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Osteoporosis and it's physiotherapy management
The document discusses osteoporosis, a prevalent skeletal disorder characterized by low bone mass and increased fracture risk, particularly in women over 50. It outlines types, risk factors, symptoms, and management strategies, including physiotherapy interventions aimed at improving strength, posture, and flexibility. Additionally, it emphasizes the importance of dietary considerations and vitamin supplementation in the management of osteoporosis.
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Osteoporosis and it's physiotherapy management
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- 2. OSTEOPOROSIS AND IT'S PHYSIOTHERAPYMANAGEMENT PRESENTED BY - MR BHUNESHWAR MISHRA WELCOME IN THE PERFECT PHYSIO TUTORIAL YOUTUBE CHANNEL
- 3. DEFINITION Osteoporosis is madeup of greek word Osteon + porosis Osteon Means bone and porosis Means hole . Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro architectural deterioration of bone tissue leading to bone fragility , and consequent increase in fracture risk . It leads to abnormally porous bone that is compressible , like a sponge. The spine , hips and wrists are common areas of bone fractures from osteoporosis.
- 5. INCIDENCE Osteoporosis is themost prevalent bone disease in the world. • According to the International Osteoporosis Foundation, 1 in 3 women over 50 Years may experience osteoporotic fractures, and 1 in 5 men . Male to Female ratio 1 : 6 .
- 6. TYPES OF OSTEOPOROSIS TWOTYPES :- a) PRIMARY OSTEOPOROSIS or Type-1 : Postmenopausal osteoporosis . b) Type-2 : Age – associated osteoporosis ) SECONDARY OSTEOPOROSIS - Loss of bone is caused by an identifiable agent or disease process such as inflammatory disorder , bone marrow cellularity disorder and corticosteroid use.
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- 9. ETIOLOGY OF OSTEOPOROSIS Rheumatologicaldisorders - Rheumatoid arthritis, • Ankylosing spondylitis • Inherited Disorders • Osteogenesis imperfecta • Glycogen storage diseases Nutritional And Gastro-intestinal Disorders - malnutrition, • parenteral nutrition, • gastrectomy, Endocrine Disorders - • hyperparathyroidism • insulin-dependent diabetes mellitus, • adrenal insufficiency
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- 11. Clinical features Fractures causedby osteoporosis are often painful. • Osteoporosis is often called the ‘Silent disease’ as many people don’t recognize they have it until a fracture occurs. • Back pain: Episodic, acute , low thoracic/high lumbar pain • Compression fracture of the spine • Bone fractures • Decrease in height • Kyphosis •Decreased activity tolerance
- 13. Height loss. • Bodyweight • Kyphosis • Humped back • Tooth loss • Skinfold thickness • Grip strength . In case of vertebral fracture: • Wall- occiput distance • Rib-pelvis distance Physical examination
- 14. Fracture Risk assessmenttools(FARX) used to evaluate the 10-year probability of hip and major osteoporotic fracture risk that integrates clinical risk factors and bone mineral density at the femoral neck. A simple clinical screening tool, based on age and weight, Osteoporosis. • OSTA was developed for postmenopausal Asian women. • Women in the high risk category and those in the moderate risk category with additional risk factors (e.g. glucocorticoid use, hypogonadism, immobilisation) for osteoporosis. FRAX scale score - Less than 10% - low Risk 10% to 20% - moderate More than 20% - high Risk
- 15. Bone Mineral Density (BMD)test :- The most common test. Results are reported using T-scores. T-scores are relative to how much higher or lower your bone density is compared to that of a healthy adult. BMD
- 16. Investigation 1. ESR 2. Boneprofile: serum calcium, phosphate, albumin 3. Alkaline phosphatase 4. Renal function 5. Plain X-rays - lateral thoraco-lumbar spine or hip
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- 18. Goals of Physiotherapist 1)To educate proper posture. 2) Teach safe ways of moving and lifting. 3) To prevent a decline in bone mass and prevent fractures. 4) To increase the strength in bones. 5) To maintain or improve balance. 6) To improve flexibility. 7) To help decrease the stress placed on the bones by tight muscles. 8) To improve overall mobility. 9) To control pain and gradually returning back to regular activities.
- 19. If patient hasfracture related to osteoporosis, treatment will start with focus on decreasing pain. • For that modalities like, 1- Cryotherapy 2- Heat therapy 3- Ultrasoundtherapy 4- Electric current After that , start with more advanced exercises involving strengthening ,balance, weight bearing and flexibility exercises.
- 20. Exercises 1)Extension exercises 2) Chintucks 3) Scapular retractions 4) Thoracic extensions 5) Hip extension . These all exercises will improve posture , balance and strength.
- 21. Facts Flexion exercises areCONTRAINDICATED. Anterior compressive forces to the vertebra can contribute to compression fractures. Orthoses is also used in osteoporotic spine . It promote extension of spine. Hip protectors :- Hip protectors are an external hip protection system that aims to reduce the hip facture. Non-strenuous exercises for patient with severe osteoporosis • Upper back and shoulder extension exercises perform with spine supported. • Back extension exercise in sitting position. This position avoids or minimizes pain in patient with severe osteoporosis.
- 23. Maintain posture Goal :-To get body lined up from head to toe, with weight going through hips. • Physical therapist role :- Give instruction that all times to try to “ BE TALL “. CORRECT LIFTING POSTURE CORRECT SLEEPING POSTURE STRENGTHENING EXERCISE • Gentle weighted exercises , using either elastics or weights for upper and lower extremities. • These exercises help to improve the individuals overall physical function and postural control.
- 27. • Exercise forimproving strength in lumbar extensors and gluteus maximus muscles. WEIGHT BEARING EXERCISES - • Walking outdoors or on a treadmill • Gentle non-pounding forms of dance. • Stair climbing • These all are useful activities to put weight through the bones and encourage an upright posture while also improving cardiovascular health. • High impact activities such as running, jumping, and pounding forms of dance should be strictly avoided.
- 28. Arm press :-Stand facing a wall, about 50cm away from it, with your feet slightly apart, arms bent at the elbows and hands at shoulder height. Lean your body forwards towards the wall by bending your elbows in a controlled movement. Push your body back to the starting position.
- 29. Balance - Poorbalance can lead to a fall which can easily fracture an osteoporotic bone. Exercises to improve balance: • Standing with feet close together • Standing on one foot, or standing with one foot in front of the other. • Closing eyes can make any of these activities even more difficult. • Safe environment is most important. • As balance gets better, more challenging exercises should be provided.
- 31. FLEXIBILITY EXERCISE :-By improving and maintaining flexibility, the stress put on bones by tight muscles will decrease and the ability to practice good posture and body mechanics will be improved. Good flexibility also improves your mobility, which in turn improves you balance and decreases your risk of falls. Stretching for upper back and chest will be prescribed to decrease the developing a stooped posture. Stretches for hips, calf, and neck are also important.
- 32. Pectoral stretching exerciseperformed in standing position. This is used to reduced kyphotic posture. ALTERNATIVE MANAGEMENT • Alternative management of osteoporosis includes diet, vitamin supplementation, and herbal supplementation. • Diet has a direct correlation to bone growth and as an individual ages, he/she may not be absorbing the adequate amount of calcium. • By using calcium-rich foods, such as milk, cheese, almonds, broccoli, and cauliflower.
- 33. • Leafy greenvegetables are a great addition to the diet with osteoporosis it has been shown that oxalate acid that is found in spinach prevents absorption of calcium in the stomach. • Vitamin supplements may also be necessary when managing osteoporosis. . • According to the University of Maryland Medical Center (UMMC), 1,500 milligrams of calcium, taken in 3 doses of 500 milligrams per day, is an effective supplement to strengthen the bones and prevent further bone loss. • Other vitamins that are recommended to retain bone strength are vitamins D and K.pplements
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