OSTEOPOROSIS

I. DEFINITION
- a bone disease characterized by a reduction of bone tissue relative to
the volume of anatomical bone which increases susceptibility to fracture.
II. EPIDEMIOLOGY
-Middle-aged and elderly people
-postmenopausal women, and women in third decade of life.
-W>M
III. ETIOLOGY
Osteoporosis presents when bone mass lies more than 2 ! below the
mean. "he bone is of normal size but contains less bone tissue without
change in the ratio of mineral component to organic material.
#t may also present from immobility and lac$ of normal weight bearing.
IV. PATHOPHYSIOLOGY
%one loss occurs after the age of early &'(s, resulting to increase fracture
ris$ with normal or moderate trauma. "he main determinant of
Osteoporosis are the pea$ bone mass level reached at s$eletal maturity
and the subse)uent rate of bone loss.
*ow bone mass may be due to multiple causes, including failure to
achieve ade)uate bone mass at s$eletal maturity and postmenopausal
bone loss.
V. CRITERIA FOR DIAGNOSIS
"he first clinical indication+ fracture following trauma+ pt. presents with
pain.
,bsolute diagnosis made when an atraumatic fracture occurs in the
presence of low bone mass.
"he diagnosis is therefore approached from the standpoint of evaluating
the pt(s. potential ris$ of fractures based on low bone mass, as well as
evaluating those who already has fractures.
-adionuclide bone scan may also be used
VI. COMPLICATIONS
-- .ractures
VII. PROGNOSIS
!ecline in physical activity and subse)uent diminished stress on bone are
associated with growing old. "herefore, loss of bone mass and increase
susceptibility to fracture should be considered normal age- related
process. /0periments show that males lose &1of cortical bone mass each
decade after 2'. .emale lose cortical bone mass at a similar rate but is
accelerated after menopause.
VIII. MEDICAL- SURGICAL MANAGEMENT
3alcitonin therapy decreases the rate of bone lose.
odium .louride is an agent $nown to increase bone mass
,nabolic steroids can prevent bone loss or increase bone mass.
/strogens may preserve bone mass.
4itamin ! increases 3alcium absorption.
%iphosphates preserve bone mass.
IX. DIAGNOSTIC LABORATORY
"here must be an accurate diagnosis of the degree of bone loss, as well
as the determination of the degree of frailty and propensity of the patient
to fall. , laboratory evaluation include the determination of 3a,
phosphorus, and al$aline phosphatase levels plus a 22-hour urinary 3a
creatine value. , non-invasive measurement of bone mass is indicated.
X. PT MANAGEMENT
"herapeutic e0ercise is an essential element in the rehab program.
"he five general principles include5
6. 7rinciple of pecificity - e0ercise should stress the specific physiologic
system being trained
2. 7rinciple of 7rogression 8 7rogressive increases in intensity of e0ercise
for continued improvement.
&. 7rinciple of -eversibility 8 the positive effects of e0ercise may be lost if
discontinued.
2. 7rinciple of #nitial 4alues 8 those with low initial capacity will have the
greatest functional improvement.
9. 7rinciple of !iminishing -eturns 8 as the biologic ceiling to e0ercise-
induced improvement in function is approached, greater is needed
to achieve minimal gain.
::"o help prevent disuse osteoporosis individuals need to maintain weight-
bearing and stress e0ercises ;e.g. prone strengthening e0ercise, pectoral muscle
stretching, cycling, endurance li$e wal$ing and swimming<.