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osteoporosis def
a systemic skeletal disorder with compormised bon strength that predisposes an indidvidual to increased fracture risk
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why is osteoporosis called a silent disease?
bc there's no pain until there's a fracture -- you won't know you have it unless there's an exam or a break
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primary type I osteoporosis (OP)
affects who? which type of bone? fx sites?
- this is the most common type of OP
- affects more postmenapausal women (usually 15-20 yrs post)
- decreases trabecular bone
- vertebral body, distal forearm
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primary type II osteoporosis
affects who? which bone type? fx sites?
- men and women over 60-70 y/o (m:f 2:1)
- decreased cortical and trabecular mass
- femoral neck, vertebrae
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secondary osteoporosis
causes, accounts for __% of OP, meds and things that increase risk
- results from other conditions - diseases, meds, lifestyle
- accounts for <5% of all OP cases
- meds: corticosteroids, oral glucocorticoids, thyroid meds, methotrexate, cortisol, pregnazone, heparin/coumadin, and diseases: DM, COPD, cancer, RA
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normal bone vs osteopenic/osteoporic
- normal: 90-100% peak bone mass, thick plates, low fracture risk
- OP: 50-75% peak bone mass, micro-arcitecture disrupted, high fracture risk
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contributing factors to OP
heredity, physical activity, nutrition (esp calcium), ethnicity, hormonal factors, lifestyle
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modifiable factors negatively influencing peak bone mass
- smoking
- sedentary lifestyle
- excess alcohol intake
- over exercising
- dietary considerations
- use of high risk meds
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non-modifiable factors that negatively influence peak bone mass
- female
- small boned
- caucasion or asian
- family history
- advanced age
- early & post menapause
- delayed puberty
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best non-invasive way to test for osteoporosis - the test, and the 2 places to measure
- DEXA: dual energy x-ray absorptiometry - this measures calcium/cm^2
- measure:
- L1-L4 or front of hip
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female athlete triad
- osteoporosis
- eating disorder
- amenorrhia - loss of menstral cycle - decreased estrogen (estrogen helps w bone density)
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T score in a OP test
the bone mineral density at the site when compared to the young normal reference mean (~30 y/o healthy bones)
it's given in standard deviations away from this norm
- Normal: -1.0 or higher
- Osteopenia: -1.0 to -2.5
- Osteoporosis -2.5 or lower
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Z score in an OP test
shows how your bones differ from aged-matched folks (not nearly as helpful as the T score)
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which part of the vertebrae gets the most OP fractures?
- the body bc it receives the most pressure (we slouch/compress forward)
- also, it's at greater risk bc it's trabecular bone (trabecular is the inside of a Crunchie, cancelous is the outside -- alphabetical!)
- fx happens during flexion
- happens more in lower thoracic vert bc there's more mobility there (bc no ribs)
- the majority are "wedge fractures"
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top 3 most common places to get OP fractures?
- 1 - vertebral body
- 2 - hip
- 3 - wrist
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symptoms of spine fractures
- back pain (acute or chronic)
- sleep disturbance
- anxiety
- depression
- decreased slef esteem
- fear of future (fear of falls and fxs)
- reduced QOL
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2 main signs of spine fractures (know these for test)
- height loss of 2 cm over 1-3 years or 6 cm historically
- kyphosis
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6 signs of spine fracture
- height loss of 2 cm over 1-3 years or 6 cm historicallykyphosis
- decreased lumbar lordosis
- protuberant abdomen
- reduced lung function
- weight loss
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function changes as a consequence of spine fracture
- impaired ADLs
- difficulty fitting into clothes
- difficulting bending, lifting, descending stairs, cooking
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vertebroplasty
sending a small balloon w a camera into fractured vertebra to inject cement
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kyphoplasty
like a vertebroplasty, but here the balloon is inflated w pressure first. The pressure needed to straighten the vert is noted, then everything is removed and that much cement is injected
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disability vs impairment
- disability - inability to fulfil a role - ex. play soccor, parent, etc.
- impairment - something you objectively measure - ex. decreased strength
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assessing a pt - starting the moment you first lay eyes on her, what do you look for or ask?
- look for posture, leaning, walking pattern, can body straighten
- ask when pain started, when it ebbs, prior problems w this pain? meds? fam history? imaging? DEXA?
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objective stuff in an OP review
goniometry to measure kyphosis, assess walking and sit to stand, stes sensation, test strenght, pec minor flexibility, scap retraction , hip rom, cervial flexion, etc
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goals in an OP eval
should be functional, like play w grandkids w/o pain, ADLs, etc
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6 points a plan in a SOAP note should address
- posture
- sterncht
- flexibilty
- balance
- weight bearing
- body mechanics and patient edu
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3 cardinal signs of OP
- body height loss (2cm in 1-3 yrs or 6 cm historically)
- postural change (kyphosis)
- fracture
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weight of head pulling on body in good posture and then with each inch forward
- good posture: ~12 lbs
- each inch forward adds ~10lbs
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kyphosis - which parts of cervical spin deo what? how does this impact breating and arms?
- upper cervial in extension (--> headaches)
- lower cervical in flexion
- the lower flexion limits the hyoid ---> compormises breathing bc lungs can't rise
- arms can't reach so high w head in this pos --> tears in arms
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some muscles impacted by forward-head
- tight upper traps & levator scap
- inhibited rhomboids & serratus ant
- inhibited neck flexors
- tight pecs
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4 points to look at in postural assessment
- head/neck
- shoulders
- kyphosis
- lumbar spine
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5 muscle groups to strengthen to fight OP
- back extensors (erector spinae, multifidis)
- lower abs (all abs, really)
- posterior shoulder girdle
- cervical flexors
- hip musculature
(extension exercises are great, showing even better results than ext w flex exercising)
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the study where women did extension exercises to prevent progression of kyphosis found...?
women who didn't do the exercises got worse kyphosis
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there's a lot in these slides that's too basic for cards but probably wants some reviewing before the test
- read the ppt, you ninny
- look at the exercises
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4 things to work on w psotural exercises to treat/prevent OP
- lower cervical extension
- scap retractors
- shoulder ER
- abs (esp transverse abs)
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