4 DefinitionsOsteoporosis is a bone disease that thins skeletal bone tissue losing bone density over timeThere is no cure for low bone mass and osteoporosis, successful management is possibleOsteoporosis is directly related to Osteopenia referring to bone mineral density (BMD) that is lower than normal peak BMD
5 EpidemiologyCurrently it is estimated that over 200 million people worldwide suffer from this diseaseResearchers 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 EpidemiologyApproximately 30% of all postmenopausal women have osteoporosis in the United States and in EuropeIn 2005, the cost associated with osteoporosis-related fractures was estimated at $19 billionBy 2025, the costs are expected to rise to approximately $25.3 billion.
8 SymptomsThere 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 HistorySmokingAlcohol ConsumptionLow Calcium and Vitamin D intakeLow lean body massDiseases (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
13 PrescriptionThe National Osteoporosis Foundation suggest the following five steps that together optimize bone health and help prevent osteoporosisObtain the recommended, age-related amount of calcium and vitamin D per dayEngage in regular weight-bearing and muscle strengthening exercisesAvoid Tobacco and excess alcoholEducation about bone healthHaving 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 agonistsRaloxifene, 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 ExerciseMechanical limitations imposed on respiratory muscle functions in individuals with severe thoracic kyphosisFor those who only complication is low bone mass, standardized exercise testing with precautions to minimize the risk of falling during the test is recommendedRegular 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
17 Exercise Testing (cont.) MethodsMeasureFunctional6 min walkTandem gait speedStep testTimed chair sit to stand testADL/functional performance testsPostureQuality of life ScalesDistanceSpeedCountTry without use of armsFlexicure 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, METs3-5 days/week30-60 min/sessionStrengthdumbbells, weight machines, etc.75% of 1RM, 8-12 reps2 sets of 8-102-3 days/week for minFlexibilityStretching, Chair exercises5-7 days/week with prolonged holding (30s as tolerated)FunctionalActivity-specific exercise, brisk walk, chair sit, balancing exercises2-3 days/week
20 Summary and Conclusion Osteoporosis is the thinning of the bone tissue and loss of bone density over timeThere is no symptoms in the early stagesThere is no cureExercising and eliminating risk factors can help prevent and manage Osteoporosis and Osteopenia
21 ReferencesAmerican College of Sports Medicine. (2009). L. Dustrine, P. Painter, G. Moore & S. Roberts (Eds.), Illinois : Human Kinetics.