osteoporosis & osteopenia
TRANSCRIPT
Photo:http://www.pngall.com/wp-content/uploads/2018/04/Body-PNG-Image-File.png
OSTEOPOROSIS & OSTEOPENIA
March 17, 2021
Lecture: Mae Murakami, PT, DPT, CLT &
Movement: Sharon Holly, CYT
OBJECTIVES
Define Osteoporosis & Osteopenia
Bone Basics Risk factorsHow do you
know you have it?
What can you do to help?
DISCLAIMER
The information presented in this presentation is for general guidance only. It is essential to take professional advice on specific issues and their impact on any individual. No liability can be accepted for any errors or omission or for any person acting or refraining from acting on the information provided
in this presentation.
Please always seek advice from your medical professional before starting any health program
WHAT IS OSTEOPOROSIS/OSTEOPENIA?
Osteoporosis
• Bone disease that occurs when the body loses too much bone, makes too little bone, or both. (NOF)
Osteopenia
• Less progressed form of osteoporosis
• Bone deficiency
What's the Difference?
• Depends on your Bone Mineral Density (BMD)
• Osteoporosis= higher risk of major fracture
BONE FACTS
Pic: https://orthoinfo.aaos.org/en/staying-healthy/bone-health-basics/#:~:text=The%20body's%20skeleton%20forms%20and,itself%20about%20every%2010%20years.
Holes are normal
Living, dynamic tissue
Grows stronger in response to
stress
Heals self when injured
Storage of minerals
Blood cell formation
BONE FORMATION
By age 30 – 100% peak bone mass
We cannot go beyond what we created in younger years, only hope to maintain!
30s-50s – more rapid bone loss
60+ - loss of bone slows somewhat, but continues
Men: bone loss at later age, also start out with 30% denser bones
Pic: https://michaeladamo.myportfolio.com/animated-video-series-davis-advantage
UNMODIFIABLE RISK FACTORS
Sex (women > men)
Family hx
Advanced age
Race (Caucasian, Asian)
Post menopausal
Body frame size
MODIFIABLE RISK FACTORS
Smoking
High alcohol intake
Caffeine
Sedentary Lifestyle OR overexercising
Low calcium, vitamin D diet
Eating disorders
Men – Low T
MEDICAL CONDITIONS THAT CAN LEAD TO BONE LOSS
• Rheumatoid arthritis• Lupus• Celiac disease• Inflammatory bowel disease• Weight loss surgery• Diabetes (type 1 & 2)• Hyperparathyroidism• Hyperthyroidism
• Leukemia & Lymphoma• Sickle cell disease• Stroke• Multiple Sclerosis (MS)
• Cancer• Prostate• Breast• Cervical
*not a comprehensive list
OSTEOPOROSIS & CANCER
Meds Aromatase inhibitors Androgen depletions
therapies
Surgery B. Testicle removal,
removal of ovaries
Radiation
Chemotherapy
OTHER MEDS THAT MAY CAUSE
BONE LOSS
Aluminum-containing antacids
Depo-Provera®
Anti-seizure meds (ex. Dilantin® or Phenobarbital)
Methotrexate
Cyclosporine A & FK506 (Tacromilus®)
Proton-Pump Inhibitors (ex. Nexium®, Prevacid®, Prilosec®)
Steroids (ex. Cortisone, prednisone)
SSRIs (ex. Lexapro®, Prozac®, Zoloft®)
GnRH agonists (ex. Lupron, Zoladex)
Thiazolidinediones (ex. Actos® and Avandia®)
Heparin Thyroid hormones in excess
Lithium
*not a comprehensive list
OSTEOPOROSIS SYMPTOMS
Often no symptoms!
Back pain, neck pain
Loss of height, becoming stooped, a protruding stomach
Trouble performing daily tasks
Fracture (wrist, hips, spine)
http://thepilateshundred.blogspot.com/2011/04/posture-201-kyphosis.html
TESTS
https://www.indiamart.com/proddetail/central-dexa-bone-densitometers-3843913055.html
https://www.sheffield.ac.uk/FRAX/tool.aspx?country=9
DEXA/DXA
• Gold standard
• Simple, quick, non-invasive
• Lower spine, hips
VFA
• Vertebral fracture assessment
• Looks at Lumbar & Thoracic spine
Trabecular bone score
• Newer test• Quality of
bone, not qty• Helps predict
fracture risk
FRAX
• Assessment tool
• Online (need BMD)
DEXA SCORES
https://americanbonehealth.org/bone-density/understanding-the-bone-density-t-score-and-z-score/
WHAT CAN YOU DO ABOUT IT?!
Medications
Surgery
• Exercise
• Posture/body mechanics
• Nutrition
• Relaxation/sleep
Surgery
•For compression fractures•Bone cement injection
•Minimally invasive•Vertebroplasty•Kyphoplasty
Meds
•Stop bone loss• Denosumab (Prolia/Xgeva)•Bisphosphonates (Fosamax/Boneva/Actonel)•SERMs•*not a comprehensive list
MEDICAL TREATMENT
EXERCISES Resistance training
Weight bearing•High impact v Low impact
Balancehttps://www.popsugar.com/fitness/photo-gallery/18361944/image/34165360/Donkey-Kick-Weight
ACSM 2018
https://doctorlib.info/health/guide-fitness-health/17.html
POSTURE/ BODY MECHANICS
Good posture and alignment can lead to less compression through the spine
Bending forward/staying in a flexed position can please excess force through anterior spine
Practice: Hip hinge to bend
Getting off of ground Log rolling to get off ground/out of bed
Tripod weight bearing
Standing press into ground to lengthen spine
https://www.hudsonvalleyscoliosis.com/kyphosis-treatment/https://osteo4u.co.uk/2019/07/16/what-is-bad-posture/
EXERCISES/ACTIVITIES TO AVOID
Deep flexion
Esp on a weighted
spine
Rotation?
No forced rotation
May be due to posture
May be ok if lying down
https://intouchyogabyronbay.com/bio-mechanics-of-forward-bends/https://www.muscleandfitness.com/exercise/workouts/abs-and-core-exercises/corkscrew/https://experiencelife.com/article/expert-answers-safe-rotational-exercises/https://www.verywellfit.com/how-to-do-the-bridge-exercise-3120738
IS IT SAFE TO DO PILATES & YOGA???
Yes! With modifications
RESEARCH
Pilates2015 study
Postmenopausal women had increased BMD, QOL & walking distace w/ decreased pain
Yoga2013 review
Moderate, wb’ing activities
Avoid flexion in standing, sitting
Mild flexion with extension may be beneficial
NUTRITION
For supplement amounts – NIH Office of Dietary supplements
https://ods.od.nih.gov/
CALCIUM• FOOD
• Dark, leafy greens• Dairy • Bioavailability
VITAMIN D• HELPS BODY ABSORB CALCIUM• SUNLIGHT• FOOD (FATTY FISH, CEREAL)• D2 V D3
MAGNESIUM• BMD/HELPS WITH BONE
FORMATION• CHOCOLATE, GREEN LEAFY
VEGETABLES
RELAXATION/SLEEP HYGIENE
Sleep
Just as important as good nutrition, exercise, & dental hygiene for overall
health!
2020 study: Short sleep duration was
associated with lower BMD and higher
risk of osteoporosis.
7-9 Hours
Stress
Could contribute through regulation of
pathways
ANY QUESTIONS?
[email protected] [email protected]
https://www.sharonholly.comhttp://www.rehabspecialistsinc.net
REFERENCES