1

Physiotherapy Services in

Osteoporosis Management

Physiotherapy Services in

Osteoporosis Management

Anthony Kwok Anthony Kwok FHKCHSE, FCHSE, CCD, MHKPA, CPMSIAFHKCHSE, FCHSE, CCD, MHKPA, CPMSIA

General Manager General Manager The Chinese University of Hong Kong The Chinese University of Hong Kong

Jockey Club Centre for Osteoporosis Care and ControlJockey Club Centre for Osteoporosis Care and Control2

“A condition of skeletal fragility due to decreased bone mass and to mic roarch i t ec tu ra l deterioration of bone tissue, with consequent increased risk of fracture (WHO, 1994”

“A condition of skeletal fragility due to decreased bone mass and to mic roarch i t ec tu ra l deterioration of bone tissue, with consequent increased risk of fracture (WHO, 1994”

Osteoporosis Osteoporosis

3

• 51% of hip fracture in Asia by 2050

• Hip fracture increased by 30% in 30 years

• 50% of postmenopausal women and elderly men diagnosed as osteoporotic

• 30% of elderly women and 17% of elderly men had vertebral fracture

•• 51% of hip fracture in Asia by 205051% of hip fracture in Asia by 2050

•• Hip fracture increased by 30% in 30 yearsHip fracture increased by 30% in 30 years

•• 50% of postmenopausal women and elderly 50% of postmenopausal women and elderly men diagnosed as osteoporoticmen diagnosed as osteoporotic

•• 30% of elderly women and 17% of elderly men 30% of elderly women and 17% of elderly men had vertebral fracturehad vertebral fracture

Burden of illness Burden of illness

4

• Over 0.4 million Hong Kong people are suffering from osteoporosis

• At least 10 elderly people fracture their hip per day due to osteoporosis

• Incidence rate of female are 3 times more than that of male

Osteoporosis in HKOsteoporosis in HK

5

Common sites of osteoporotic fractures

Common sites of osteoporotic fractures

6

Age specific incidence rates for hip, vertebral, and Age specific incidence rates for hip, vertebral, and distal forearm fractures in men and womendistal forearm fractures in men and women

0

1000

2000

3000

4000Men Women

Inci

denc

e/10

0,00

0 pe

rson

-yr

35-39 ≥85 ≥85

Age group, yr

Hip

Vertebrae

Colles’

Hip

Vertebrae

Colles’

7

Mortality and morbidity due to hip fracture is high

Mortality and morbidity due to hip fracture is high

• Mortality is 10-20% higher than subjects of the same age and sex

• 15-20% remain in long term care institutions

• 25-35% lose their functional independence

8

Vertebral Fracture:• An important risk factor• If one with a Hx of vertebral #:

Future vertebral #: increase 4 XOther # (e.g. Hip) : increase 2 X

• Any prior # after age 50: RR 1.76 for further #• Once got fracture, fracture risk increases • Need to take active treatment to revert the

situation

9

The incidence of falls in HK

• One in five elderly falls annually• 40,000 elderly had falls and consulted

A&E Dept• 24.8% of fallers had fractures• 72.2% had life threatening conditions e.g.

head injuries(Leung & Chan, 2005)

10

Common Reasons of falls in HK

• Previous white collar employment• Poor self-perceived health• Dizziness• Presence of CVA• Difficulties in ADL• BMI (20 – 24: i.e. normal to slightly obese)• Slow gait velocity• Non-practice of Morning Walk• Use of local skin preparations such as

analgesics balms or plasters (Ho, 2005)

11

The consequence of fall in an osteoporotic sufferer will be a

fracture as an end result!!

12

What physiotherapists can help….At the community1. Early identification and prevention

(Fall prevention/osteoporosis screening programs at community level)

2. Community Participation (video show)(Community exercise classes)

3. Patient education and empowerment(Health education)

13Early identification and prevention

14

Community Participation• Cooperation with Elderly

Service Centres/NGO• Self-help groups• Use of outside hospital

networks• Innovative in teaching

exercises: dance, free weight, theraband, fitball

• As technical and support persons

• Train-the-trainers

15Encourage suitable hobbies

16Weight Training at Community Centres

17

What physiotherapists can help….

• Pain Relief/ Pain Control• Postural Correction• Weight-bearing Exercises: High, medium,

Low impact • Reduce joint stiffness• Increase muscle strength/ endurance• Improve balance• Prevent fall and fracture

18

Knowing the suitable and appropriate osteoporosis medications and working

with the patients’ doctors

• For osteoporosis in the Spine only/ Hip only/ Spine & Hip

• For men & women/ or women only• For effective pain relief in patient with

osteoporosis • The possible adverse effects or CI • Drug compliance

19

Know your weight-bearing exercises

• High impact: skipping, stairs running, ball games

• Medium Impact: Hiking, Line dancing, Fast pace social dance

• Low impact: walking, Tai Chi, Slow pace social dance, Physical activities in standing position

20

Benefit of exercise• Reduce the rate of bone loss

• Strengthen muscles

• Correct posture

• Improve quality of life

21

Design Exercise Programs

• Safety! Safety! Safety!• Be practical and achievable • Is supervision required or not?• Progression: when and how? • Is it simple to follow?

22

Before starting exercise• Know their abilities• Seek medical advice if appropriate• Wear proper sports attire and shoes• Select suitable venue • Drink water • Do exercise on a regular basis• Exercise daily for 30 to 60 minutes• The exercise programme should cover

all types

23

Exercise programme•Warm up

•Core exercise

•Cool down24

Warm upWarm up(Exercise to mobilize joints)(Exercise to mobilize joints)

Turn the trunk to left & right Shoulder forward circles

Arm backward circles Tiptoes circles Stepping (can hold on a chair)

Bend the neck sideways

25

Triceps Latissimus Dorsi Biceps & forearm muscles

Hip flexors Hamstrings Calf

Warm upWarm up(Stretching exercise)(Stretching exercise)

26

Biceps curl with weightLift weight overhead

Hold fistWrist up and down

Core exerciseCore exercise(Muscle strengthening exercise)(Muscle strengthening exercise)

27

Knee extension in sittingStep forward and raise both arms

Raise thigh sidewayChair stand

Core exerciseCore exercise(Muscle strengthening exercise)(Muscle strengthening exercise)

28

Bring hip backwardBend hip in standing

Lunge walking with weightsBend knee in standing

Core exerciseCore exercise(Muscle strengthening exercise)(Muscle strengthening exercise)

29

Weight bearing exercise Weight bearing exercise and aerobic exerciseand aerobic exercise

In generalIn general

•• Walking, Brisk walkingWalking, Brisk walking

Patients with poor physical fitnessPatients with poor physical fitness

•• Tai Chi, Tai Chi swordTai Chi, Tai Chi sword

30

Walk on toes Walk on heels Tandem walking

Balance trainingBalance training(Walk 5 min. for each exercise)(Walk 5 min. for each exercise)

31

Balance Training

32

33 34

Fall prevention (I)Fall prevention (I)

Keep adequate lighting

Tidy up wires

Wear proper glasses

Wear shoes with non-slippery sole

35

Frequently used items should be stored easy accessibly

Install handrail and place a non-slippery mat

Consult you doctor if feeling dizzy after taking drugs

Wear hip protector for patients with poor balance

Fall prevention (II)Fall prevention (II)