HM Medical Clinic

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Powerpoint presentation

Prevention of Osteoporotic Vertebral Compression Fractures Utilizing SAFE Exercise and the Marti Henshaw, BSc, MSPT

What is Osteoporosis? • NIH: "A musculoskeletal disorder with compromised bone strength that predisposes an individual to increased fracture risk. • IOF: "A disease in which the density and quality of bone are reduced." • Literally: "Porous bones." • Lay: "T-score less than -2.5."

Incidence of Osteoporosis and Low  Almost 44 million women and men over the age of 50 in the US (, 16 Apr 13)  Osteoporosis is more prevalent than CAD, MI or DM Surgeon General's Report 2004  It is more prevalent than breast, uterine and ovarian cancer combined.

Incidence of Osteoporotic Fracture • Worldwide, there is an osteoporotic fracture every 3 seconds. • 1 in 3 women and 1 in 5 men will have one. • A prior fracture is associated with 86% increased risk of future fracture. • A 10% loss of bone mass in a vertebrae can double the risk of vertebral fracture; in the hip risk increases 2.5x., 16 Apr 13

Age, Gender, Menopause, Family History, Low
Body Weight/Being Small and Thin, Broken Bones
or Height Loss, Not Getting Enough Calcium and
Vitamin D, Not Eating Enough Fruits and
Vegetables, Getting Too Much Protein, Sodium and
Caffeine, Having an Inactive Lifestyle, Smoking,
Drinking too much alcohol, Losing Weight.
(, 9/22/12)

DISEASES AND CONDITIONS Ankylosing spondylitis Blood and bone marrow disorders Chronic obstructive pulmonary disease (COPD), including Cushing's syndrome Eating disorders, especially anorexia nervosa Female athlete triad (includes loss of menstrual periods, an eating disorder and excessive exercise) Gastrointestinal bypass procedures Hyperparathyroidism Inflammatory bowel disease, including Crohn's disease and ulcerative colitis Kidney disease that is chronic and long lasting Sara Meeks Seminars Liver disease that is severe, including biliary cirrhosis Lymphoma and leukemia Malabsorption syndromes, including celiac disease Multiple myeloma Multiple sclerosis Organ transplants Parkinson's disease Polio and post-polio syndrome Poor diet, including malnutrition Premature menopause Rheumatoid arthritis Spinal cord injuries This list may not include all diseases and conditions that may cause bone loss. Sara Meeks Seminars • Aluminum-containing antacids • Antiseizure medicines (only some) such as Dilantin® or • Aromatase inhibitors such as Arimidex®, Aromasin® and • Cancer chemotherapeutic drugs • Cyclosporine A and FK506 (Tacrolimus) • Gonadotropin releasing hormone (GnRH) such as Lupron® • Heparin • Lithium • Medroxyprogesterone acetate for contraception (Depo- Sara Meeks Seminars Proton pump inhibitors (PPIs) such as Nexium®, Prevacid® and Selective serotonin reuptake inhibitors (SSRIs) such as Lexapro®, Prozac® and Zoloft® Steroids (glucocorticoids) such as cortisone and prednisone Tamoxifen® (premenopausal use)
Anti-rejection drugs in organ-transplant patients
Thiazolidinediones such as Actos® and Avandia® Thyroid hormones in excess This list may not include al medicines that may cause bone loss. Sara Meeks Seminars Vertebral Compression Fracture T8-T10 most common with another cluster Only 20-30% are symptomatic In North America, up to 45% of VCF are unrecognized ., 16 Apr 13 STAGES OF VERTEBRAL FRACTURE From: STAND TALL by Morris Notelovitz, M.D. Triad Publishing, Gainesvil e, Florida PATTERNS OF POSTURAL
From Magee, D., Orthopedic Physical Assessment, 2nd ed, 1992 2000 SARA MEEKS PHYSICAL THERAPY COMPLICATIONS FROM COMPRESSION
Crowding of Internal Organs
Bowel Obstruction
Prolonged Inactivity
Prolonged Pain
Deep Venous Thrombosis
Loss of Body Height
Increased Osteoporosis
Low Self-Esteem
Progressive Muscle Weakness
Emotional & Social Problems
Loss of Independence
Increased Nursing Home
(Increase in Thoracic) Kyphosis


Old JL. Vertebral Compression Fractures in the
Elderly Am Fam Phy Jan 2004
Back Pain
Height Loss
Impaired ADL's
Increased Risk of
Difficulty Fitting
Sleep Disturbance
Decreased Lumbar Clothes
Increased Risk of
Difficulty Bending, Death
Decreased Self
Descending Stairs,
Reduced Lung
Fear of future:
Falls and Fractures Weight Loss
Reduced Quality of
Early Satiety

Source: Papaioannou et al. 2002. Reprinted from The American Journal of
Medicine, Diagnosis and management of vertebral fractures in elderly adults.
113(3):220-228 (2002)
Bone Health and Osteoporosis
A Report of the Surgeon General October 2004
How do I know that my patient has low bone mass or osteoporosis? Diagnosis and Detection BONE MINERAL DENSITY TEST • Gold Standard • AP View Lumbar Spine and Hip • Only Non-Invasive Test Sara Meeks Seminars Compares client's bone density to that of a healthy 30 year old adult. Normal: 0 to –1 Osteopenia: -1 to -2.4 Osteoporosis: -2.5 and below Every unit of T-Score is associated with a 10%- 12% loss of bone density. • Fracture- minimal trauma
(e.g., Colles Fracture, Compression Fracture, Rib Fracture. Any fall from standing body height is a fracture of minimal
Loss of body height
• Transparent skin
• Periodontal disease
• Back Pain
Protruding Abdomen
Sara Meeks Seminars Assume your patient has osteoporosis: And/or Show Signs: Postural changes History of Fracture Unless they have a DEXA scan to show that • Wal to occiput
• Inability to touch wall with back of head is (+). • > 7cm in women rules in thoracic VCF with high degree of accuracy. • 0 cm reduces chance of VCF but does not reliably rule it out. Siminoski, et al, 2003 • Rib/Pelvis Distance
Space between iliac crest and bottom of R12 at midaxillary line Less than 2 fingerbreadths is (+) > 2 fingerbreadths rule out lumbar VCF with high degree of certainty. ≤ 1 fingerbreadth: rule in lumbar VCF with high certainty. Siminoski, et al, 2001 Vertebral Compression Fractures occur during movements that include Nachemson, A. Toward a better understanding of low-back pain: A review of the mechanics of the lumbar disc. Rheu. Rehab. 1975;14:129 If these can cause fractures what about. . typical senior "fitness" class moves? DEFINITELY AVOID Abdominal Crunches or Sit-Ups Abdominal Roll Ups ABDOMINAL MACHINE Brings Ribcage towards Pelvis Knee to Chest Uni or Bi-Lateral TOE TOUCHES Seated or Standing Sara Meeks Seminars S.A.F.E.*
Movement & Exercise™
*Skeletal y Appropriate For Everyone
When Choosing Exercises Consider the Force of Gravity • Vary the forces on the bones. • Maintain stability and optimal spinal alignment as much as possible as you make activity more • Do exercise program to strengthen back and hip stabilizers and to offset the repetitive-use patterns of the activity. • Exercise to Prevent, Arrest or Reverse Patterns of Postural Change. DEFINITELY AVOID Any Exercise That Includes •Forward Bending •Trunk Twisting •Lateral Bending Especially Simultaneously Most protective exercise to prevent Sinaki M, Mikkelsen BA: Postmenopausal spinal osteoporosis: flexion versus extension exercises. 1984 You can perform extension on your stomach or back, in side lying, standing and Erector Spinae Strengthening The (Lower) Core
Richardson, Jull & Lee PELVIC FLOOR
Sara Meeks Seminars Core Strengthening: Core Strengthening: Sara Meeks Seminars Gluteus Medius & Maximus Strengthening Powers, C, et al, 2013 Prevent, Arrest and even Reverse the Patterns of Postural Change Meeks' Basic Realignment Routine Don't be Stooped by


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