OSTEOPOROSIS,

OSTEOPENIA,
AND
OSTEOMALACIA
Definition
Osteoporosis
Literally, porous bone
a bone disease characterized by a reduction
of bone tissue relative to the volume of
anatomical bone which increases
susceptibility to fracture
Definition
Osteopenia
Literally, too little bone
Marked osteoporosis with patchy
appearance on X-ray

Definition
Osteomalacia
Literally, soft bone
a bone disease characterized by a failure of
calcium deposition
Must be differentiated from osteoporosis
Epidemiology
Middle-aged and elderly people
postmenopausal women, and women in
third decade of life.
W>M
Etiology
Osteoporosis presents when bone mass
lies more than 2 SD below the mean.
The bone is of normal size but contains
less bone tissue without change in the
ratio of mineral component to organic
material.
It may also present from immobility and
lack of normal weight bearing.

Pathophysiology
Bone loss occurs after the age of early 30s,
resulting to increase fracture risk with normal
or moderate trauma.
The main determinant of Osteoporosis are the
peak bone mass level reached at skeletal
maturity and the subsequent rate of bone loss.
Low bone mass may be due to multiple
causes, including failure to achieve adequate
bone mass at skeletal maturity and
postmenopausal bone loss.


Diagnosis
fracture following trauma; pt. presents
with pain.
The first clinical indication
Absolute diagnosis made when an
atraumatic fracture occurs in the
presence of low bone mass.
Diagnosis
The diagnosis is therefore approached
from the standpoint of evaluating the
pts. potential risk of fractures based on
low bone mass, as well as evaluating
those who already has fractures.
Radionuclide bone scan may also be
used
Diagnosis
There must be an accurate diagnosis of
the degree of bone loss, as well as the
determination of the degree of frailty and
propensity of the patient to fall.
A laboratory evaluation include the
determination of Ca, phosphorus, and
alkaline phosphatase levels plus a 24-
hour urinary Ca creatine value.
A non-invasive measurement of bone
mass is indicated.





Complications
Pathologic fractures
Prognosis
Decline in physical activity and
subsequent diminished stress on bone
are associated with growing old.
Therefore, loss of bone mass and increase
susceptibility to fracture should be
considered normal age- related process.
Prognosis
Experiments show that males lose 3%of
cortical bone mass each decade after
40.
Female lose cortical bone mass at a similar
rate but is accelerated after menopause.
Medical/Surgical Management
Pharmacologic
Calcitonin therapy
decreases the rate of bone loss.
Sodium Flouride
an agent known to increase bone mass
Anabolic steroids
can prevent bone loss or increase bone mass.
Medical/Surgical Management
Pharmacologic
Estrogens
may preserve bone mass.
Vitamin D
increases Calcium absorption.
Biphosphates
preserve bone mass.
PT Examination
As fractures are usually the
condition treated due to
osteoporosis, musculoskeletal
examination is indicated.
PT Diagnosis
If without fracture:
Primary prevention/risk reduction for
skeletal demineralization
If with fracture:
Impaired joint mobility, muscle performance,
and range of motion associated with
fracture
PT Management
Therapeutic exercise is an essential
element in the rehab program.
The five general principles include:
Principle of Specificity
Principle of Progression
Principle of Reversibility
Principle of Initial Values
Principle of Diminishing Returns
PT Management
Principle of Specificity
exercise should stress the specific
physiologic system being trained
Principle of Progression
Progressive increases in intensity of
exercise for continued improvement.
Principle of Reversibility
the positive effects of exercise may be lost if
discontinued.
PT Management
Principle of Initial Values
those with low initial capacity will have the
greatest functional improvement.
Principle of Diminishing Returns
as the biologic ceiling to exercise-induced
improvement in function is approached,
greater is needed to achieve minimal gain.
PT Management
To help prevent disuse osteoporosis
individuals need to maintain weight-
bearing and stress exercises
prone strengthening exercise
pectoral muscle stretching
Cycling
endurance like walking and swimming