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57 Cards in this Set
- Front
- Back
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What is Metabolism
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Chemical process within cells which helps maintain structure, grow, and adapt to environment
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What is the Skeleton
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Metabolically active organ which continues remodeling throughout life to maintain structural integrity
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What does skeleton store?
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Calcium and Phosphorus
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What is Osteoporosis?
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Chronic progressive disease - Porous bones
Combination of bone mass and micro damage to bone structure. |
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Etiology of Osteoporosis
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Primary – senile/idiopathic
Secondary: leukemia, glucocorticoid, Gi, RA |
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What is Trabecular bone
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Spongy or callus – center meshwork of bones. 20% of adult skeleton, 15-20% calcified
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What is Compact bone
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Cortical bone
80% of skeletal mass, 80-90% calcified |
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What is Remodeling
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A repeating cycle of osteoclasts breaking down existing bone (resorption) --> osteoblasts laying down new cells for mineralization (formation)
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Benefits of remodeling?
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Maintains the strength and integrity of the skeleton by replacing fatigue-damaged older bone with new bone
Acts as a source of vital minerals necessary for the maintenance of mineral homeostasis |
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What happens when CA level drops
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CA cannot regulate heart rate, muscle contractions, or BP so it is pulled from bone
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Parathyroid role in Calcium in the blood
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Hyperparathroidism – chronic exposure to high serum PTH concentration results in bone resorption
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Osteomalacia
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Softening of the bones
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Osteopenia
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Low bone mass
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Osteopetrosis
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Increased bone density
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Osteoporosis:
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Decreased bone density (strength)
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Contributory factors for osteoporosis
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Mild but prolonged negative calcium balance
Declining gonadal and adrenal function Relative progressive estrogen deficiency Sedentary lifestyle |
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Menopause effect on osteoporosis
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Estradiol and progesterone block cytokines that in turn slow down bone reabsorption
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Secondary causes of Osteoporosis
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-Prolonged therapy with corticosteroids, heparin, anticonvulsants, and other medications
-Alcoholism, malnutrition, malabsorption, or lactose intolerance -Endocrine disorders -Other conditions or diseases ( spinal cord injury, hyperthyroidism) |
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What happens when bone mass peaks
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Roughly 25-35 yearsResorption begins to exceed the rate of bone formation
-Decreased intestinal calcium absorption -increased bone resorption to compensate for low calcium levels -impaired osteoblastic activity |
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Risk factors for Osteoporosis
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Genetics//Ethnicity//Physical Inactivity//Tobacco//Alcohol//Medications//Diet(A Midget)
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Ethnicity
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Bone mass correlates positively with skin pigmentation
Whites least amount of bone mass Darker skin have the greatest bone mass |
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Gender
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Men have wider long bones than women and thin women have less cortical bones
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Obesity
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Increasing mechanical strain on bone, may result in increased peak bone mass. Increased amount of biologically available estrogen, protecting against fracture
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Inactivity
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Physical Stress TheoryDecreased bone formation and INCREASED excretion of calcium in urine.Disuse osteopenia results from a change in cellular function or an increase in the recruitment of osteoclasts.
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Tobacco/Alcohol
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Cig = found to decrease bone densityAlch = >2 drink/day // decreased osteoblastic activity // impair GI absorption – pulls CA from bone
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Meds
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Systemic Corticosteriod TherapyLoss of 10-15% of spinal trabecular bones mass in first 6 mo followed by 1-2% after thatImpaired calcium absorption // impede osteoblastic activity
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Diet
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Anorexia and bulima = decreased food intake decreased calcium in body. Low body weight and dec nutrients
Celiac disease – impairs absorption of calcium, nutrients, and vitamin D needed for maintaining healthy bones |
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High Cholesterol
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Associated with high fat diet, may decrease overall bone production
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Clinical Manifestations of Osteoporosis
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T-spine Kyphosis // decreased body height // weak abdominals // forward head // dowages hump // dec lumbar lordosis //posterior pelvic tilt
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Common fracture sites
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Vertebral bodies, hip, ribs, radius, femur
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Prevention of Osteoporosis
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Minimize risk factors // intake proper calcium during development // regular exercise // risk can be reduced by 50% if nutrients met in first 20-30 years// Vitamin D
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How does Vitamin D help in osteoporosis
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Absorb, synthesize, and transport calcium within the body, necessitating adequate sunshine each day
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What is Bone mineral Density testing
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For women over 65 years. Recommended for postmeno younger than 65 if they had a bone fracture in adulthood.Men over 70
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What is a Dual X-ray absorptiometry
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Produces two xray beams: one high one low energy. Bone is measured by how many xrays pass through. Difference between the two beams can determine bone density (spine/hip)
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Assessing Osteoporosis
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History and physical examination // Lab testing// imaging studies// xrays
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T-Score significance
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-1.0+ = normal, low risk for fracture
-1.0 to -2.5 = osteopenia (low bone mass) -2.5 or lower = osteoporosis |
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What are pharmacological managements used for
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To inhibit bone resorption, maintain or increase bone mass, thereby reducing fracture risk.
Estrogen replacement therapy. Selectrive estrogren replacement modulators, biophosphatess, zoledronic acid |
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Estrogen replacement therapy
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Shown to decrease risk for osteoporosis
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Selective Estrogen Replacement Modulators
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Chooses which estrogen is going to be used
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Biophosphate
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Inhibits bone resorption, reverse bone loss
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Zoledronic Acid
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Infusion intravenously – 70% reduced risk of vertebral and 41% of hip fracturess
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Prognosis of Osteoporosis
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24% of women over 50 years old die within one year of hip fracture
Med treatment can dec vertebral fractures by 40-60% Biophosphonates can cause adverse long term side effects (esophagitis, HB, Abd pain, diarrhea) |
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Physical Medicine
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Reduction of pain// correct postural dysfunction // decrease risk of falls// increase/maintenance of bone mass
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PT implications of Osteoporosis
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Seated rows, Wall squats, and back extensions and lat pull downs improve bone in the wrist hip and spine by 1-2% even in women how did not take HRT
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Exercises for people with Osteoporosis
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Maintain spinal musclesWeight-bearing exercises – walking and joggingPatient education
Bone Estrogen Strength Training – weighted exercise combined with calcium citrate supplementation increased bone density even in women who did not take HRT |
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What is Wolffs Law
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Bone is laid down in areas of stress and reabsorbed in areas of non-stress.
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What is Paget Disease
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Osteitis deformans – second most common bone disease
Progressive disorder |
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How is Paget disease characterized
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Abnormal bone remodeling with increased bone resorption and excessive unorganized new bone formation caused by activated osteoblasts
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What is a Paget
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Excess bone that is formed and lacks the structural atbility of normal bone leading to complaications
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Complications of Pagets
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Deformity, Fracture, Arthritis, pain,
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Risk factors for Pagets
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Over 50, genetics, high incidence in british isles
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S&S of Pagets
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Bone pain and skeletal deformities
Bones change shapes, size, direction Structural abnormalities of bone Loss of muscle strength, joint motion, and CV endurance leading to functional limitations |
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Describe Paget disease of the skull
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Can produce neurologic complications as a result of either direct impingement or ischemia
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Medication for Paget disease
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Bisphophonates – Inhibit osteoclasts
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PT implications of Paget Disease
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Exercise is recommended Joints adjacent may function at a mechanical disadvantage, causing muscular pain that can be reduced with exerciseSeverity determines exercise program
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What are important exercises for Pagets
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Stretching, strengthening, endurance, aerobics, balance and coordination
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Exercises to avoid with Pagets
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Jogging, running, jumping, forward bending and twisting.
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