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  2. A systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue lead to: bone fragility susceptibility to fracture
  3. Normal bone Osteoporosis
  4.  PRIMARY OSTEOPOROSIS:  TYPE 1 –mainly affects women, hormone related and due to overactive osteoclasts .bone loss is most rapid in 10 yrs after menopause.  TYPE2:affecting both sexes, age related and due to underactive osteoblasts.  IDIOPATHIC: less common, affects young.  SECONDARY OSTEOPOROSIS: this is associated with factors which predispose individual to reduced bone density e.g.. Nutrition, hormones, drugs, disease, rheumatologic conditions.
  5. Vertebral Fracture Forearm Fracture Hip Fracture
  6. Predictors of low bone mass  Female  Advanced age  Gonadal hormone deficiency ( estrogen or testosterone )  White race  Low body weight & BMI(<19kg/m^2)  Family history of osteoporosis  Low calcium intake  Smoking / excessive alcohol intake  Low level of physical activity  Chronic glucocorticoid use  History of fracture National Osteoporosis Foundation 1998
  7.  Pain D-L spine  Development of kyphotic hump- dowager’s/bison’s hump  Generalized rarefaction of bone  Loss of vertebral height  Early fatigue  Skin creases around abdomen  Fractures : vertebral ,femoral neck(elderly),distal forearms(young)
  8.  Rate of Resorption > formation  Bone becomes weak and brittle & loss of bone mass  Bone mineral density is decrease due to deficiency of Ca and Vitamin D.  Since there is Ca deficiency it stimulates parathyroid gland.  PTH desorbs Ca from bones to meet bodily requirement of Ca.
  9.  Physical examination  Measurement of bone mineral content Dual X-ray absorptiometry (DXA) Ultrasonic measurement of bone CT scan Radiography
  10. Osteoporosis  Height loss  Body weight(<51kg)  Kyphosis  Humped back(>3cm)  Tooth loss(<20)  Skin fold thickness  Grip strength Vertebral fracture Arm span-height difference Wall-occiput distance(>0cm) Rib-pelvis distance(<2FB)
  11. Physical examination
  12. Bone densitometry by DEXA (dual energy x- ray absorptiometry ): • Is more precise and can detect osteoporosis early. National Osteoporosis Foundation 1998
  13.  X-ray : thinning of bone trabaculae + generalized rarefaction • In spinal column: osteoporotic compression fracture may be seen in vertebrae
  14.  Calcium and vitamin D  Hormone replacement therapy  Selective estrogen receptor modulators( SERMs )  Bisphosphonates  Calcitonin  Other treatments  Non-pharmacologic intervention  Statins  Vit.K  floride
  15.  Exercises can prevent osteoporosis  Exercise effect Adolescent - Increased peak bone mass Elderly - Small increase in BMD Fitness may prevent falling  Evidence-based data :Reduction of hip & leg fractures in observational studies
  16.  Treat predisposing factors  Fall prevention Correct visual impairment Avoid drugs - BZs, hypnotics, antidepressant, drugs cause hypotension, Extrinsic factors  External hip protector Decrease the risk of hip fracture by 50%
  17. Age of the patient. Current health status Family history and past medical history Cardio-pulmonary status of the patient The lung capacity and whether the patient gets out of breath” Depends upon:
  18. a. Reduce pain b. Reduce disability c. Preventing fracture d. Muscle strengthening Occupational therapy :  modification of home environment - handrails, non slippery environment, night lights, non skid rugs in washroom.
  19. Lumbosacral support :or a more rigid type of brace provides localized support, decreased pain, limit motion and attempt to realign the vertebrae Collars: useful in supporting head upwards, a soft collar may make sleep comfortable. CASH brace
  20. Body Mechanics Avoid forward bending •Carry loads close to the body •Tighten your stomach when you lift items •Never twist with a load •Sit up straight with knees level to hips •Change positions every 30 min •Sleep with back straight
  21. Fracture cases acute vertebral fracture : bed rest ,pain relief- TENS/IFT , patient should be mobilized as early as possible , gentle exercises in hydrotherapy pool to promote relaxation , extension exercises. Other types of fracture : colles #- ROM increase after plaster removal, pelvic#- mobilization within limits of pain, rib #-TENS, relaxed deep breathing & forced expiratory technique rather than coughing
  22. EXERCISE:  There are three essential areas that are prone to osteoporosis - the hip, forearms and spine  for Spine :simple spine isometric exercises on a mat would help.  For the Hips - walking and half squats help  For Forearms - standing or normal push ups are beneficial.  One can also use a theraband or resistance band for building muscle mass
  23.  Walking, low impact aerobics, weight training using free weights or 1-2kg dumbbells and barbells (The Wolff’s Law states that when stress or mechanical load is applied to the bone via the muscle and tendons, it has a direct effect on bone formation and remodelling.), resistance training with the help of rubber tubes and swimming are helpful. Also exercises which improve ones postures, balance and body strength are recommended.”
  24.  Exercises  Balancing exercise: Stand straight and lift one leg up by bending at your knee and taking support. Stand on one leg for 2-3minutes.
  25.  Cycling: On an exercise mat, lie on your back. Raise your legs and move them slowly in a cycling movement.
  26.  Knee bending: Lie down on your back. Lift both your legs and bend them at the knees. Hold the position for 15 counts.
  27. Leg raises: Lie down on your back. Keep one leg straight and one bent. Slowly raise the straight leg as high as you can without lifting your hip from the floor. Practice this 10 times before switching over to the other leg.
  28. Steps climbing: On a low grade/less high bench, climb up and down 15 times slowly with the support of a railing
  29.  Exercises to avoid: A person with osteoporosis has weakened bones which are prone to fracturing. Hence, there are certain activities they ought to avoid. These include:  High impact aerobics or running or jogging  Any exercise that requires sudden, forceful movement  Abdominal sit-ups  Any exercise that requires a twisting motion, such as a golf swing  Any exercise requiring sudden jolts, stops and starts, such as tennis or squash.
  30. PT Set back:  Physiotherapy in the form of short wave diathermy cannot be done for more than a certain number of sittings, as this modality in turn can cause mobilisation of calcium from the bones.
  31. Q u i ck Ti m e ™ an d a T I F F ( U n co m p r e ss ed ) d ec om pr es so r a r e ne ed ed t o se e t hi s p i c t ur e.