Osteoporosis; treatment, causes, treatment

OSTEOPOROSIS

Osteoporosis is a disease of the bone that leads to decreased mineral content and weakening of the bone. This weakening may lead to fractures, especially of the spine, hip, and wrist. Approximately 10 million Americans have osteoporosis, 80% of them women.The diagnosis of osteoporosis is determined by the T score of a bone mineral density (BMD) scan. The T score is the number of standard deviations (SD) above or below a reference value (young, healthy Caucasian women). The World Health

Organization (WHO) has established the following criteria.

Normal: –1.0 or higher

Osteopenia: –1.1 to –2.4

Osteoporosis: –2.5 or less

Osteoporosis


Risk Factors

Primary osteoporosis

 Risk factors for developing primary osteoporosis include being postmenopausal, Caucasian or Asian descent, family history, low body weight, little or no physical activity, and smoking. Additional risk factors

include prolonged bed rest and advanced age.

Secondary osteoporosis

 Secondary osteoporosis develops owing to other medical conditions (i.e., gastrointestinal diseases, hyperthyroidism, chronic renal failure, excessive alcohol consumption) and the use of certain medications such as glucocorticoids. Regardless of etiology, osteoporosis is detected radiographically by

cortical thinning, osteopenia (increased bone radiolucency), trabecular changes, and fractures.

 

Prevention of Osteoporosis

The National Osteoporosis Foundation (NOF) recommends

four ways to prevent osteoporosis.

v  Diet rich in calcium and vitamin D

v  Weight-bearing exercise

v  Healthy lifestyle with moderate alcohol consumption and no smoking

v  Testing bone for its density and medication if needed

v  Bone is living tissue, continually replacing itself in response to the daily demands placed on it. Normally this continual replacement keeps our bone at its optimum strength. Cells in bone called osteoclasts resorb bone, especially if calcium is needed for particular body functions and not enough is obtained in the diet. Another type of cell, the osteoblast, builds bone. This cycle is usually kept in balance with bone resorption equaling bone replacement until the third decade of life. At this point, peak bone mass should be reached. With increasing age there is shift to greater resorption. For women, resorption is accelerated during menopause owing to the decrease in estrogen.

Physical Activity

Physical activity has been shown to have a positive affect on bone remodeling. In children and adolescents, this activity may increase the peak bone mass. In adults, it has been shown to maintain or increase bone density; and in the elderly, it has been shown to reduce the effects of agerelated or disuse-related bone loss. Maintenance of, or an increase in, bone density is important for preventing fractures associated with osteoporosis. Weak bones due to osteoporosis have been attributed to causing more than 1.5 million fractures per year at a cost of $17 billion dollars.

Many of these individuals never return to their previous functional level.

Effects of Exercise

Muscle contraction (e.g., strengthening exercises, resistance training) and mechanical loading (weight bearing) deform bone. This deformation stimulates osteoblastic activity and improves BMD.

 

Recommendations for Exercise

The NOF recommends weight-bearing exercise in the prevention of osteoporosis but does not specify what type of exercise or how often it should be done. Based on current research, the following recommendations are made.

Mode

Weight-bearing exercise, such as walking, jogging, climbing stairs

Non-weight-bearing exercise, such as with a bicycle

ergometer

Resistance (strength) training

 Frequency

Two to three days/week with one day of rest between each session

Intensity

At 80% of one repetition maximum (1 RM) with resistance training for the upper extremities

One to three sets of 8 to 12 repetitions At 16/20 on the Borg scale of perceived exertion for

trunk exercise.

Osteoporosis


Exercise Precautions and Contraindications

Because osteoporosis changes the shape of the vertebral bodies (they become more wedge-shaped), leading to kyphosis, flexion activities and exercise such as supine curl-ups and sit-ups as well as the use of sitting abdominal machines should be avoided. Stress into spinal flexion increases the risk of a vertebral compression fracture. Avoid combining flexion and rotation of the trunk to reduce stress on the vertebrae and the vertebral discs. When performing resistance exercise, it is important to increase the intensity progressively but within the structural capacity of the bone.

 

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