Veronica Southard PT MS GCS

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Posture and Osteoporosisand Hip Fracture

• Veronica Southard PT MS GCS

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Factors contributing to bone loss

• Dec Ca in diet
• Dec Ca absorption
• Hormonal changes
• Lack of exercise
• Gender
• Caffeine
• Genetics
• alcohol
• Cigarettes

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CA role in bodily functions

• M contraction
• N conduction
• Cell membrane maintenance
• Blood clotting

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Effects of Exercise on the Skeletal system

• Dec. bone loss. However ex must be done for 9
  months to 1 year to increase bone density. It
  can be strengthening or aerobic

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Bone density

• Low bone density is defined as 1.0gm/cm2. This
  is also considered the fracture threshold.
• Ca supplementation will not be effective in
  reducing the loss occurring during the first 5
  post menopausal years.
• Bed rest has a more profound effect on loss of
  bone then the above

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CA role in bodily functions

• M contraction
• N conduction
• Cell membrane maintenance
• Blood clotting

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Regulating Ca

• PTH- prevents hypocalcaemia. PTH makes sure the
  kidney gets 9 gms of Ca/day for reabsorption at
  the nephron. Osteoclastic cells are sensitive to
  PTH. In the GI tract, PTH assists with Ca
  absorption
• Vitamin D Active Vitamin D is a hormone that is
  converted first in the liver then the kidneys.
  Active VitD assists in actively transporting Ca
  through the system

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Regulating Ca cont

• Calcitonin, excreted by the thyroid, assists in
  depositing Ca in the bone
• Estrogen until menopause, protects females from
  osteoporosis
• RDA Ca young adults 750-1000mg., premenopausal
  1000mg, preg/postmeno1500mg.
• Vitamin D 400IU hopefully ½ from sun, 1/2 from
  diet

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Remodeling

• Each day 15 of the skeleton is being remodeled.
• The osteoclast goes into the bone and excavates,
  this takes 1 month, then reintroduces Ca back
  to the circulation.
• The osteoblast however, needs three months to
  fill in that hole.
• Therefore you need enough Ca and have
  osteogenic stimulus provided by exercise to
  sustain bone mineral density
• Peak bone mass occurs at 35 years. Highest amt.
  Of Ca

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Measurement of BMD

• X-Ray
• Single- photon absorptiometry. (SPA)
• Dual-photon absorptiometry. (DPA)
• Quantitative computerized tomography (QCT)
• Dual-energy x-ray absorpiometry(DEXA)
• Quantitative ultrasound

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Types of Osteoporosis

• Primary Occurs at a younger age in
  postmenopausal females and later in the life of
  males. Affects the trabecular more than cortical
  bone.
• Secondary Occurs in the 8th and 9th decades 21
  females.males. Almost equal involvement of the
  trabecular and cortical bone. Major etiological
  factors are meds, diseases, hypogonadism, and
  celiac disease.

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Food for thought

• Failure to accrete bone mass through the 2nd and
  3rd decade can lead to osteoporotic fractures
  later in life.
• Treat any stress fractures lately?
• Working at a sports medicine practice?

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Diagnosis of Osteoporosis

• Bone mineral content
• BMD is defined in g/cm2
• BMD scores are compared to normals(20-45) spine
  AP.
• Scores report the relative distance in SD from
  the means.
• Z score is age matched
• T score compares present sataus to young normal

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Tests and Measures

• Special Attention to Posture
• Balance Functional Reach
• Gait
• Scapula m strength
• Body mechanics
• 6 minute walk test

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Whats different with the posture of an elder?

• Increased thoracic kyphosis
• Decreased lumbar lordosis
• Posterior pelvic tilt
• Forward head, rounded shoulders
• Flexed hips and knees
• Tight gastrocs/soleus

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Posture

• Normally, external forces created by the body are
  favorable for energy conservation.
• In elders, when mobility becomes limited, forces
  acting on the joints produced by gravity are no
  longer efficacious .

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REEDCO Posture Scoring

• Used to assess static posture. Score from 100
  (perfect) to 0 (poor)
• Allows scoring over 4 occasions.
• Provides a venue for quantifiable documentation
  of improvement.

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Osteoporosis

• Preventable
• Fantastic venue for promotion and wellness
  throughout the lifespan
• Children should be educated regarding intake,
  avoidance of risk factors, exercise
• Young women should be made aware during
  childbearing age of the successful management and
  prevention
• Peri/postmenopausal women

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What is available for prevention of Osteoporosis
today?

• Pharmacology
• Nutritional Interventions
• Physical ActivityExercise
• Bone enhancing Need a mechanical load
• Must realize they have to continue

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Osteoporosis Education

• Optimal skeletal alignment
• Avoidance of postures and positions putting a
  bone at fracture risk
• Avoid spinal flexion exercises
• Generally stretching the anterior structures

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Examination

• Take an exercise inventory
• Type
• Frequency
• Duration
• Intensity

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Tests and Measures

• Special Attention to Posture
• Balance Functional Reach
• Gait
• Scapula m strength
• Body mechanics
• 6 minute walk test

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Acute Fracture Management

• Teach posture
• Body mechanics
• Make sure pt. Is up at least 10 minutes out of
  every waking hour and gradually increase
• Walking is important, rolling support if
  necessary
• Sit in a firm but comfortable chair

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Exercises During Recovery

• Isometric Trunk Extension
• Chin Tuck
• V exercise
• W exercise
• Money exercise
• Judicious use of Aquatics

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Hip Fracture Sites

• Most common are intertrochanteric and femoral
  neck
• Intertrochanteric usually pt. Has osteoporosis
• Femoral neck circulation is a concern
• Subtrochanteric 10 of all fx. cm. Distal to
  lesser trocanter

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Hip Fixes
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Risk Factors for Hip Fractures

• Female
• White
• Low weight
• Physical inactivity
• Cognitive impairment
• Old age
• Pyschotropic meds

• Estrogen deficiency
• High levels ETOH
• Caffeine
• Reduced m strength LE
• Impairment of postural control
• Neurological cond. CVA,PD

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Outcomes?Rehab Hip FX

• Functional independence is achieved more in
• 1. Pts. lt 85 years
• 2.Had no post op complications
• 3.PT BID in acute care
• 4.I in bed mob., transfers, amb with walker

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One year post op

• 92 were amb if they were amb before
• Only 41 regained prefracture status

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Case Studies

• What practice pattern?
• Which TM
• What additional considerations?
• What are the goals of your interventions and
  treatment options?

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References

• NIH Osteoporosis and Bone Related Diseases
  http//www.osteo.org
• National Osteoporosis Foundationhttp//www.nof.or
  g
• Gerinotessection on Geriatrics APTA January
  2002. Vol 9, No.1

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