1 Diagnosis Before Your Appointment yPrepare to describe your symptoms yGather medical history yMake list of medications yWrite down concerns and questions and bring them

2 Diagnosis 1.Expect what from treatment? 2.Treatment effect on daily activities? 3.How to prevent further disability? During Your Appointment

3 Bone Densitometry

4 zAnyone with a fragility fracture zAll women age 65 and older zPostmenopausal younger than 65 with risk factors zMen over 50 with risk factors

5 Treatment

6 Medication zBisphosphonates zEstrogen Replacement Therapy zMedications made from natural hormones zSERMs ( selective estrogen receptor modulator) : Raloxifen

MEDICATION BISPHOSPHONATES 7

8 Vitamin D metabolites Parathyroid hormone New bisphosphonates New SERMs Medication-Under Investigation

9 Treatment zAppropriate treatment of fragility fractures zHip nailing

10 Prevention Calcium and Vitamin D Intake z Units vitamin D and mg of calcium per day zConsult your doctor for dosage

11 Prevention

Weight-Bearing Exercise Consult your doctor first

Tai-chi helps reduce falls

Year Olds Prevention

15 Prevention Year Olds

16 Prevention Year Olds

17 Prevention Over 50

18 Osteoporosis While you cannot change your genetics or heredity, skeletal frame, gender, race or age, you can control other risk factors

Prescribing Exercise to Patients with Osteoarthritis 19

The FOUR types of PA

zBone is a dynamic tissue capable of continually adapt to changing mechanical environment yWhen a bone is loaded in compression, tension or torsion, bone tissue is strained and lead to osteoclast and osteoblast recruitment to model bone to better suit its new mechanical environment yMechanotransduction: this process of turning a mechanical signal into a biochemical one zPossibility of inducing pain and fracture Patients’ Acute Response to Exercise

Long Term Benefits of Exercise zWeight-bearing aerobic exercises and muscle-strengthening exercises have been shown to be an integral part of osteoporosis treatment zA regular and properly designed exercise program may help to prevent falls and fall- related osteoporotic fractures, which in turn reduces the risk of disability and premature death

Recommendations for Prescribing Exercise to Patients with Osteoporosis zAll three components of an exercise program are needed for strong bone health: yWeight-bearing aerobic exercise such as jogging, brisk walking, stair climbing; yMuscle strengthening exercise with weights; and yBalance training such as Tai Chi. zIn general, prescribe moderate intensity exercise that does not cause or exacerbate pain zInitial training sessions should be supervised and monitored by personnel who are sensitive to special needs of older adults

Recommendations for Prescribing Aerobic Exercise to Patients with Osteoporosis  Frequency: Perform aerobic PA on ≥ 3 days/wk zIntensity: To perform moderate intensity for weight- bearing aerobic exercise  Time: Perform 20-30min per session to a total of ≥ 150 min/wk zType: Weight-bearing aerobic exercise includes stair- climbing/ descending, walking with intermittent jogging and table-tennis

Recommendations for Prescribing Resistance Exercise to Patients with Osteoporosis  Frequency: Perform ≥ 2 nonconsecutive days/wk, ideally 3 times/week zIntensity: yTo perform moderate intensity in terms of bone loading forces, but some may be able to tolerate more intense training yFor individuals at risk of osteoporosis, go for high-intensity (80- 90% 1-RM) if tolerable  Time: Each target muscle group should be trained for a total of ≥ 1 sets with 8-10 reps/set

Recommendations for Prescribing Resistance Exercise to Patients with Osteoporosis zType: y8-10 resistance exercises yAny form of training that are site specific i.e. targeting areas such as the muscle groups around the hip, the quadriceps, dorsi/plantar flexors, rhomboids, wrist extensors and back extensors

Special Precautions zMajority are old and sedentary and thus considered as moderate to high risk for atherosclerotic disease zExercises that involve explosive movements or high- impact loading should be avoided. yLow impact weight-bearing activity is characterised by always having one foot on the floor yBallistic movements or jumping (both feet off floor) is termed high impact training

Special Precautions zExercises that cause twisting (e.g. golf swing), bending or compression of the spine (e.g. rowing or sit-ups) should be avoided zExercise which highly demand on balance and agility (e.g. Rope Jumping, Skiing, etc) should be avoided to prevent risk of fall zExercise with long lever arm that induce high torque on the joint should be avoided (e.g. High resistance straight leg raising exercise may increase the risk of osteoporotic fracture of the NOF)

29 National Osteoporosis Foundation (202) American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, IL Resources