1. 6/17/2015 “ قالوا سبحانك لا علم لنا الا ما علمتنا انك انت العليم الحكيم ” سورة البقرة - الآية 32 “ قالوا سبحانك لا علم لنا الا ما علمتنا انك انت العليم الحكيم ” سورة البقرة - الآية 32

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3. Menopausal phase Post menopausal phase Climacteric: means period of waning ovarian function which signals the end of the reproductive life span. It is divided into three phases: Pre menopausal phase

4. 6/17/2015 Natural or physiological menopause. Pathological menopause (premature, artificial, delayed). Menopause is defined as the cessation of menstrual cycles and results from follicular depletion which May be either:

5. 6/17/2015 Menopausal changes Breast changes. Female genital organs. Cardiovascular changes. Endocrinal changes

6. 6/17/2015 Postmenopausal symptoms Amenorrhea. vasomotor Psychological changes. Gastrointestinal Obesity. Fatigue Sexual Osteoporosis

8. Osteoporosis, which means “ porous bone”, is quantitative reduction of bone mass, a disease characterized by progressive bone thinning. The deterioration of bone tissue can lead to bone fragility and fracture, especially of the hip, spine, and wrist. Osteoporosis

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12. The development of osteoporosis associated with a variety of risk factors. Etiology of osteoporosis Age and sex Race Genetic factor Smoking Nutritional factors Physical activity and weigh bearing stress

13. 6/17/2015 Alcohol abuse Endocrinal factor Body built Breast feeding Nuliparity

14. 6/17/2015 (1) Hormonal theory Pathogenesis of osteoporosis (2) Nutritional theory (3) Local biomechanical theory The development of osteoporosis can be explained by three theories:-

15. 6/17/2015 Pathogenesis of osteoporosis Alteration in cellular activity whether decreased osteoblastic activity, increase resorption activity or a synchrony of theses phases that result in loss of bone

16. 6/17/2015 Osteoporotic patients usually complains from: Clinical features of osteoporosis (I) Bone pain (II) fracture (III) Loss of height (IV) Deformities of the vertebral column

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23. Diagnosis of osteoporosis (A) Radiological methods (B) Laboratory methods

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28. Treatment of bone loss (Osteoporosis) [I] Exercise [II] Electrical modalities [III] Advices

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31. Suggested exercise program for individual suffering from bone loss A basic exercise program should have the following four components: Frequency Duration Intensity Variety

32. 6/17/2015 The exercise program should be performed in three stages: Warm-up stage Active exercise stage And finally Cool-down gradually

33. 6/17/2015 (II) Specific training (Spine and extremities) Forms of exercise which can performed by patient suffering from bone loss (I) Aerobic training (Generalized)

34. 6/17/2015 A) Non weight bearing exercise B) Weight bearing exercise (I) Aerobic training (Generalized)

35. 6/17/2015 Exercises were performed from various positions as Crock lying position. Half crock lying position. Prone lying position. Prone kneeling. Sitting position. (II) Specific training program (a) Spine (b) For upper limbs

36. 6/17/2015 Crock lying position Shoulder press exercise Head press exercise Decompression exercise for the spine Exercise to decrease lumbar lordosis. Back extension exercise.

37. 6/17/2015 Half crock lying position Leg press exercise

38. 6/17/2015 Prone lying position Back extension exercise

39. 6/17/2015 Prone kneeling position Exercise to flatten lumbar spine Back extension exercise

40. 6/17/2015 Sitting position Back extension exercise

41. 6/17/2015 Upper limbs Forms of exercise for upper limbs

42. 6/17/2015 *Piezo electric potential. [II] Electrical modalities for bone loss * Increase calcium flux of osteoblastic cells. * Induce osteogenesis and reduce resorption on the bone surface. (A) Electromagnetic fields (EMFs) It reduces bone loss through:

43. Parameters Frequency:- 50 – 150 Hz Duration:- 1 Hour daily Intensity:- 10 microvolt 6/17/2015

45. (B) Pulsed ultrasound therapy Using frequency of 1.5MHz and intensity from 0.5- 2W/cm for 10 minutes over paravertebral muscles *It makes an electromechanical kinetic effect on the cell membrane interface the treated bone. *Also relieves the pain via gate control theory, increase blood supply to the treated area that carry waste metabolites.

46. 6/17/2015 (C ) Ultraviolet therapy *It converted 7 dehydrocholesterol into vit.D3 which converted in the liver into 25hydrocholecalciferol, then in the kidney into active vit.D which increases the formation of calcium binding protein that aids calcium absorption from the GIT and helps to control calcium deposition in the bone.

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49. (D) Laser It reduced pain and enhance calcium deposition. It increases mechanical load over the bone and blood supply to the treated area. electrical stimulation increases endogenous calcitonin levels (E) Electrical stimulation

50. 6/17/2015 For patient with osteoporosis, some movements should be avoided : (1) Reaching above your shoulders is not recommended for someone with severe kyphosis. [III] Advices (2) Be cautious about bending forward to pick something from the floor. (3) A twisting movement in the spine is dangerous for someone with spinal fractures.

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52. * Getting into and out of the bed. * Getting in and out of the chair. *Driving. Move safely to avoid injury

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