LEC21: Osteoporosis and Physical Activity

Question 1

What is osteoporosis?

Answer 1

A condition where blood calcium levels (i.e. calcium in the extracellular fluid) are depleted which leads to a loss of mineral mass from bones

Question 2

Osteoporosis: when bone resorption (blank) bone deposition

Answer 2

Exceeds

Question 3

What is bone resorption controlled by?

Answer 3

Osteoclasts

Question 4

What is bone deposition controlled by?

Answer 4

Osteoblasts

Question 5

When someone has osteoporosis, they will…

Answer 5

have weak and fragile bones and an increased risk of bone fractures

Question 6

When an individual has osteoporosis, they will have (blank) without any obvious symptoms (‘the silent thief’)

Answer 6

Bone loss occur

Question 7

What is bone mass?

Answer 7

Refers to the weight of the skeleton

Question 8

What is bone mineral density?

Answer 8

Refers to the ratio of weight to the volume or area of the bones

Question 9

What is the basic assumption of heavier bones

Answer 9

It means stronger bones

Question 10

Approximately (blank) Canadians have osteoporosis

Answer 10

2 million

Question 11

(blank) women and (blank) men have osteoporosis

Answer 11

1 in 4, 1 in 8

Question 12

Can osteoporosis strike at any age?

Answer 12

Yes

Question 13

What are the most common sites for fractures?

Answer 13

Wrist, shoulder, hip, and spine

Question 14

What are the areas most commonly affected by osteoporosis?

Answer 14

Spine, wrist, hip

Question 15

What do vertebral fractures in advanced osteoporosis look like?

Answer 15

Bones become thinner and weaker with osteoporosis. Overtime, bones in the spine can become thin and collapse causing a person to hunch over

Question 16

The line of gravity due to a kyphotic deformity

Answer 16

In a normal spine, the forces are distributed equally on the surface of the endplate avoiding stress peaks. The kyphotic deformity creates asymmetrical loading of the endplate which increases the risk of further fractures and increasing deformity

“wedge fractures”
“dowager’s hump”

Question 17

What are factors affecting bone mineral density gains in childhood and adolescence

Answer 17

Genetics, mechanical forces, risk factors, nutrition, hormones, gender

Change peak bone mass (account for 60=80% of the peak bone mass variance)

Question 18

Factors that affect calcium levels

Answer 18

1. Dietary calcium
2. Dietary vitamin D
3. Alcohol intake
4. Smoking
5. Regular exercise
6. Estrogen

Question 19

Factors that affect calcium levels: dietary vitamin D

Answer 19

“Osteoporosis Canada’s new guidelines (July 2010)
- Recommended daily supplements of 400 to 1000 IU for adults under age 50 without osteoporosis
- For adults over 50, supplements of between 800 and 2000 IU are recommended.
- A daily supplement of 800 IU should be regarded as a minimum dose for all adults with osteoporosis.”

Question 20

Factors that affect calcium levels: alcohol intake

Answer 20

A diuretic that causes calcium to be excreted in the urine

Question 21

Factors that affect calcium levels: smoking

Answer 21

Decreases activity of osteoblasts

Question 22

Factors that affect calcium levels: regular exercise

Answer 22

Weight bearing or resistance training makes bone respond (activates osteoblasts)

Question 23

Factors that affect calcium levels: estrogen

Answer 23

1. Lack of estrogen decreases the ability of the intestines to absorb dietary calcium
2. Lack of estrogen decreases the ability of the kidneys to reabsorb calcium
3. Post-menopausal women – calcium levels in the extracellular fluid (ECF) are low – bone resorption occurs to try to bring the ECF calcium levels back to normal

Question 24

Effects of exercise and calcium intake on BMD in post-menopausal women

Answer 24

Most effective when taking calcium and having exercise

Question 25

What is the purpose of physical activity for individuals with osteoporosis?

Answer 25

1. Improve BMD: to decrease fracture risk 2. Improve muscular strength: to decrease fall risk, to decrease fracture risk 3. Improve balance and posture: to decrease fall risk, to decrease fracture risk

Question 26

What will an improvement in bone mineral density (BMD) cause?

Answer 26

A decrease to fracture risk

Question 27

What will an improvement in muscular strength cause?

Answer 27

A decrease in fall risk and fracture risk

Question 28

What will an improvement to balance and posture cause?

Answer 28

A decrease in fall risk and fracture risk

Question 29

How can you increase bone mineral density (BMD)?

Answer 29

You need to put stress on the skeletal system which can be done through activities

Question 30

What two types of activities increase bone mineral density (BMD)

Answer 30

1. Ground reaction forces (GRF) e.g. walking, jogging, stair climbing) 2. Joint reaction forces (JRF) e.g. weight lifting, rowing, cycling

Question 31

What activities helped increase bone mineral density (BMD)?

Answer 31

Aerobic activity: higher intensities (85-90% of HRmax) Resistance training: training with loads of > 80% 1 RM

Question 32

Many of the studies that have looked at the effect of exercise on BMD in older adults have found (blank) changes in BMD.

Answer 32

no change or only very modest increases

Question 33

(blank) is a more realistic outcome than increasing BMD.

Answer 33

Maintaining BMD

Question 34

To decrease fracture risk, a better approach may be to focus on what?

Answer 34

Muscle strengthening and balance and postural training Decrease fall risk which will decrease fracture risk

Question 35

What therapeutic goals should be targeted in individuals with osteoporosis?

Answer 35

1. Fall prevention 2. Safe movement or spine-sparing strategies 3. Prevention of further bone loss

Question 36

Prevent fractures via: fall prevention

Answer 36

Improve dynamic balance, mobility, muscle strength, posture

Question 37

Prevent fractures via: safe movement or spine-sparing strategies

Answer 37

1. Attention to posture during movement to protect the spine 2. Train back extensor muscles to improve endurance 3. Stretch muscles restricting optimal posture

Question 38

Prevent fractures via: prevention of further bone loss

Answer 38

1. Exercise may not have a certain effect on bone mineral density 2. Muscle strengthening and weight-bearing dynamic exercise

Question 39

What are recommendations for older adults with osteoporosis or osteoporotic vertebral fracture?

Answer 39

1. Strongly recommend that individuals with osteoporosis engage in a multicomponent exercise program that includes resistance training in combination with balance training 2. Recommend that individuals with osteoporosis do not engage in aerobic training to the exclusion of resistance or balance training

Question 40

Exercise considerations for osteoporosis

Answer 40

1. Weight bearing (stimulates bone growth) a. Aerobic modalities: walking, jogging, low impact aerobics, stair climbing, weight bearing sports (bowling, tennis, badminton, volleyball, etc.) b. Resistance training modalities: machine weights, free weights, body weight, resistive bands/tubing 2. Postural training: to strengthen muscles in trunk and those supporting the spine a. Protraction and retraction of scapula b. Consider training seated and standing posture c. Consider isometric exercises to avoid compression of the vertebrae in the spine (see contraindications) 3. Balance training: to decrease fall risk (and therefore to decrease fracture risk)

Question 41

Contraindicated movements for osteoporosis

Answer 41

1. Large amounts of spinal flexion (forward) or extension (back) 2. Large amounts of lateral flexion of the spine (side to side) 3. Large amounts of twisting or rotation of spine 4. Large amounts of loading through the spine (e.g. jumping)

Question 42

End-range trunk flexion for individuals with osteoporosis: instead of (blank), do (blank)

Answer 42

instead of: yoga/pilates movements that involve flexion Do: supported flexion, not to end-range eg. modified downward dog with hip hinge and chair

Question 43

End-range trunk rotation for individuals with osteoporosis: instead of (blank), do (blank)

Answer 43

Instead of: trunk rotation machine or twisting movements for abs Do: side plank on wall or floor Instead of: yoga/pilates twisting postures Do: slow, controlled twisting in supine

Question 44

Precarious balancing for individuals with osteoporosis: instead of (blank), do (blank)

Answer 44

Instead of: standing on a chair Do: use a step stool with a wide base of support and non-slip materials on the stepping surface and interface with floor

Question 45

Bending or lifting for individuals with osteoporosis: instead of (blank), do (blank)

Answer 45

Instead of: forward bending with spine, or lifting load away from body Do: bend with knees and hips not spine. Use lower body to help lift. Stand close to load when bending, hold load close to body

Question 46

Turning, with or without load in hand for individuals with osteoporosis: instead of (blank), do (blank)

Answer 46

Instead of: twisting with feet planted Do: step to turn, so that leading foot and torso face same direction