Osteoporosis PDF

Osteoporosis Objectives Definition. Etiological factors. Clinical Features. Examination. Interventions. Definition: Osteoporosis was defined as a progressive skeletal disorder, that results in reduction of bone mass (⬆osteoclast activity); a failure of bone formation (⬇...

Osteoporosis Objectives Definition. Etiological factors. Clinical Features. Examination. Interventions. Definition: Osteoporosis was defined as a progressive skeletal disorder, that results in reduction of bone mass (⬆osteoclast activity); a failure of bone formation (⬇ osteoblast activity) to keep pace with bone reabsorption and increased destruction. Etiologic Factors: (1) Hormonal deficiency: estrogens or androgens. (2) Nutritional deficiency: inadequate calcium, impaired absorption of calcium; excessive alcohol, caffeine consumption. (3) Decreased physical activity: inadequate mechanical loading. (4) Diseases that affect bone loss: hyperthyroidism, diabetes, hyperparathyroidism, rheumatoid arthritis, liver disease, certain types of cancer. Etiologic Factors: (5) Medications that affect bone loss: corticosteroids, thyroid hormone, anticonvulsants ,catabolic drugs, some estrogen antagonists, chemotherapy. (6) Additional risk factors: family history, Caucasian & Asian race, early menopause, thin/small build, smoke. The Bone: Formed of collagen soft frame work and calcium phosphate → tensile strength of bone. Formed of outer layers cortical bone and inner layers trabecular bone. The bone like a bank → deposit and withdraw. Deposit during childhood and adulthood by osteoblast cells. Withdraw after third decade by osteoclast cells. Calcium: - Calcium is a mineral that is an essential part of bones and teeth. The heart, nerves, and blood-clotting systems also need calcium to work. - Calcium supplements are used for treatment and prevention of low calcium levels and resulting bone conditions including osteoporosis (weak bones due to low bone density), rickets (a condition in children involving softening of the bones), and osteomalacia (a softening of bones involving pain). Calcium: Normal serum calcium: - The corrected total serum calcium concentration is normally 8.5-10.2 m /dl. - Normal value of phosphorus is 2.5 – 4.5 mg /dl. Vitamin D:  Vitamin D is essential for strong bones, it helps the body use calcium from the diet.  Vitamin D synthesized in the skin upon exposure to sunlight ultraviolet convert 7-dehydrocholesterol to vitamin D3 then in the liver hydroxylated to 25 hydroxy vitamin D, then in the kidney 1.25 dihydroxy vitamine D (active form vitamin D).  Traditionally, vitamin D deficiency has been associated with rickets, a disease in which the bone tissue doesn't properly mineralize, leading to soft bones and skeletal deformities. Parathyroid Hormone: Vitamin D regulate calcium and phosphorus homeostasis, Drop in blood calcium con.→ Stimulate parathyroid hormone release from parathyroid gland → stimulate 25 hydroxy vitamin D into 1.25 dihydroxy vitamin D → correct calcium and phosphorus level.  Mobilization of calcium from bone.  Increase intestinal absorption of dietary calcium.  Increase reabsorption of calcium filtered by the kidney, and increase phosphorus excretion by the kidney. Primary hyperparathyroidism Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands. A cancerous tumor is common cause of primary hyperparathyroidism. Secondary hyperparathyroidism Severe calcium deficiency. Severe vitamin d deficiency. Chronic kidney, liver failure. Causes of vitamin D deficiency: A strict vegan diet. Limited exposure to sunlight. Kidneys or Liver cannot convert vitamin D to its active form. Digestive tract cannot adequately absorb vitamin D. Certain medical problems, including crohn's disease, and celiac disease. Obesity. Vitamin D is extracted from the blood by fat cells. Tests for vitamin D deficiency: 1- Vitamin D blood test: - A level of 20 to 50 ng/ml is considered adequate for healthy people. - A level less than 12 ng/ml indicates vitamin D deficiency.  Clinical features (1)- Bone loss, normally is about 1% per year (starting for Women at ages 30-35, for men ages 50-55), Increasing loss in post-menopausal women by 5% per year for 3-5 yrs. (2)- Structural weakening of bone. (3)- Disability to support loads. (4)- High risk of fractures. (5)- Inner layers trabecular bone more involved than cortical bone; common areas affected: (A) vertebral column. (B) femoral neck. (C) distal radius/wrist, humerus. Examination (3) Assess dizziness: (1)Medical record (2) Physical Dizziness Handicap review. activity/fall history. Inventory. (4) Sensory integrity: vision, hearing, (5) Motor function: somatosensory, strength, endurance, (6) ROM/flexibility. vestibular; sensory control motor. integration. (8) Postural (9) Gait and balance (7) Postural deformity. hypotension. assessment.  Diagnosis DEXA scan (dual energy x-ray absorptiometry):  The most common test doctors use to measure bone health is called dual energy x-ray absorptiometry (DXA or DEXA).  A DXA scanner is a machine that produces two x-ray beams. One is high energy and the other is low energy.  The machine measures the amount of x-rays that pass through the bone from each beam. This will vary depending on how thick the bone is.  Based on the difference between the two beams, your doctor can measure your bone density. DXA scan results: T-score of +1 to -1.0 = normal bone density T-score between -1.0 and -2.5 = low bone density, or osteopenia (which is bones are weaker than normal but not so far gone that they break easily, which is the hallmark of osteoporosis). T-score of -2.5 or lower = osteoporosis. Interventions (I) Medications: 1- (A) Evista. (B) fosamax (alendronate). (C) calcitonin. Evista. Selective estrogen receptor modulators it works by acting as an estrogen agonist in bone and an estrogen antagonist in areas like the breast and uterus.( Act like estrogen). (I) Medications: 2- Hormone replacement therapy: HRT,, is an anti-resorptive therapy and works by stimulating the estrogen receptors on the bone cells. HRT is best prescribed for the five or so years during and just after the menopause (prophylactic treatment). It is associated with very slight increases in the risks of developing breast cancer, venous thromboembolism (VTE), cardiovascular disease and strokes. Interventions (II) promote health, provide counseling. (A) Daily (B) Daily (C) Diet. calcium intake. vitamin D intake. 1000 mg 200 IU low in salt, premenopausal. premenopausal avoid excess 1500 mg after = 134mg protein: inhibits age 50 years of 400 IU after body's ability to age. menopause absorb calcium. 600 IU after age 75.  (III) Maintaine Bone Mass A- Exercises. Exercise has two important roles in the prevention of fractures. Firstly it is shown to aid bone density, and secondly it tones and strengthens muscles, thereby ensuring good balance, coordination and skeletal support. Loading the skeleton with physical weights or bodyweight stimulates the osteogenic cells. Many people are not used to doing any regular exercise and would need to start very gently and carefully. Mode of Exercises: (A) Weight Bearing (Gravity-Loading) Exercises: stimulates the osteogenic cells. Walking (30 min/day); stair climbing; jogging use of weight belts to increase loading. (B) Resistance Exercises: e.g., Hip and knee extensors, triceps. Weight lifting Strengthens muscles, thereby ensuring good balance, coordination and skeletal support. (IV) Postural balance training (A) Postural reeducation, postural exercises to reduce kyphosis, forward head position. (B) Flexibility (stretching) exercises. (C) Functional balance exercises, e.g., Chair Rises, standing kitchen sink exercises (e.g. Toe raise, unilateral stance, hip extension, hip abduction). (D) Tai Chi. (E) Gait Training. (V) Safety Education/Fall Prevention (a) Proper shoes: thin soles, flat shoes enhance balance abilities (no heels). (b) Assistive devices: cane; walker as needed. (c) Fracture prevention: counseling on safe activities; avoid sudden forceful movements, twisting, standing, bending over, lifting.