Bone Conditions

Question 1

Osteoporosis and Osteopenia Bone Density

Answer 1

• Normal = within -1 standard deviation for BMD
• Osteopenia = -1 to -2.5 sd BMD
• Osteoporosis = -2.5 sd and below
• Severe osteoporosis = same BMD as osteoporosis + 1 or more fragility fracture:

o Fragility fracture: pathological fracture resulting from a fall from standing height or less

Question 2

Osteoporosis and Osteopenia Risk Factors & Common Fracture Area

Answer 2

ACCESS

A-Alcohol use
C-Corticosteriod use
C-Calcium low
E-Estrogen low
S-Smoking
S-Sedentary lifestyle

Common #:
Spine: Tx, Lx
LL: femoral neck, proximal tibia, pelvis
UL: proximal humerus, distal radius

Question 3

Common Posture of Osteoporosis

Answer 3

• Inc. Cx lordosis
• Head forward posture
• Inc. Tx kyphosis
• Round shoulders
• Loss of lumbar lordosis

Question 4

Spinal Movements that should be incorporated in Rx

Answer 4

• Atlanto-occipital flexion/upper cervical flexion (chin tuck)
• Cx rotation
• Tx extension
• Lx extension

Question 5

Osteoporosis PT Rx Exercise Types to include

Answer 5

1. Functional exercises to work on balance:
   - Standing on one leg
   - Narrow BOS with reaching
   - Inline lunges
   - Sit to stand
   - Stepping over an object
   - Walking and turning
2. 50 moderate impacts per day:
   - Stomping
   - Step ups/downs
   - Small jumps off step
   - Heel drops
3. Cardiovascular exercise:
   - Lower impact: walking, marching, stairs
   - Moderate impact: dancing, jogging, skipping

Question 6

Contraindicated exercise for Osteoporosis

Answer 6

Spinal flexion+rotation
Esp uncontrol/repetitive/sudden
e.g.
- Quick wood chopper
- Child pose with OP
- Flexion with poor posture

**Unload flexion & rotation–>perform separately = safe
e.g.
▪ Supine knees to chest
▪ Supine reclined spinal twist
▪ 4-point cat/cow

Question 7

Impact of different exercises

Answer 7

No/minimal impact:
o Cycling
o Swimming

Lower impact:
o Walking
o Marching
o Stairs
o Heel drops

Moderate impact:
o Dancing
o Jogging
o Racket sports
o Skipping
o Stomping
o Vigorous heel drops

High impact:
o Basketball
o Tuck jumps
o Volleyball
o Football

Question 8

Osteomalacia

Answer 8

Cause:
-Softening of bones (=Rickets)

Presentation
-diffuse joint and bone pain/soft deformed bones
-# due to weight bearing

Question 9

Paget’s

Answer 9

Cause:
excessive breakdown and formation of bone–> disorganized bone remodeling

Presentation:
-pain, misshapen bones, fractures, and arthritis in the joints
-common affected: pelvis, femur, and lower lumbar vertebrae

Question 10

Osteogenesis imperfecta

Answer 10

Cause:
Genetic disorder - Brittle bone disease

Presentation:
defective development of connective tissue–> abnormally brittle/fragile bones–> easily fractured

Question 11

Osteopetrosis

Answer 11

Cause:
-Very rare, inherited deficiency in carbonic anhydrase
-Osteoclast dysfunction – do not get bone breakdown

Presentation:
-brittle bones and an increased risk of fracture

Question 12

Osteomyelitis Cause

Answer 12

Inflammation response in bone, caused by infection:
-sepsis, open trauma, infected surgical implant

At risk:
Children and immunosuppressed at highest risk.

Question 13

Osteomyelitis Presentation

Answer 13

Red flags:
Non-mechanical pain: at night, at rest

Systemic feature: Fever, redness, heat, swelling, feeling of malaise

Question 14

Osteomyelitis PT Rx

Answer 14

• Ice–>for inflammation
• Refer to Doc immediately
• NO Joint mobilisation!!
• Maintaining/improving joint mechanics & connective tissue function