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Osteoporosis

Osteoporosis. Loss of bone mass Over 35 yrs of age,  in activity in the bone forming cells Non-discriminating disease Diet & exercise may limit the degree of bone loss Osteopenia Lowered bone mass First stage to osteoporosis Screening methods DEXA, heel scan, & hand scan. Osteoporosis.

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Osteoporosis

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  1. Osteoporosis • Loss of bone mass • Over 35 yrs of age,  in activity in the bone forming cells • Non-discriminating disease • Diet & exercise may limit the degree of bone loss • Osteopenia • Lowered bone mass • First stage to osteoporosis • Screening methods • DEXA, heel scan, & hand scan

  2. Osteoporosis • Age-related loss • Over the age of 60 • Women are at higher risk • 3-5 year acceleration after menopause • Estrogen withdrawal elevates bone loss in conjunction with age-related loss • Greater amount of osteoporotic fractures in women • 2 basic types • Type I & II

  3. Osteoporosis

  4. Mechanisms • Type I • Estrogen deficiency • Less frequent experience in males • Type II • May be related to Vitamin D deficiency & hyperparathyroidism • Excessive fractures provide challenges for exercise prescription

  5. Female gender Advanced age Caucasian/Asian race Positive family history Low body weight Premature menopause Prolonged premenopausal amenorrhea Nulliparity (no children) Lack of exercise Chronic smoking Excessive alcohol Low dietary calcium Risk Factors

  6. Effects on the Exercise Response • Orthopedic limitations • History of fractures • Physical therapy • Lack of activity exacerbates CAD • Severe kyphosis

  7. Effects on Exercise Training • Less fit than others in this age bracket • Low-low intensity to start • Minimal balance at first • Build muscular endurance • Orthopedic limitations • Can slow progress • Mechanical limitations • Respiratory limitations due to kyphosis

  8. Management & Medication • Hormone Replacement Therapy • Estrogen • Calcitonin • Inhibits bone resorption • Bisphosphates • Inhibit bone resorption • Anabolic effect on vertebral cancellous bone • Na fluoride, Vit D, & parathyroid hormone • Promote bone formation

  9. Exercise Prescription • Aerobic & resistance training • Safety of program should be considered by the physician & PT for advanced cases! • Progress up to 75% of 1RM • Lower reps with higher relative intensities • Model weight bearing activities • Upper, lower, & trunk (extensors) • Avoid forward flexion of spine • Advanced cases need special attention • Swimming

  10. Exercise Prescription • Aerobic activity • Low balance requirement to start • 40-50% of VO2 reserve • Progress with time • Progress with intensity • Coordinate with resistance training program

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