HSS - osteoporosis

  1. osteoporosis def
    a systemic skeletal disorder with compormised bon strength that predisposes an indidvidual to increased fracture risk
  2. 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
  3. 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
  4. 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
  5. 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
  6. 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
  7. contributing factors to OP
    heredity, physical activity, nutrition (esp calcium), ethnicity, hormonal factors, lifestyle
  8. modifiable factors negatively influencing peak bone mass
    • smoking
    • sedentary lifestyle
    • excess alcohol intake
    • over exercising
    • dietary considerations
    • use of high risk meds
  9. non-modifiable factors that negatively influence peak bone mass
    • female
    • small boned
    • caucasion or asian
    • family history
    • advanced age
    • early & post menapause
    • delayed puberty
  10. 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
  11. female athlete triad
    • osteoporosis
    • eating disorder
    • amenorrhia - loss of menstral cycle - decreased estrogen (estrogen helps w bone density)
  12. 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
  13. Z score in an OP test
    shows how your bones differ from aged-matched folks (not nearly as helpful as the T score)
  14. 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"
  15. top 3 most common places to get OP fractures?
    • 1 - vertebral body
    • 2 - hip
    • 3 - wrist
  16. 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
  17. 2 main signs of spine fractures (know these for test)
    • height loss of 2 cm over 1-3 years or 6 cm historically
    • kyphosis
  18. 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
  19. function changes as a consequence of spine fracture
    • impaired ADLs
    • difficulty fitting into clothes
    • difficulting bending, lifting, descending stairs, cooking
  20. vertebroplasty
    sending a small balloon w a camera into fractured vertebra to inject cement
  21. 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
  22. disability vs impairment
    • disability - inability to fulfil a role - ex. play soccor, parent, etc.
    • impairment - something you objectively measure - ex. decreased strength
  23. 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?
  24. 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
  25. goals in an OP eval
    should be functional, like play w grandkids w/o pain, ADLs, etc
  26. 6 points a plan in a SOAP note should address
    • posture
    • sterncht
    • flexibilty
    • balance
    • weight bearing
    • body mechanics and patient edu
  27. 3 cardinal signs of OP
    • body height loss (2cm in 1-3 yrs or 6 cm historically)
    • postural change (kyphosis)
    • fracture
  28. weight of head pulling on body in good posture and then with each inch forward
    • good posture: ~12 lbs
    • each inch forward adds ~10lbs
  29. 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
  30. some muscles impacted by forward-head
    • tight upper traps & levator scap
    • inhibited rhomboids & serratus ant
    • inhibited neck flexors
    • tight pecs
  31. 4 points to look at in postural assessment
    • head/neck
    • shoulders
    • kyphosis
    • lumbar spine
  32. 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)
  33. the study where women did extension exercises to prevent progression of kyphosis found...?
    women who didn't do the exercises got worse kyphosis
  34. 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
  35. 4 things to work on w psotural exercises to treat/prevent OP
    • lower cervical extension
    • scap retractors
    • shoulder ER
    • abs (esp transverse abs)
Card Set
HSS - osteoporosis
HSS - osteoporosis