November is Osteoporosis Month

1. November isOsteoporosisMonth Ryan Bishop Lisa St. Onge David T. Roberts Jo Anne Robinson Evan Walsh Normal Osteoporotic

2. Osteoporosis • Osteoporosis is a very serious disease that effects millions world wide • Characterized by low bone mass and structural deterioration of bone tissue • Leading to bone fragility and an increased susceptibility to fractures, especially of the hip, spine and wrist, although any bone can be affected • Bone absorption outpaces the depositing of new bone

3. Osteoporosis • Decreased calcium levels is a factor of Osteoporosis • Osteoporosis can be caused by lowered hormone levels • Both estrogen and testosterone are responsible for increased osteoblast activity and therefore synthesis of bone matrix • In females, menopause is linked with lowered estrogen levels, resulting in higher osteoporosis rates • Since testosterone levels are relatively constant, men are much less susceptible to the condition

4. Osteoporosis • 1 in 2 women and 1 in 5 men over 65 sustain bone fractures due to osteoporosis

5. Osteoporosis Myths • Osteoporosis is an inevitable part of aging • Only older women get osteoporosis • Only Caucasian women get osteoporosis • Osteoporosis isn’t a serious or deadly disease

6. Osteoporosis Myths • Osteoporosis isn’t very common • Osteoporosis medical costs aren’t very high • If I had osteoporosis I would know it • Once I have osteoporosis there is nothing I can do about it

7. Subjective Assessment • Sedentary lifestyle • Underweight or losing weight • Low calcium intake • Tobacco use • History of fractures • common areas include hip, wrist, arm, and leg • Family history of Osteoporosis • Mechanism of injury is a fall

8. Subjective Assessment • For women: • Ovaries have been removed • Reached menopause • Had an early menopause • Never been pregnant • Before menopause had periods of amenorrhea (absence of menstrual cycle) • For men: • Abnormally low testosterone levels

9. Objective Assessment • Height and weight • Chest expansion measure at xiphisternum • Kyphosis of the cervical or thoracic spine • Shoulder elevation • Lumbar spine ROM • Balance • Pain • Strength, endurance, and aerobic capacity

10. Objective Assessment • A Bone Mineral Density test should be performed every two years for risk groups • DXA (Dual Energy X-ray Absorptiometry) measures the spine, hip or total body • pDXA (Peripheral Dual Energy X-ray Absorptiometry) measures the wrist, heel or finger • QUS (Quantitative Ultrasound) uses sound waves to measure density at the heel, shin bone and kneecap • All results are compared to either ‘young normal’ or ‘age matched’ values

11. Possible Causes • No single cause, but there are many major and minor risk factors the seem to play a role in the development of osteoporosis • The main health implication of osteoporosis is the increased possibility of fractures

12. Major Risk Factors • Family history of Osteoporotic fracture • Especially if mother had a hip fracture • A vertebral compression fracture, or a fracture with minimal trauma after age 40 • Long-term use of glucocorticoid therapy • More than 3 months on a drug such as prednisone • Medical conditions that inhibit absorption of nutrients • i.e. celiac disease, Crohn's disease

13. Major Risk Factors • Primary hyperparathyroidism • Tendency to fall • Osteopenia apparent on x-ray • Bone mass is 1 standard deviation below the young normal level • Hypogonadism • Low testosterone in men, loss of menstrual periods in women • Early menopause • Before age 45

14. Minor Risk Factors • Rheumatoid arthritis • Hyperthyroidism • Prolonged use of anticonvulsants • Prolonged heparin use • Body weight less than 57 kg (125 lbs) • Present weight is more than 10% below weight at age 25

15. Minor Risk Factors • Low calcium intake • Excess caffeine • Consistently more than 4 cups a day of coffee, tea, or cola • Excess alcohol • Consistently more than 2 drinks a day • Smoker

16. Fracture Risk Factors • Low bone mineral density (BMD) • Prior fragility fracture • Age • The risk of fracture increases with age • Family history of Osteoporotic fractures • Tendency to fall

17. Fracture Risk Factors

18. Gender Differences • Principle difference is hormonal levels • In women, estrogen levels drop significantly after menopause resulting in a 2-5% drop per year in bone density for 5-10 years • Bone density is often higher in sedentary but normally menstruating women than in active but amenorrheric women • 40% of postmenopausal women and 12.5% of men over 50 suffer at least one osteoporotic fracture in their lifetime • In fact, in Canada 20-30% of osteoporotic fractures occur in men • Lower testosterone levels in men can lead to an increase in bone loss, although the decline is more gradual in men and is not universal

19. Treatment • Weight-bearing activity • Walking, jogging, aerobics, dancing, stair climbing and skating • Resistance exercises • Balance exercises such asTai Chi • Activities that improve posture

20. Treatment • Nutritional supplementation

21. Treatment • Nutritional supplementation • Consuming this quantity of calcium is a difficult task considering that to do this you would have to eat or drink the equivalent of five glasses of milk each day • oral calcium supplementation is an effective route, along with Vitamin D supplementation and decreased caffeine consumption

22. Treatment • Medications play a role in prevention and treatment of Osteoporosis • Variety of drug treatments available • Primary aim is to reduce further loss of bone mineral density • Used to prevent osteoporosis in individuals who are at high risk • Often essential in the avoidance of fractures

23. Role of the Kinesiologist • Prevention of the disease through education regarding: • Physical activity • Proper posture • Balanced diet • Early detection • Refer the patient to receive a Bone Mineral Density (BMD) Test • Suggest the use of crampons, canes and other balances aids

24. Questions • Name three (3) major risk factors for osteoporosis. • What does BMD stand for? • Basal Metabolic Disorder • Bone Mass Density • Bone Mineral Density • Big Milk Drinker • How many Canadian men suffer from osteoporosis?

25. References AllRefer Health. (2005). Diseases and Conditions: Osteoporosis. Retrieved November 20, 2005, from http://health.allrefer.com/health/osteoporosis-info.html National Osteoporosis Foundation. (2005). About Osteoporosis. Retrieved November 20, 2005, from http://www.nof.org/ National Osteoporosis Foundation. (2005). Prevention. Retrieved November 20, 2005, from http://www.nof.org/ National Osteoporosis Foundation. (2005). For Professionals. Retrieved November 20, 2005, from http://www.nof.org/ Osteoporosis Canada. (2005). About Osteoporosis. Retrieved November 20, 2005, from http://www.osteoporosis.ca/ Anderson, M.K., Hall, S.J., and Martin, M. (2004). Foundations of Athletic Training: Prevention, Assessment, and Management (3rd ed.). New York: Lippincott Williams & Wilkins.