Respiratory Disease and Osteoporosis

Craig KnoxPhysiotherapist

Fracture Liaison CoordinatorLismore Base Hospital

lucocorticosteroid

nduced

steoporosis

Definition:

• 'Prolonged glucocorticoid therapy' is defined as the commencement of a dosage of inhaled glucocorticoid equivalent to, or greater than, 800 micrograms beclomethasone dipropionate or budesonide per day, or a supraphysiological glucocorticoid dosage equivalent to or greater than 7.5 mg prednisolone in an adult taken orally per day for a time period that is anticipated to last for 3 months or more. The bone density scan must be during the time of Glucocorticoid therapy. Patients no longer taking steroid medication do not qualify for a Medicare benefit.

Patients at risk…

• Mr Y with COPD is on Symbicort 400/12 x2 puffs twice a day which is 1600mg per day

• Mrs R with pulmonary fibrosis on Prednisone in variable dose but currently 10 mg daily of a four months duration

• Mr H with cryptogenic organising pneumonia on long term high dose steroids above 25mg daily

• Affecting 30—50% of patients [Angeli et al. 2006; Feldstein et al. 2005; Shaker and Lukert, 2005].

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383483/#bibr6-1759720X09343729https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383483/#bibr25-1759720X09343729https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383483/#bibr81-1759720X09343729

Cost $$$

• $140 unless lucky enough to qualify for a 12312 item number

Picture of DEXA scan

Who’s at risk ? SmokerLow BMIHigh EtOHLate menarchyEarly menopauseEarly hysterectomyHypogonadismLow calcium intakeLow vitamin DAgeFemalePoor balanceReduced exercise toleranceFamily HxFalls

Prolonged (> 3 months) use of steroid medication

What should be done?

A case of “do as I say, not as I do…”

Benefits of Exercise …

LBH exercise and

Osteoporosis brochure

stretches

You don’t NEED an expensive gym…

Challenge Their Balance

• 15-20 mins a day. Offer support initially, then wean as able.

• Heel – toe steps• Forward/backwards/sideways/figure 8 walking• Single leg stance• Tai Chi• Choose a “new” old dance step each week• Eg.

Nutbush

Work on Strengthening

• Sit – Stand• Lunges• Squats• Rhomboids – seated row, bow and arrow• Biceps curl• POSTURE is key – minimize bending and twisting the spine• ? Start with 2 sets of 10? Aim to increase weight/resistance and

decrease reps?

Improve Flexibility of Thoracic Cage

• Daily 10-20 minutes to reverse the effects of modern postures• Eg modified Savasana• Doorway stretch• Back Against wall• Don’t forget the basics – calf, hip flexors

Try this…

Modified Savasana Stretch

Any Questions?

Respiratory Disease and OsteoporosisSlide Number 2Slide Number 3Slide Number 4Slide Number 5lucocorticosteroid�nduced�steoporosisDefinition:Patients at risk…Cost $$$Picture of DEXA scanWho’s at risk ? Slide Number 12What should be done?A case of “do as I say, not as I do…”Benefits of Exercise …LBH exercise and Osteoporosis brochurestretchesYou don’t NEED an expensive gym…Challenge Their BalanceNutbushWork on StrengtheningSlide Number 22Slide Number 23Improve Flexibility of Thoracic CageTry this…Modified Savasana StretchAny Questions?