Bone Health Arthritis and Osteoporosis

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Bone HealthArthritis and Osteoporosis

• Myra Siminovitch, BSc. PT, M.B.A.

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Importance of Bone Health

• Osteoporosis and Arthritis
• Affect significant numbers of the adult
  population
• With the aging of the population the numbers of
  individuals affected will continue to rise
  exponentially
• Often result in pain, loss of mobility and
  independence
• Can seriously limit activity and impact the
  quality of life
• Osteoporosis is a preventable disease
• Certain forms of arthritis can be better managed
  with life style changes

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What is Arthritis?

• Arthritis is derived from the Greek words
• Arth meaning JOINT
• Itis meaning Inflammation or Infection
• Arthritis, therefore, means
• Inflammation of the Joint
• In many kinds of Arthritis.there is no
  inflammation
• Arthritis refers to conditions that affect Joints
  and the surrounding tissues
• Did you Know That?
• More than 4 million Canadians suffer from
  arthritis...1 in 6 adults
• Expect an increase of 1 million per decade
• 60 of sufferers are under 65 years of age
• One of the leading causes of disability
• 20 thousand Canadians are on the waiting list for
  joint replacement
• Arthritis costs Canada 4.4 billion/year

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What is Osteoporosis?

• Osteoporosis is a metabolic bone disease
  characterized by low bone mass and
  micro-architectural deterioration of bone tissue
  leading to enhanced bone fragility leading to
  increased risk of fracture
• Osteoporosis results from not having enough bone
  tissue, low bone density, or low bone mass, as
  well as from having bone with a weakened structure

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Osteoporosis
Often called the silent thief because there are
no symptoms associated with the deterioration of
bone until a fracture occurs
Did you Know That?
1.4 Million Canadians Have Osteoporosis There are
25,000 Hip Fractures a Year 70 are Osteoporosis
related 20 result in death 35 are sustained by
men 50 of survivors experience disability More
women die each year as a result of an
Osteoporotic Fracture than from Breast and
Ovarian Cancer combined
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Who Gets osteoporosis?

• 1 in 4 women over the age of 50
• 1 in 8 men over the age of 50
• Men Osteoporosis
• Under-diagnosed, under-reported and inadequately
  researched
• More likely to develop secondary to lifestyle or
  another medical condition
• long-term glucocorticoid treatment.. prednisone
• low levels of male hormone..hypogonadism
• low peak bone density
• prolonged immobility lack of weight bearing
  exercises
• excessive alcohol consumption or smoking

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The loss of bone density and structural weakness
lead to bones that can break under the slightest
strain
Hip Spine Wrist

• Most common fracture sites

Hip Most Devastating gtup to 20 of women and an
even higher percentage of men will die as a
result of complications following fracture Wrist
Most Common type of fracture in women under 75
Vertebral Fractures Frequently Undiagnosed unless
there is pain or an observed loss of height
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Bone Remodeling Process

• Bone is a living tissue and constantly being
  repaired
• Osteoclasts, bone eroding cells invade the bones
  surface dissolving the mineral and causing small
  cavities in the bone
• Osteoblasts, the bone forming cells, fill in the
  cavities with new bone until the bone surface is
  completely restored

Normal Growth and Development of Bone

• Most individuals achieve their peak bone mass by
  age 20 and maintain it until 35-40
• Then both men and women begin losing bone mass at
  a rate of ½ to 1 per year
• Women lose bone at an accelerated rate during the
  first 10 years after menopause-2 to 5 per year
• Men lose bone more slowly with a higher rate of
  loss after 65

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Four Factors that contribute to Bone Health

• Nutrition
• Physical Activity
• Genetics
• Hormones

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Risk Factors

• Female
• Age 50 or older
• Prolonged hormonal imbalances
• Past Menopause
• Early or surgical menopause
• Not enough calcium in your diet
• Insufficient Vitamin D
• Not enough physical activity
• Low body weight (thin, small boned)
• Caucasian or Asian ancestry
• Smoking
• Caffeine (consistently gt3 cups of coffee, tea or
  cola / day)
• Alcohol (consistently gt2 drinks / day)
• Family history of osteoporosis
• Excess use of certain medications (prednisone,
  anticonvulsants, thyroid hormone)
• Primary hyperparathyroidism (excessive
  functioning of the parathyroid glands)
• History of hyperthyroidism
• The more risk factors you have, the greater your
  risk of developing osteoporosis

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Risk factors You Cannot Change

• Gender
• Age
• Genetics
• Ethnicity
• Risk Factors You Can Change
• Lifestyle
• Nutrition
• Smoking
• Physical Activity

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How is Osteoporosis Diagnosed?

• Bone Densitometry Test
• Safe, painless and the most common test
• Gives a snapshot of ones bones
• Detects low bone density
• Very low dose x-ray is directed through the bones
• Two sites measured
• Hip
• Spine

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How is Osteoporosis Diagnosed?

• Bone density test results are similar to
  interpreting an IQ score
• Results are rated above, equal or below a
  statistically determined average
• T Test
• Bone mass is compared with that of an average
  young adult
• Z Test
• Bone mass is compared with that of individuals in
  similar age group
• Score Ranges
• Normal scores range between (1) and (-1) with 0
  being the score of an average young adult
• Osteopenia scores range between (-1) and (-2.5)
• The score is 1 to 2.5 standard deviations below
  average peak mass
• Osteoporosis scores range from (-2.5) or less
• The score is more than 2.5 standard deviations
  below average peak bone mass

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Drug Therapies

• Drugs currently used to treat osteoporosis fall
  into two methods of action
• Slow down bone erosion (action on osteoclasts)
• Promote bone building (action on osteoblasts)
• Biphosphonates
• Bind to the surfaces of the bones and slow down
  the bone-eroding cells (osteoclasts)
• Fosamax, Actonel, Didronel/Didrocal
• Hormones
• Estrogen plays a major role in maintaining the
  balance between the osteoblasts (bone builders)
  and osteoclasts (bone excavators) by slowing bone
  erosion
• SERMS (selective estrogen receptor modulator)
• Affects the bones much the same way estrogen does
  without having the same effects on the uterus and
  breast
• Raloxifene

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How to Prevent Osteoporosis Choose a Healthy
Lifestyle

• Ensure Good Nutrition
• Eat foods high in Calcium
• Dairy sources
• Milk products, cheese and yogurt
• Vegetables
• Broccoli, collards, kale, bok choy
• Fish
• Salmon, sardines
• Certain foods increase calcium loss
• Salt, caffeine, protein, phytates and oxalates
• Calcium Requirements
• Up to 9 700mg.
• 10-12 boys 900mg.
• 10-12 girls 1200-1400mg.
• 13-16 1200-1400mg.
• 17-18 1200mg.
• 19-49 1000mg.

Calcium Supplements If unable to get enough
calcium from foods a supplement is required Two
best sources Calcium carbonate Inexpensive High
est percentage of elemental calcium/tablet Easil
y absorbed Calcium citrate Less
constipating May be better absorbed
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Vitamin D

• Calcium is not efficiently absorbed in older
  adults without Vitamin D
• Vitamin D Requirements
• 800 IU for older adults gt50 years of age
• Sources of Vitamin D
• Sunlight (15 minutes a day of summer sun
  exposure)
• Milk fortified with vitamin D (100 IU per 250 ml.
  glass)
• Salmon, sardines, herring, mackerel and fish oils
  contain small amounts
• Multi- vitamins
• Vitamin D Supplements

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How to Prevent OsteoporosisThe Benefits of Being
Physically Active

• Healthier bones
• Better coordination and balance
• Improved muscle strength and flexibility
• Increased endurance for activities of daily
  living
• Improved posture

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Bone Building Exercises

• Two Types
• Weight Bearing Exercise exercises where the
  weight of the body is transmitted through the
  bones, working against gravity e.g. walking,
  jogging, stair climbing, dancing, racquet sports
• Resistance Exercise exercises that strengthen
  the muscles e.g. weight lifting
• Free weights or machines
• Tension and pressure transmitted to the bone
  through weight bearing and the action of muscles
  stimulates bone growth and repair
• Frequency
• Weight bearing exercise-gt2-3X/week
• Resistance training-gt2-3X/week
• Intensity
• Resistance training..80 of maximal effort
• Duration
• Weight bearing exercise..30 minutes/day
• Resistance training..3 sets of 8-10 reps/muscle
• Balance Exercises
• Prevent Falls
• Prevent fractures
• Easy to retrain balance
• standing with eyes closed
• standing on 1 foot..eyes open ..eyes closed

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Posture Osteoporosis

• Dramatic postural deformities
• Forward head posture with chin poking forward
• Significant rounding of upper back
• Flat and even rounded lower back
• Protruding Abdomen
• Difficult respiration digestion
• Increased risk of falls
• Bodys center of gravity displaced
• Back neck pain
• Loss of function
• Postural Exercises
• Tailored to the individual
• Decrease harmful stresses on the spine
• Reduce the risk of spinal fractures rounded
  shoulders
• Strengthen the postural muscles
• Back extensors..Scapular retractors..abdominal
  muscles
• Stretch tight muscles
• Pectoral stretch..tight chest muscles
• Chin Tuck

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Exercise Precautions For People with
Osteoporosis

• Exercises must be tailored to the individual and
  their health status
• Excessive compressive stresses must not be put on
  weakened bones
• Avoid high-impact exercises..jumping, jogging
• Avoid activities where there is a high risk of
  falling
• Avoid flexion rotation of the trunk
• Initially, exercise program should be supervised
  by a competent health care practitioner

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Most Common Forms ofArthritis

• Rheumatoid Arthritis
• Progressive, systemic, inflammatory disorder
• Most destructive kind of arthritis
• Often associated with deformities
• Polymyositis
• Inflammation in the muscle -gtdestruction of
  muscle fibers
• Characterized by weakness, affects upper arms,
  thighs, neck
• Polymalgia Rheumatica
• Inflammatory condition which affects the joint
  liningSynovium of the joint
• Pain in many muscles
• Infectious Arthritis
• Bacterial infection of the joint, e.g.
  Staphylococcus/Gonococcus
• Usually 1 joint involved
• Gout
• Crystals
• Inflammation within the joint space
• Disease of life style, affected by
• body weight, diet and alcohol
• Spondyloarthropathies

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Osteoarthritis

• Most Common form of arthritis
• Affects 3 million Canadians
• Progressive destruction of the articular
  cartilage
• Formation of new bone at the margins of the joint
  (osteophytes)
• Chief complaints-gtpain, stiffness, deformity and
  loss of function
• Referred to as the wear and tear of joints
• Most commonly seen in the hips, knees and the
  spine
• Cartilage wears off the end of the bone and then
  it hurts with every step

Obesity

• Overweight people are at greater risk for
  developing OA than people of average-weight
• Weight-reduction is likely to cause reduction in
  OA symptoms.
• Weight-bearing joints have strong correlation
  with obesity.
• Surprisingly, OA of hand also has positive
  association with obesity, making it a systemic
  risk factor for OA.

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Management of Osteoarthritis

• To alleviate pain
• To prevent further strain or damage to affected
  jointsslow progression rate
• To improve movement
• To improve muscle strength endurance
• To maintain or improve functional independence
• To maximize quality of life

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Protection of Affected Joints

• Reduction of activities that increase pain
• Improvement of posture
• Selection of an appropriate walking aid
• Orthotics/ Braces
• Pacing prioritizing
• Orthotics
• An appliance that is applied to a body part to
  correct a deformity or maintain a body segment
  (brace, splint innersole)
• to protect against further injury or pain
• to assist in movement by reducing the forces
  placed on a joint

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Why Exercise?

• Vital to improvement of symptoms
• Regular physical activity is linked to a wide
  array of physical and mental health benefits
• To increase strength, endurance, flexibility,
  balance and coordination
• To relieve pain
• lubricates joints
• stimulates nerve endings other than pain endings
• Types of exercises
• Range Of Motion Exercises
• To improve movement, range of joint movement
• To improve flexibility
• Exercises To Increase Muscle Strength
  Endurance
• Strong muscles maintain good bone position
• Critical in carrying out everyday activities
• How To Exercise
• MODERATION
• Joint exercised too much-gtarthritis aggravated
• Joint exercised too little-gtmotion becomes
  limited, joints become stiff and more painful

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Poor Sitting PostureThe Slouched Position

• Causes over stretching of posterior spinal
  ligamentous structures
• The more flexed the posture the greater the
  pressure on the discs
• Causes some back and neck pain and all neck and
  back pain is aggravated by
• POOR SITTING POSTURE

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Nonpharmacologic Therapy

• Patient Education
• Arthritis Self-Help courses administered by
  Arthritis Foundation
• Hydrotherapy-gtaqua fitness
• Physical Therapy
• Pain Control
• Exercises, modalities( TENS, Heat, Cold)
• Occupational Therapy
• Splints.
• Ambulation devices (braces, walkers, patellar
  taping and canes).
• Lateral heel and sole wedge insoles.
• Weight Reduction
• Referral to Dietitian.
• Enrollment in aerobic exercise program.

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Surgery

• Patients whose symptoms are not controlled with
  above interventions and have moderate to severe
  pain should be considered for surgery.
• Debridement of the joint.
• Total/Partial joint arthroplasty.
• Osteotomy.
• Arthrodesis.

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Conclusion

• Osteoporosis and Arthritis affect significant
  numbers of individuals.
• Both males and females are affected.
• If not treated or managed, can negatively impact
  quality of life.
• Prevention of Osteoporosis should begin in
  childhood and continue throughout life.
• Arthritis can be better managed through healthier
  lifestyle choices.