Osteoporosis

What is Osteoporosis?

• A disease that causes bones to become brittle and fragile

• Literally means “porous bone”

• The consequence of long-term bone demineralization

Who gets it and why?

• There are different types of osteoporosis classified by the cause

• Primary Osteoporosis: type I and type II

• Secondary Osteoporosis

Primary Osteoporosis

Type I : Post-menopausal• 25% of Post-menopausal women will

develop it

• Due to drop in estrogen

• Most common between 50-70 yrs

• Incidence increases with age

Primary Osteoporosis

Type II: Age Related • Bone loss due to aging process

• Men and women generally over 70 yrs

Secondary Osteoporosis

May be caused by: • Steroids (corticosteroids) • Anticoagulant• Anticonvulsants • Result of disease or disorders (kidney disease,

anorexia, hyperthyroidism) • Impairment of calcium absorption • Immobilization• Inflammatory arthritis

Risk Factors

• Low calcium intake• Sedentary lifestyles• Tobacco use• Being underweight• Amenorrhea • Estrogen deficiency• Decreased bone-mass mineral content, as detected

by a bone-mass density test• Genetics/family history

Prevention• Weight bearing exercise (walking is the

easiest form)•  Important to start during developing years, before

25, to build strong dense bones

• Continue into adulthood to prevent density loss

• Diet •  High calcium and vitamin D to help absorb the calcium\

• Vitamin supplementation

  Maintain appropriate body weight•  Being too thin increases risk

Signs of Osteoporosis

• Decreased height over time

• Hunched back

• Broken bones

• Back pain

• Tooth loss

Diagnosis:

• Bone density is evaluated through various types of radiation technology

• Bone density evaluated by number of standard deviations between bone mineral density and peak bone mass

Normal loss: 0-1 Osteopenia: – 1-2 Osteoporosis: < –2 Severe osteoporosis: > –2.5

Symptoms of Osteoporosis

• Joint pain swelling

• Fractures due to minor trauma

• Bone deformity

• Debilitation

Treatment

• There are a wide range of treatment options• Once out of developmental years (past 25

years), reversal is unlikely, but goal is to prevent further loss

• Various drug treatments in combination with weigh bearing exercise and dietary adjustments to include vitamin D and calcium are most common

Important Considerations for Physical Activity

• Par-Q and medical release must be completed• Adjust loading if osteoporosis is present due to

increased risk of fractures (Include resistance often hip or wrist)

• Include strength training/weight bearing activity in programs for all ages, in all populations for prevention

• Target Extensor groups to prevent common deformity

Contraindications to Physical Activity?

• It is widely accepted that physical activity helps to prevent further bone loss and helps to increase flexibility, balance, and strength helping to decrease the chance of falls

• However, precautions must be taken to avoid fractures:

• Avoid Twisting and bouncing movements• Avoid heavy lifting • Use proper lifting technique, even for light loads• Stop immediately if pain is experienced• Age considerations (older adult population exercise

contradictions from pervious week) • Use padded garments

The Hip Web

An example of a protective padded garment to prevent fractures

Special Considerations

• Although most common in older women, Osteoporosis is not gender or age specific

• When prescribing exercise may encounter:• Individuals immobilized for long periods of time

• Female athletes

• Corticosteroid users

Immobilization

• May Cause Disuse Osteoporosis• Long term immobilization may cause degeneration of

bone • Due to limited weight bearing and muscle activity • Bone loss can be detected as early as 2 weeks after

immobilization

• Prevention: • Isotonic and isometric exercises during immobilization

• Treatment: • Losses may be regained after remobilization with

increased weight bearing exercise

Female Athletes

The Female Triad • Triad of disorders commonly found in young

female athletes • Disordered Eating, Amenorrhea, Osteoporosis• Most common in sports requiring ideal body weight

(gymnastics, figure skating, cross-country running, diving, swimming, and ballet)

• Does not only effect female athletes• Usually caused by desire to be ultra thin to improve

performance or physical appearance

Female Athletes• How it works:

• Eating disorders cause amenorrhea and lack of minerals and vitamins for bone growth

• Amenorrhea with continued lack of vitamin intake accelerates bone loss causing osteoporosis

• Prevention:• Education• Early recognition of eating disorder

• Counseling • Monitor body weight (maintain healthy weight)• Supplementation

  Corticosteroids • What are they?

• Drugs used to alleviate swelling, redness, warmth, and pain or joints or organs

• Who uses them?• Most commonly arthritics and asthmatics

• Adverse Effects:• Long term use may cause sever bone density loss• Up to 7.5mg/day for 6 months may decrease

trabecular bone volume up to 20%, with continued but slower loss if longer use

• Side effects are not age specific

Anderson, Hall, and Martin. (2005). Foundations of Athletic Training: Prevention, assessment, and management(3rd ed). Pennsylvania: Lippincott Williams & Wilkins

Black, J. M., Hawks, J. H. (2005). Medical-surgical nursing: Clinical Management for positive outcomes (7th ed.). Missouri: W. B. Saunders.

Earle RW, and Baechle TR. (2004). NSCA’s essentials of personal training. Windsor: Human Kinetics.

 Jordan, K., Cooper, C. (2002). Epidemiology of Osteoporosis. Best Practice & Research Clinical Rheumatology, 16(5), 803.

Klippel, JH (Ed.) (1997). Primer on the Rheumatic Diseases(11th ed). Georga: Arthritis Foundation.

 The Osteoporosis Society of Canada. (2005). About Osteoporosis. Retrieved February 23, 2005, from http://www.osteoporosis.ca/english/about%20osteoporosis/default.asp?s=1

 The Osteoporosis Society of Canada. (2005). Programs and Resources. Retrieved February 23, 2005, from http://www.osteoporosis.ca/english/program%20and%20resources/default.asp?s=1

 Minister of Public Works and Government Services Canada. (2001). Osteoporosis Info-Sheet for Seniors. Retrieved February 23, 2005, from http://www.phac-aspc.gc.ca/seniors-aines/pubs/info_sheets/osteoporosis/osteo_e.htm

References