuring kyphosis **Since the word dowager is a technical term for a "dignified elderly woman " it began to be used to describe this condition since so many older women develop the condition.
  • NOF = Natl’ OP Foundation
  • sardine 500 mg - per 100 g portion figs 506 mg- per 220 g portion (4) tofu 510 mg –per 100 g portion yogurt- 243 mg per 150 g portion (plain)
  • NOF recommends that adults under age 50 get 1,000 mg of calcium every day, and adults age 50 and older get 1,200 mg of calcium every day.
  • Caffeine appears to decrease calcium absorption by a small amount. Drinking more than three cups of coffee every day may be harmful to bone health. If you enjoy drinking coffee and tea, you can help to make up for any calcium loss by getting enough calcium to meet your body’s needs. For coffee drinkers, the addition of milk can help make up for the loss of calcium caused by caffeine. Phosphorus: Phosphorous exists in the human body as phosphate and, like calcium, is a major part of bone. The phosphorus found in food is needed to build healthy bones and other tissues. Because phosphorus is in many foods, it’s rare for healthy people not to get enough. Phosphorous in the form of phosphate or phosphoric acid is often added to processed foods and soft drinks. As a result, concern has been expressed that Americans may be getting too much phosphorous. Certain soft drinks and sodas, especially colas, contain phosphorous in the form of phosphoric acid. These drinks may also have caffeine. Some people are concerned that the phosphoric acid and caffeine in soft drinks can harm bone health. Colas may have other chemicals, besides phosphoric acid and caffeine, that can affect the bones. People with osteoporosis should not drink more than five cola
  • Final osteoporosis powerpoint

    1. 2. <ul><li>Which two substances mainly get reabsorbed by the body as we age which makes bone tissue weaker and leads to osteoporosis? </li></ul><ul><li>Calcium and phosphorus </li></ul><ul><li>Calcium and potassium </li></ul><ul><li>Calcium and sodium </li></ul><ul><li>Calcium and iron </li></ul>
    2. 3. <ul><li>Most common type of bone disease </li></ul><ul><li>“ thin bones” </li></ul><ul><li>Body fails to form enough new bone or too much old bone absorbed by osteoclasts or both </li></ul><ul><li>As we age, calcium and phosphorus reabsorbed into body making bone tissue weaker </li></ul><ul><li>Results in brittle, fragile bones prone to fracture even without injury </li></ul><ul><li>Most commonly in wrist, neck of femur, vertebrae of lower spine </li></ul>
    3. 4. <ul><li>Causes: </li></ul><ul><ul><li>drop in estrogen in menopause and drop in testosterone in men </li></ul></ul><ul><ul><li>Being confined to a bed </li></ul></ul><ul><ul><li>Chronic RA, kidney disease, eating disorders </li></ul></ul><ul><ul><li>Corticosteroids </li></ul></ul><ul><ul><li>Vitamin D deficiency </li></ul></ul><ul><li>Risk Factors: </li></ul><ul><ul><li>women over 50 </li></ul></ul><ul><ul><li>men over 70 </li></ul></ul><ul><ul><li>Large amounts of alcohol </li></ul></ul><ul><ul><li>Family history </li></ul></ul><ul><ul><li>Hormone treatment history for prostate/breast cancer </li></ul></ul><ul><ul><li>Smoking </li></ul></ul><ul><ul><li>Too little calcium in diet </li></ul></ul>
    4. 6. <ul><li>Patient History </li></ul><ul><ul><li>General demographics </li></ul></ul><ul><ul><li>Social History </li></ul></ul><ul><ul><li>Employment/Hobbies </li></ul></ul><ul><ul><li>Growth and Development </li></ul></ul><ul><ul><li>Living Environment </li></ul></ul><ul><ul><li>General Health Status </li></ul></ul><ul><ul><ul><li>BMI- lower BMI is at greater risk (especially BMI of 21 or below) </li></ul></ul></ul><ul><ul><li>Social/Health Habits </li></ul></ul><ul><ul><li>Family History </li></ul></ul><ul><ul><li>Medical/Surgical History </li></ul></ul><ul><ul><li>Current Conditions/Chief Complaint </li></ul></ul><ul><ul><li>Functional Status </li></ul></ul><ul><ul><li>Medications </li></ul></ul><ul><ul><li>Other Clinical Tests </li></ul></ul><ul><ul><ul><li>Bone Mineral Density Test </li></ul></ul></ul><ul><ul><ul><li>X-ray (Typically DEXA scan) </li></ul></ul></ul>
    5. 7. <ul><li>Why is the neurological part of the systems review important for patients with osteoporosis? </li></ul><ul><li>Sensation is a major concern </li></ul><ul><li>Want to know their ability to balance to prevent falls </li></ul><ul><li>They have problems with motor learning </li></ul><ul><li>Concerned with motor control </li></ul>
    6. 8. <ul><li>Systems Review areas of special concern </li></ul><ul><ul><li>Musculoskeletal </li></ul></ul><ul><ul><ul><li>Gross ROM </li></ul></ul></ul><ul><ul><ul><li>Gross strength </li></ul></ul></ul><ul><ul><ul><li>Gross symmetry </li></ul></ul></ul><ul><ul><ul><li>Posture </li></ul></ul></ul><ul><ul><li>Neuromuscular </li></ul></ul><ul><ul><ul><li>Gross coordinated movements (balance, gait, locomotion, transfers) </li></ul></ul></ul><ul><ul><ul><li>Motor Function (motor control and learning) </li></ul></ul></ul>
    7. 9. <ul><li>Special Tests </li></ul><ul><ul><li>Berg Balance Scale </li></ul></ul><ul><ul><li>Tinetti </li></ul></ul><ul><ul><li>TUG </li></ul></ul><ul><ul><li>MMTs- find specific muscles to target if weak </li></ul></ul>
    8. 10. <ul><li>Things to keep in mind: </li></ul><ul><ul><li>Clinical findings </li></ul></ul><ul><ul><li>Extent of loss of function </li></ul></ul><ul><ul><li>Chronicity or severity of problem </li></ul></ul><ul><ul><ul><li>Do they have broken bones or have they fallen? </li></ul></ul></ul><ul><ul><li>Multisite involvement? </li></ul></ul><ul><ul><li>Preexisting conditions </li></ul></ul><ul><ul><ul><li>Broken bones in the past? </li></ul></ul></ul><ul><ul><li>Potential discharge destination </li></ul></ul><ul><ul><ul><li>Can affect which interventions they can do on their own </li></ul></ul></ul><ul><ul><li>Social considerations </li></ul></ul><ul><ul><li>Physical function </li></ul></ul><ul><ul><li>Overall health status </li></ul></ul><ul><ul><ul><li>Severely poor diet, low weight, more elderly, broken bones, and doesn’t exercise you would treat differently than someone without these conditions </li></ul></ul></ul>
    9. 11. <ul><li>Want to identify primary dysfunction in order to direct intervention </li></ul><ul><li>For osteoporosis it could be: </li></ul><ul><ul><li>Lack of education </li></ul></ul><ul><ul><li>Strength </li></ul></ul><ul><ul><li>Posture </li></ul></ul><ul><ul><li>Lifestyle factors </li></ul></ul>
    10. 12. <ul><li>According to the APTA, the range of visits for skeletal demineralization is 3-18 </li></ul><ul><li>Factors that modify frequency of visits: </li></ul><ul><ul><li>Accessibility/availability of resources </li></ul></ul><ul><ul><li>Adherence to intervention program </li></ul></ul><ul><ul><li>Age </li></ul></ul><ul><ul><li>anatomical/physiological changes </li></ul></ul><ul><ul><li>Caregiver consistency/expertise </li></ul></ul><ul><ul><li>Chronicity/severity of current condition </li></ul></ul><ul><ul><li>Cognitive status </li></ul></ul><ul><ul><li>Comorbidities, secondary impairments </li></ul></ul><ul><ul><li>Decline in functional status </li></ul></ul><ul><ul><li>Living environment </li></ul></ul><ul><ul><li>Multisite involvement </li></ul></ul><ul><ul><li>Nutritional status </li></ul></ul><ul><ul><li>Psychological/socioeconomic factors </li></ul></ul><ul><ul><li>Social support </li></ul></ul><ul><ul><li>Stability of condition </li></ul></ul><ul><li>General Plan of Care: Patient/Client will reduce the risk of skeletal demineralization through strength-training and weight bearing therapeutic exercise programs and through lifestyle modifications. </li></ul>
    11. 14. <ul><li>General Goals of Intervention </li></ul><ul><li>Ability to perform physical actions, tasks, or activities is improved. </li></ul><ul><li>Awareness and use of community resources are improved. </li></ul><ul><li>Behaviors that foster healthy habits, wellness, and prevention are acquired. </li></ul><ul><li>Decision making is enhanced regarding patient/client health and the use of health care resources by patient/client, family, significant others, and caregivers. </li></ul><ul><li>Health status is improved. </li></ul><ul><li>Patient/client, family, significant other, and caregiver knowledge and awareness of the diagnosis, prognosis, interventions, and anticipated goals and expected outcomes are increased. </li></ul><ul><li>Patient/client knowledge of personal and environmental factors associated with the condition is increased. </li></ul><ul><li>Performance levels in self-care, home management, work (job/school/play), community, or leisure actions, tasks, or activities are improved. </li></ul><ul><li>Physical function is improved. </li></ul><ul><li>Risk of recurrence of condition is reduced. </li></ul><ul><li>Safety of patient/client, family, significant others, and caregivers is improved. </li></ul><ul><li>Utilization and cost of health care services are decreased. </li></ul>
    12. 15. <ul><li>Aerobic capacity/endurance conditioning or reconditioning </li></ul><ul><li>Balance, coordination , and agility training </li></ul><ul><li>Body mechanics and postural stabilization </li></ul><ul><li>Flexibility exercises </li></ul><ul><li>Gait and locomotion training </li></ul><ul><li>Relaxation </li></ul><ul><li>Strength, power, and endurance training for head, neck, limb, pelvic-floor, trunk, and ventilatory muscles </li></ul><ul><li>Barrier accommodations or modifications </li></ul><ul><li>Injury prevention or reduction </li></ul>
    13. 16. <ul><li>How many times per week are weight bearing endurance activities preferred by the ACSM for bone health? </li></ul><ul><li>1-2 </li></ul><ul><li>2-3 </li></ul><ul><li>3-5 </li></ul><ul><li>5-7 </li></ul>
    14. 17. <ul><li>Mode </li></ul><ul><li>Weight-bearing endurance activities </li></ul><ul><li>Jumping </li></ul><ul><li>Resistance Exercise </li></ul><ul><li>Intensity </li></ul><ul><li>Moderate to high intensity required for bone loading </li></ul><ul><li>Frequency </li></ul><ul><li>Weight-bearing endurance activities 3-5 times a week at least, 5-7 times preferred </li></ul><ul><li>Resistance exercise at least 2 times/week </li></ul><ul><li>Duration </li></ul><ul><li>30-60 min combined weight-bearing endurance activities, jumping, and resistance training that targets all major muscle groups </li></ul>
    15. 18. <ul><li>Which is the most common and most accurate way to determine Bone Mineral Density testing: </li></ul><ul><li>a) densitometry scale </li></ul><ul><li>b) Spine CT </li></ul><ul><li>c) Dual-energy x-ray absorptiometry </li></ul><ul><li>d) x-ray </li></ul>
    16. 19. <ul><li>A bone mineral density (BMD) test measures how much calcium and other types of minerals are present in a section of your bone. Your health care provider uses this test, along with other risk factors, to predict your risk of bone fractures in the future and detect osteoporosis. </li></ul><ul><li>Bone fracture risk is highest in people with osteoporosis. </li></ul>
    17. 20. <ul><li>Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. </li></ul><ul><ul><li>Your health care provider uses this test to predict your risk for bone fractures in the future. </li></ul></ul><ul><li>A special type of spine CT that can show loss of bone mineral density, quantitative computed tomography (QCT) , may be used in rare cases. </li></ul><ul><li>In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones. </li></ul><ul><ul><li>However, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis. </li></ul></ul><ul><li>You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age. </li></ul>
    18. 21. <ul><li>Kyphosis is common in a person with Osteoporosis and often associated with the term: </li></ul><ul><li>a) Milwaukee hump </li></ul><ul><li>b) Cobb’s hump </li></ul><ul><li>c) Postural hump </li></ul><ul><li>d) Dowagers hump </li></ul>
    19. 22. <ul><li>Bone pain or tenderness </li></ul><ul><li>Fractures with little or no trauma </li></ul><ul><li>Loss of height (as much as 6 inches) over time </li></ul><ul><li>Low back pain due to fractures of the spinal bones </li></ul><ul><li>Neck pain due to fractures of the spinal bones </li></ul><ul><li>Stooped posture or kyphosis-&quot;dowager's hump” </li></ul><ul><li>***There are no symptoms in the early stages of the disease!!!*** </li></ul>
    20. 23. <ul><li>Orthopedic Center of Central Virginia </li></ul><ul><li>Osteoporosis Center </li></ul><ul><li> </li></ul><ul><li>Support & Nationwide events!! </li></ul>
    21. 24. <ul><li>Which food is lowest in calcium? </li></ul><ul><li>a) sardines </li></ul><ul><li>b) figs </li></ul><ul><li>c) tofu </li></ul><ul><li>d) yogurt </li></ul>
    22. 25. <ul><li>Get at least 1,200 milligrams per day of calcium and 800 - 1,000 international units of vitamin D3. </li></ul><ul><ul><li>Vitamin D helps your body absorb calcium. </li></ul></ul><ul><ul><li>Your doctor may recommend a supplement to give you the calcium and vitamin D you need. </li></ul></ul><ul><li>Follow a diet that provides the proper amount of calcium, vitamin D, and protein. </li></ul><ul><ul><li>While this will not completely stop bone loss, it will guarantee that a supply of the materials the body uses to form and maintain bones is available. </li></ul></ul>
    23. 26. <ul><li>Caffeine: </li></ul><ul><ul><li>Caffeine in high amounts can cause bone loss. It interferes with calcium absorption and causes a slight increase in the amount of calcium in the urine. </li></ul></ul><ul><li>Phosphoric Acid: </li></ul><ul><ul><li>Some studies suggest that too much phosphorous can reduce the amount of calcium that the body absorbs. </li></ul></ul><ul><ul><li>Be careful not to substitute caffeinated drinks for milk and calcium-fortified juices. When drinks that have caffeine take the place of milk and other sources of calcium, bone health may be affected. </li></ul></ul>
    24. 27. <ul><li>Which of the following activities would be contraindicated for an individual with osteoporosis? </li></ul><ul><li>A. reaching up in the cupboard </li></ul><ul><li>B. bending over to tie a shoe </li></ul><ul><li>C. arm exercises with a 3 lb. weight </li></ul><ul><li>D. swimming </li></ul>
    25. 28. <ul><li>Consult physician prior to beginning a program </li></ul><ul><li>Weight Bearing </li></ul><ul><li>Flexibility </li></ul><ul><li>Balance </li></ul><ul><li>(decrease falls) </li></ul><ul><li>Resistance </li></ul><ul><li>Whole Body </li></ul>
    26. 29. <ul><li>Dynamic abdominal exercises like sit-ups and excessive trunk flexion can cause vertebral crush fractures. </li></ul><ul><li>Twisting movements such as a golf swing can also cause fractures </li></ul><ul><li>Exercises that involve abrupt or explosive loading, or high-impact loading, are contraindicated. </li></ul><ul><li>If you participate in Yoga or Pilates inform the instructor so that positions can be modified </li></ul>
    27. 30. <ul><li>Bending can cause vertebral fracture and should be avoided </li></ul><ul><li>Some exercises are not suitable for people with osteoporosis because they exert very strong force on relatively weak bones </li></ul><ul><li>Avoid high impact: running, jogging </li></ul><ul><li>Medical Conditions: Obesity, High Blood, Pressure , Heart Disease may affect participation </li></ul>
    28. 31. <ul><li>Hiking </li></ul><ul><li>Walking (outside, treadmill) </li></ul><ul><li>Dancing (good warm up) </li></ul><ul><li>Stair climbing </li></ul><ul><li>Elliptical training machines </li></ul><ul><li>Low-impact aerobics: step aerobics </li></ul><ul><li>Stair-step machines </li></ul><ul><li>Cycling </li></ul><ul><li>Volleyball </li></ul><ul><li>Tennis </li></ul>
    29. 32. <ul><li>Free weights or weight machines at home or in the gym </li></ul><ul><li>Resistance tubing that comes in a variety of strengths </li></ul><ul><li>Water exercises </li></ul>
    30. 33. <ul><li>Lead a healthy lifestyle/ diet </li></ul><ul><li>Online discussions and forums </li></ul><ul><li>Healthtalkonline: share experiences </li></ul><ul><li>National Osteoporosis Society </li></ul><ul><li>Family involvement and activity </li></ul><ul><li> </li></ul><ul><li> </li></ul>
    31. 34. <ul><li>Which of the following is not a treatment for Osteoporosis? </li></ul><ul><li>A. parathyroid hormones </li></ul><ul><li>B. estrogen supplement </li></ul><ul><li>C. biophosphates </li></ul><ul><li>D. corticosteroids </li></ul>
    32. 35. <ul><li>Estrogen- associated with cancer </li></ul><ul><li>Evista- estrogen effects </li></ul><ul><li>Calcitonin-slows bone loss </li></ul><ul><li>Parathyroid hormone-increase bone production </li></ul><ul><li>Biophosphates- Boniva,Fosamax, Actonel, Reclast </li></ul><ul><ul><li>Given to reduce risk of fracture, increase bone density, and stop bone loss </li></ul></ul>
    33. 36. <ul><li>Corticosteroids (steroid hormones) </li></ul><ul><li>Thyroid medications </li></ul><ul><li>Blood thinners </li></ul><ul><li>Diuretics (water pills) </li></ul><ul><li>Antibiotics </li></ul><ul><li>Immune system suppressants </li></ul><ul><li>Aluminum containing antacids </li></ul><ul><li>Vitamin A- over the recommended daily dosage </li></ul>
    34. 37. <ul><li>APTA Guide to PT Practice </li></ul><ul><li>American College of Sports Medicine </li></ul><ul><li> </li></ul><ul><li>Pubmed </li></ul><ul><li>http :// / </li></ul><ul><li>http :// </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li> </li></ul><ul><li>http:// </li></ul>