Osteoporosis Management

Question 1

Osteopenia

Answer 1

• low bone mass
• Bone mineral density (BMD) level between 1.0 and 2.5 standard deviations below the young adult mean as measured by DXA. [-2.5 < T-score < -1.0]

Question 2

functional definition of osteoporosis

Answer 2

Skeletal disorder characterized by compromised
bone strength and increased fracture risk

Question 3

Operational Definition of osteoporosis

Answer 3

Bone mineral density (BMD) level at or more than
2.5 standard deviations below the young adult mean as measured by DXA
(Dual energy X-ray absorptiometry). [T-score ≤ -2.5]

Question 4

primary osteoporosis

Answer 4

• Osteoporosis that is the result of aging or menopause, or both
• Aging causes a decrease of osteoblastic activity, resulting in decreases in bone formation
• Menopause causes an increase of osteoclastic activity, which results in increases in bone breakdown (resorption)

Question 5

secondary osteoporosis

Answer 5

osteoporosis resulting from medication, disease or other condition

Question 6

how many Americans aged 50 + years old have osteoporosis or osteopenia?

Answer 6

55%

Question 7

prevalence

Answer 7

a. twice as common among women as men.
b. common among Caucasians and Asians than Hispanics.
These diseases are more common among Hispanics than African Americans

Question 8

Most common fracture sites from osteoporosis

Answer 8

• vertebrae
• hips
• wrists

Question 9

common functional consequences

Answer 9

chronic pain, limited mobility,
respiratory dysfunction, fear of injury, and stigma

Question 10

functional decline is particularly profound following….

Answer 10

hip fracture

Question 11

functional decline after hip fracture

Answer 11

a. 50% of persons with hip fracture NEVER regain their pre-fracture function.
b. Among persons living at home prior to a hip fracture, 25% require long-term
nursing home care.
c. Up to 25% with hip fracture will die within one year

Question 12

Non-modifiable risk factors for osteoporosis

Answer 12

a. Female
b. Older age
c. Caucasian or Asian background
d. Fair complexion and blue eyes
e. Thin, petite body build
f. Family history of osteoporosis
g. Early menopause
h. Lactose intolerance

Question 13

Modifiable risk factors for osteoporosis

Answer 13

i. Low calcium and Vitamin D diet
ii. Smoking
iii. Chronic dieting
iv. Estrogen deficiency
v. Sedentary lifestyle
vi. high caffeine use
vii. excessive alcohol consumption

Question 14

risk factors for osteoporotic fractures

Answer 14

a. History of falls
b. Poor physical condition
c. Dementia
d. Impaired vision
e. Environmental hazards
f. Current use of benzodiazepines or anticonvulsants
g. Resident of nursing home or other long term care facility

Question 14

Vertebral Fracture Facts

Answer 14

• Mortality increases after first year
• Deformity
• Neutral Fatigue
• Ambulation issues
• Issues with IADLs
• Does not need to move to nursing home
• social participation challenges
• dependent

Question 15

Hip Fracture Facts

Answer 15

• Mortality increases during 1st year
• No deformity
• Neutral fatigue
• Ambulation issues
• IADL issues
• Possibly needs to move to nursing home
• social participation callenges
• dependent

Question 16

Wrist Fracture Facts

Answer 16

• Mortality: unknown
• Deformity not typically present
• neutral fatigue
• no ambulation issues
• issues with IADLs
• Does not need to move to nursing home
• no social participation challenges typically present
• no dependency

Question 17

Severe consequences of vertebral fractures

Answer 17

• decreased lung function
• decreased mobility
• decreased strength
• decreased endurance
• decreased balance capacity
• decreased ADLs
• decreased IADLs
• decreased social function
• trouble sleeping
• trouble finding clothes that fit

Question 18

History items specific to osteoporosis

Answer 18

• Current medications associated with fall risk and bone loss
• Bone health related comorbidities
• History of fractures
• Results from prior BMD assessment and imaging studies

Question 19

Tests and measures specific to osteoporosis

Answer 19

• Quantification of thoracic kyphosis

Question 20

Education items specific to osteoporosis

Answer 20

Patient should demonstrate knowledge and application of:
* fracture prevention strategies including slowing the rate of bone loss
* An exercise program that emphasizes bone safe posture, as well as resistance, aerobic, balance, and flexibility exercises
* Safe and unsafe postures and movements

Question 21

Intervention items specific to osteoporosis

Answer 21

• Education on posture, body mechanics, and activity modification to reduce fracture risk during daily activities including exercise
• Bone-healthy (fracture preventative and BMD preserving) body mechanics patterns as exercises

Question 22

For patients with/at risk for osteoporosis, you should establish:

Answer 22

culturally sensitive standards for nutrition, exercise, fall prevention and bone health

Question 23

For patients with/at risk for osteoporosis, you should conduct programs designed to change….

Answer 23

the health behaviors of older adults related to
nutrition, exercise, fall prevention and bone health

Question 24

programs for patients with/at risk for osteoporosis should include...

Answer 24

i. Needs Assessment and Research ii. Program development iii. Group-specific marketing iv. Program implementation v. Evaluation of program implementation and program outcomes

Question 25

Non-pharmacological strategies

Answer 25

interventions targeted at the individual’s specific problems related to nutrition, exercise, fall prevention, and bone health

Question 26

Pharmacological strategies:

Answer 26

i. Antiresorptive therapy to inhibit osteoclastic bone resorption ii. Anabolic therapy to stimulate osteoblastic new bone formation

Question 27

FDA approved anti-resorptive therapy

Answer 27

bisphosphonates, estrogens, selective estrogen receptor modulators, calcitonin, and denosumab

Question 28

FDA approved anabolic therapy

Answer 28

teriparatide and abaloparatide

Question 29

Two grade B recommendations from the USPSTF

Answer 29

- The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years and older - The USPSTF recommends screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in postmenopausal women younger than 65 who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool

Question 30

frequency physical activity recommendations

Answer 30

- adequate physical activity/exercise (100%) - weight-bearing exercises (95%) - muscle strengthening exercises (84%) - low impact weight-bearing [walking] (78%) - resistance exercises (58%) - balance training exercises (58%) - moderate impact weight-bearing [stair climbing] (44%

Question 31

Epidemiology recap

Answer 31

osteoporosis is most prevalent among persons who are thin, sedentary, and have a fair complexation, but old age, race, and gender are affected

Question 32

risk factors recap

Answer 32

risk factors for osteoporosis and osteoporotic fractures are different, and short-term physical therapy can more likely reduce the risk of hip fractures compared to vertebral compression fractures

Question 33

strategies to reduce risk recap

Answer 33

reducing risk if the responsibility of society, the community, clinicians, and individuals

Question 34

take home message - osteoporosis is...

Answer 34

- common, costly, and disabling - Physical therapists should assess an older adult’s bone health during the initial evaluation

Question 35

take home message- osteoporosis precipitates impairments...

Answer 35

- beyond the musculoskeletal system - Physical therapists should utilize knowledge of these potential impairments in prevention and intervention programs.

Question 36

take home message - osteoporosis directly and indirectly precipitates...

Answer 36

- activity and participation limitations. - Physical therapists should address the activity and participation limitations as well as the osteoporosis precipitating these problems.

Question 37

take home message - osteoporosis should be treated by...

Answer 37

a team of health care professionals with an integrated and coordinated plan of care

Question 38

osteoporosis screening recommendations for men

Answer 38

The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for osteoporosis to prevent osteoporotic fractures in men