1. Osteoporosis
Bobby Parker

2. Overview Definitions Epidemiology Symptoms Treatment
Effects of Exercise
Testing
Prescription
Conclusion
References

3. Video

4. Definitions
Osteoporosis is a bone disease that thins skeletal bone tissue losing bone density over time
There is no cure for low bone mass and osteoporosis, successful management is possible
Osteoporosis is directly related to Osteopenia referring to bone mineral density (BMD) that is lower than normal peak BMD

5. Epidemiology
Currently it is estimated that over 200 million people worldwide suffer from this disease
Researchers estimate that about 1 out of 5 American women over the age of 50 have osteoporosis. About half of all women over the age of 50 will have a fracture of the hip, wrist, or vertebra (bones of the spine).
Women can lose up to 20% of their bone mass in the five to seven years after menopause

6. Epidemiology
Approximately 30% of all postmenopausal women have osteoporosis in the United States and in Europe
In 2005, the cost associated with osteoporosis-related fractures was estimated at $19 billion
By 2025, the costs are expected to rise to approximately $25.3 billion.

7. Epidemiology Image

8. Symptoms
There are no symptoms in the early stages. You will not notice any pain or changes as the bones become thinner!
In the later stages, symptoms include bone pain/tenderness, fractures, loss of height, low back/neck pain due to fractures of the spinal bones, Stooped posture (kyphosis)
Since your bones are getting thinner, there is an increase risk of breaking a bone because the bone is less dense.

9. Osteoporosis Images Normal bone Matrix Osteoporosis

10. Risk Factors Older age Gender (females have a higher percentage)
Family History
Smoking
Alcohol Consumption
Low Calcium and Vitamin D intake
Low lean body mass
Diseases (anorexia, bulimia, asthma, cystic fibrosis, celiac disease, etc.)

11. Diagnosis DEXA Scan (Dual X-ray Absorptiometry) is the most common
Quantitative computed tomography (QCT)
The World Health Organization (WHO) Fracture Risk Assessment Tool (FRAXTM). It’s available online and can be used to determine the 10-year probability of a major osteoporotic fracture

12. Images

13. Prescription
The National Osteoporosis Foundation suggest the following five steps that together optimize bone health and help prevent osteoporosis
Obtain the recommended, age-related amount of calcium and vitamin D per day
Engage in regular weight-bearing and muscle strengthening exercises
Avoid Tobacco and excess alcohol
Education about bone health
Having a bone density examination/taking medication when recommended

14. Medication Antiresorptive medications:
Bisphosphonates (alendronate and alendronate plus vitamin D3)
Selective estrogen receptor modulators (SERMs) or estrogen agonists
Raloxifene, which is FDA approved for osteoporosis in post menopausal women)
Bone Forming (Anabolic) medications:
Teriparatide (Forteo which is a form of parathyroid hormone)
Limited time on for postmenopausal women and men with very low bone mineral density

15. Effects on Exercise
Mechanical limitations imposed on respiratory muscle functions in individuals with severe thoracic kyphosis
For those who only complication is low bone mass, standardized exercise testing with precautions to minimize the risk of falling during the test is recommended
Regular aerobic, weight-bearing, and resistance exercise training has been shown to have a positive effect on the bone mineral density (BMD) of the spine in post menopausal women

16. Exercise Testing Methods Measures Aerobic
Cycle (ramp protocol 5-20 W/min; staged protocol W/3min stage)
Treadmill (1-2 METs/stage)
12-lead ECG, HR BP
RPE (6-20)
METs
Strength
Weight machines
Free Weights
Handheld dynamometer
Pain
Fatigue
Neuromuscular
Gait analysis
Balance

17. Exercise Testing (cont.)
Methods
Measure
Functional
6 min walk
Tandem gait speed
Step test
Timed chair sit to stand test
ADL/functional performance tests
Posture
Quality of life Scales
Distance
Speed
Count
Try without use of arms
Flexicure to determine the index of kyphosis (IK)

18. Exercise Programming Modes Intensity/Frequency/Duration Aerobic
Large muscle activities (Walking, Cycling, Elliptical, Running, etc.
40-70% peak HR, METs
3-5 days/week
30-60 min/session
Strength
dumbbells, weight machines, etc.
75% of 1RM, 8-12 reps
2 sets of 8-10
2-3 days/week for min
Flexibility
Stretching, Chair exercises
5-7 days/week with prolonged holding (30s as tolerated)
Functional
Activity-specific exercise, brisk walk, chair sit, balancing exercises
2-3 days/week

19. Postmenopausal Osteoporosis

20. Summary and Conclusion
Osteoporosis is the thinning of the bone tissue and loss of bone density over time
There is no symptoms in the early stages
There is no cure
Exercising and eliminating risk factors can help prevent and manage Osteoporosis and Osteopenia

21. References
American College of Sports Medicine. (2009). L. Dustrine, P. Painter, G. Moore & S. Roberts (Eds.), Illinois : Human Kinetics.