OSTEOPOROSIS & OSTEOPENIA

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