-
T score >-2.5SD with hx of fragility fractures
T score >-2.5SD
T score from -1 to -2.5SD
- severe osteoporosis
- osteoporosis
- osteopenia
-
2 causes of primary osteoporosis
5 causes of secondary osteoporosis
- 1 Menopause
- 2 Senile (normal decline)
- 1 Endocrine - DM, pregnancy, hyperthyroidism, etc
- 2 Nutrition - malabsorption (ex IBS), malnutrition, etc
- 3 Meds - corticosteroids, dilantin, lasix, etc
- 4 Collagen/Metabolic - marfan syndrome, osteogenisis imperfecta, Ehlers-Danlos syndrome
- 5 Other - chronic renal failure, RA, myeloma
- (prolly not important to know all the examples)
-
Percent of adults 50+ with osteoporosis
Percent of adults 50+ with osteopenia
- Osteoporosis
- Men 2%
- Women 10%
- Osteopenia
- Men 30%
- Women 49%
-
3 things for female athlete triad
combo of disordered eating, amenorrhea, and osteoporosis
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Quantitative loss of bone but mineralization is normal, pain from fracture site specific
Osteoporosis
-
Insufficient mineralization of bone due to vit D deficiency (AKA Rickets in childhood). Generalized bone pain, appendicular instead of axial, long bone deformity, and sensory neuropathy may occur
Osteomalacia
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Initially increased focal bone resorption but later increased bone formation. Insidious onset and increased incidence with age. Prone to deformity (tibial/femur bowing, vertebral flattening, skull impingment of auditory nerve). Weak bone is formed and stress fracture common.
Paget's Disease
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Spine of older person, usually male and older, often accompanied by profound osteoporosis and has loss of spinal motion
Ankylosing spondylitis
-
Be familiar with Nachemson body positions for intradiscal pressure
Let the boy watch
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occurs as a result of a minimal trauma (fall from standing height or less) or no trauma
fragility fracture
-
3 (ish) common osteoporotic fx sites
- vertebral bodies
- femoral neck
- UE - distal radius and proximal humerus
-
_______: anterior compressive forces from spinal flexion cause fx when there is decreased BMD
________: both ant and post portions of vertebral bodies severely compressed/collapsed. _____ is when this fx is displaced and comminuted
________: herniation of IV disc through vertebral end plate, often associated c trauma in thoracic and lumbar spine, more common in young people
- anterior wedge
- crush, burst
- biconcave/codfish/Schmorl's nodes
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_________: with more severe kyphotic deformity this may be more prominent, sharp posterior angulation, at apex of thoracic curve
________: fatty fibrous deposit around base of neck or upper back, secondary to Cushing's or prolonged corticosteroid use. Not tender to palpation.
________: 10% of population, commonly pubescent athletes. defect in apophyseal ring of vertebral body and can cause anterior wedge fx or herniation of IV disc into end-plate
- Gibbus deformity
- Buffalo hump
- Scheuermann's disease
-
With VCF, periosteum and ant longitudinal ligament are _____ innervated. ALL is mechanism for reduction of wedge fx when spine extended or flexed?
Pain referred _________, around rib cage in _________ pattern
- pain
- extension
- anterolaterally in a dermatomal pattern
-
TLSO brace limits?
Jewet limits?
CASH limits?
Clam Shell/Molded jacket limits?
Spinomed promotes? For what phase of injury?
- flex, sidebend, rot
- flex
- flex
- flex, sidebend, rot
- promotes back extension for subacute
-
T score relative to peak BMD for what age of same race and gender?
If T score goes down one SD, what is the fracture risk increase?
Can lumbar osteophytes give a misleading BMD DEXA score?
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Don't know if comparative radiation levels are important, but obj 8
What's the age for screening for osteoporosis in women?
65 or for younger women with equal or greater risk of fx (it was a trick question)
-
Managing acute VCF
avoid spinal ______, ______ and _______
orthosis on when ____ ___ ______
encourage amb with ________ posture
minimize _______ (only for meals and toilet use)
____ roll
teach: ____ to _____ and _____ to ______ transfers. avoid _____ and develop _______ control
consider use of reachers or ADL aids to minimize forward ______
- flex, rot, sidebend
- out of bed
- upright
- sitting
- log
- sit to stand and stand to sit, avoid plopping and develop eccentric control
- minimize flexion
-
Non-modifiable risks for osteoporosis (3 major)
Modifiable risks (2 major)
- non-modifiable: genetics, hormones, medical hx
- modifiable: nutrition and exercise
-
incidence of osteoporosis by race?
incidence of lactose intolerance by race?
- High to low: Caucasian/Asian => Hispanic => African American
- African American 80% => Hispanic 51% => Northern European 21%
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First clinical signs that someone may have osteoporosis (6)
- posture change
- height loss
- loss of teeth
- protruding abdomen
- stress fx
-
Precautions for evaluation of osteoporotic patient
- MMT ex shoulder flex puts thoracic spine at risk and hip abd puts high load on bone
- Functional Reach
- Standing and picking up items from floor
-
2 mechanical actions that can increase BMD
- ground rxn force aka impact force
- joint rxn forces
-
_____ of osteoporosis: high impact good, peak ground reaction forces greater than or equal to 2 x body weight. Resistance training, high but safe load
_______ of osteoporosis: low impact aerobic activity less than or equal to 1.5 x body weight, lifting limited to 10lbs if acute VCF
-
For osteoporotic patients, exercises to avoid, caution, and encourage
_________: sit ups, toe touches
__________: knee to chest, supine hooklying spinal rotation
_________: spinal extension and LE ext against gravity, scapular adduction, stage 1 and 2 lower abd strengthening
-
3 core principals of Sara Meek's Method
- unload spine
- strengthen proximal hip and shoulder muscles that are weak/lengthened
- correct postural dysfunction by re-aligning: vertebrae, femur/pelvis, scapula/thorax
-
Reasons why person may have difficulty tolerating supine
- spinal thoracic kyphosis, or hip joint contracture: musculoskeletal
- gastroesophageal reflux disorder: gastrointesinal
- orthopnea - CHF, COPD, RLD/obesity
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Review scoliosis obj 29
do it
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