SYED MASOOD

A systemic skeletal
disease characterized by
low bone mass and
micro architectural
deterioration of bone
tissue lead to:
bone fragility
susceptibility to fracture

Normal bone Osteoporosis

 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.

Vertebral
Fracture
Forearm
Fracture
Hip
Fracture

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

 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)

 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.

 Physical examination
 Measurement of bone mineral content
Dual X-ray absorptiometry (DXA)
Ultrasonic measurement of bone
CT scan
Radiography

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)

Physical examination

Bone densitometry by DEXA (dual energy x-
ray absorptiometry ):
• Is more precise and can detect osteoporosis
early.
National Osteoporosis Foundation 1998

 X-ray : thinning of
bone trabaculae +
generalized
rarefaction
• In spinal column:
osteoporotic
compression
fracture may be
seen in vertebrae

 Calcium and vitamin D
 Hormone replacement therapy
 Selective estrogen receptor modulators(
SERMs )
 Bisphosphonates
 Calcitonin
 Other treatments
 Non-pharmacologic intervention
 Statins
 Vit.K
 floride

 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

 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%

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:

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.

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

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

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

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

 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.”

 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.

 Cycling: On an exercise mat, lie on your back.
Raise your legs and move them slowly in a cycling
movement.

 Knee bending: Lie down on your back. Lift
both your legs and bend them at the knees.
Hold the position for 15 counts.

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.

Steps climbing: On a low grade/less high bench,
climb up and down 15 times slowly with the
support of a railing

 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.

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.

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