Case Management 2 Osteoporosis

T score >-2.5SD with hx of fragility fractures
T score >-2.5SD
T score from -1 to -2.5SD

2 causes of primary osteoporosis
5 causes of secondary osteoporosis

Percent of adults 50+ with osteoporosis
Percent of adults 50+ with osteopenia

3 things for female athlete triad

Quantitative loss of bone but mineralization is normal, pain from fracture site specific

Insufficient mineralization of bone due to vit D deficiency (AKA Rickets in childhood). Generalized bone pain, appendicular instead of axial, long bone deformity, and sensory neuropathy may occur

Initially increased focal bone resorption but later increased bone formation. Insidious onset and increased incidence with age. Prone to deformity (tibial/femur bowing, vertebral flattening, skull impingment of auditory nerve).  Weak bone is formed and stress fracture common.

Spine of older person, usually male and older, often accompanied by profound osteoporosis and has loss of spinal motion

Be familiar with Nachemson body positions for intradiscal pressure

occurs as a result of a minimal trauma (fall from standing height or less) or no trauma

3 (ish) common osteoporotic fx sites

_______: anterior compressive forces from spinal flexion cause fx when there is decreased BMD
________: both ant and post portions of vertebral bodies severely compressed/collapsed. _____ is when this fx is displaced and comminuted
________: herniation of IV disc through vertebral end plate, often associated c trauma in thoracic and lumbar spine, more common in young people

_________: with more severe kyphotic deformity this may be more prominent, sharp posterior angulation, at apex of thoracic curve
________: fatty fibrous deposit around base of neck or upper back, secondary to Cushing's or prolonged corticosteroid use. Not tender to palpation.
________: 10% of population, commonly pubescent athletes. defect in apophyseal ring of vertebral body and can cause anterior wedge fx or herniation of IV disc into end-plate

With VCF, periosteum and ant longitudinal ligament are _____ innervated. ALL is mechanism for reduction of wedge fx when spine extended or flexed?
Pain referred _________, around rib cage in _________ pattern

TLSO brace limits?
Jewet limits?
CASH limits?
Clam Shell/Molded jacket limits?
Spinomed promotes? For what phase of injury?

T score relative to peak BMD for what age of same race and gender?
If T score goes down one SD, what is the fracture risk increase?
Can lumbar osteophytes give a misleading BMD DEXA score?

Don't know if comparative radiation levels are important, but obj 8
What's the age for screening for osteoporosis in women?

Managing acute VCF
avoid spinal ______, ______ and _______
orthosis on when ____ ___ ______
encourage amb with ________ posture
minimize _______ (only for meals and toilet use)
____ roll
teach: ____ to _____ and _____ to ______ transfers. avoid _____ and develop _______ control
consider use of reachers or ADL aids to minimize forward ______

Non-modifiable risks for osteoporosis (3 major)
Modifiable risks (2 major)

incidence of osteoporosis by race?
incidence of lactose intolerance by race?

First clinical signs that someone may have osteoporosis (6)

Precautions for evaluation of osteoporotic patient

2 mechanical actions that can increase BMD

_____ of osteoporosis: high impact good, peak ground reaction forces greater than or equal to 2 x body weight. Resistance training, high but safe load
_______ of osteoporosis: low impact aerobic activity less than or equal to 1.5 x body weight, lifting limited to 10lbs if acute VCF

For osteoporotic patients, exercises to avoid, caution, and encourage
_________: sit ups, toe touches
__________: knee to chest, supine hooklying spinal rotation
_________: spinal extension and LE ext against gravity, scapular adduction, stage 1 and 2 lower abd strengthening

3 core principals of Sara Meek's Method

Reasons why person may have difficulty tolerating supine

Review scoliosis obj 29