1. OSTEOPOROSIS
-What it is and what you can do about it-

5. A musculoskeletal disorder with
compromised bone strength that
predisposes an individual to increased
fracture risk
NIH Consensus Development Panel on
Osteoporosis Prevention, Diagnosis, and Therapy. JAMA
2001: 285:785-795

6. In other words….
Reduction of bone mass,
both quantity AND quality so that
bones become fragile and easily fracture
PEAK BONE MASS
The amount of bone we accumulate as a young adult (generally
age 30-35)
About 90-98% is accumulated by age 18-20
www.niams.nih.gov/Health_Info/Bone/Osteoporosis/bone-mass.asp

7. Normal Bone
Osteoporotic
Bone

9.  Also in childhood—babies are being born with it
 Affects all populations—women, men, young adults, the
elderly, patients in the clinic, and anyone here in this room today
 Knows no boundaries regarding age, gender, lifestyle or ethnicity
or any other factor
 Affects over 55% of persons aged 50+ men & women
(Reference National Osteoporosis Foundation 2002)
 Total # of people estimated to have the condition in the US—44
million
 Is more prevalent than coronary heart disease (12.5 million,) heart
attack (1.1 million,) or diabetes (17 million.) (Ref: Surgeon
General’s Report 2004
 Is more common than breast, uterine and ovarian
cancer, combined

10. Patterns Of Postural Change

11. DETERMINANTS OF
PEAK BONE MASS
Heredity – up to 75% *
Physical Activity Nutrition
Hormonal Status Ethnicity Lifestyle Factors
http://www.niams.nih.gov/Health_Info/Bone/Osteoporosis/bone_mass.asp#a
Accessed October 21, 2011

12. TESTS
FOR
OSTEOPOROSIS

13. The Only Current Non-Invasive
Diagnostic Test Available for
Clinical Use
BONE DENSITY SCAN
Bone Mineral Density (BMD) Now
Considered a Risk Factor
For Fracture and Not the Primary Diagnostic
Tool it has Been

14. GOLD STANDARD
•LUMBAR SPINE
•HIP

15. T Score
 O to -1………………Normal Bone
 -1 to -2.4…………….Osteopenia
 -2.5 & Below………..Osteoporosis
 Below -2.5 in presence of fracture…
……Severe Osteoporosis

16. MOST COMMON FRACTURES
WRIST HIP
VERTEBRAL BODY
OTHER COMMON
FRACTURE SITES
RIBS PELVIS
ANY BONE IN THE BODY

17. HIP
•Most disabling/life threatening
•Older woman who falls backward
most likely to fracture her hip
•1/2 women with hip fracture die
within one year of fracture
•At 6 months following a hip
fracture, only 15% can walk across
a room unaided.

18. CLINICAL CONSEQUENCES OF SPINE FRACTURES
SYMPTOMS SIGNS FUNCTION FUTURE RISKS
Back Pain
(acute/chronic)
Sleep Disturbance
Anxiety
Depression
Decreased Self
Esteem
Fear of future: Falls
and Fractures
Reduced Quality of
Life
Early Satiety
Height Loss
Kyphosis
Decreased Lumbar
Lordosis
Protuberant
Abdomen
Reduced Lung
Function
Weight Loss
Impaired ADL’s
Difficulty Fitting
Clothes
Difficulty Bending,
Lifting, Descending
Stairs, Cooking
Increased Risk of
Fracture
Increased Risk of
Death
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

19. However
more fractures occur in women
with normal bone
or osteopenia
than in those with osteoporosis
Pasco JA, Seeman E, Henry MJ, et al. The population burden of fractures
originates in women with osteopenia, not osteoporosis. Osteoporos Int
(2006)17:1404
Sornay-Rendu E, Munoz F, Garnero P, Duboeuf F, Delmas PD.. Identification of
osteopenic women at high risk of fracture: the OFELY study. J Bone Miner Res.
2005 Oct;20(10):1813-9. Epub 2005 Jun 20.
E. Siris & P. D. Delmas. Assessment of 10-year absolute fracture risk: a new
paradigm with worldwide application. Osteoporosis International (2008);19:383-384

20. WHO Fracture Risk Assessment Tool
 10 factors identified to increase fracture risk
independent of bone mineral density
 Age, sex, weight (under 125 lbs) & height, previous
fractures, parental hip fracture history, smoking
status, glucocorticoid use, rheumatoid
arthritis, secondary disorders linked to osteoporosis
such as diabetes, 3 or more alcoholic beverages per day
http://www.shef.ac.uk/FRAX
http://www.betterbones.com/bonefracture/whowillfract
ure.pdf

21. TRIANGLE OF MANAGEMENT

22. EXERCISE
THE
“E”
PILL

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25. F
R
O
N
T
O
F
B
A
C
K
B
O
N
E

26. Principles of The Meeks Method
Site-Specific Exercise
UN-LOAD the Vertebral Bodies
DECOMPRESSION
FRONT of the Backbone
Single Best Exercise for Most Back Pain

27. GLADYS

29. JAMES
Habitual Posture Best Posture
Best Posture - 1
Hour Later

30. JOYCE
Before After (30 mins)

31. LUCILLE
Before After (1 hour)

32. “SURPRISE” THE BONES
Walk backward, sideward, on uneven surfaces
The Single Best Exercise for Most
People at almost Anytime
Promotes Weightbearing through
the Hip Joints and the Bones
W
A
L
K
I
N
G
R
u
n
n
i
n
g
J
u
m
p
i
n
g

33. REMEMBER
PRINCIPLES
OF
MOVEMENT
and
AVOID OR USE
CAUTION WITH THE
FOLLOWING
EXERCISES/ACTIVITIES

34. YOGA
QI GONGT’AI CHI
AEROBICS BODY PUMP
KICK BOXING
PILATES GYROTONIC
GOLF TENNIS BOWLING
TAE BOSTOMP
POOL CLASSES and SWIMMING
Page 216
Page 216
Page 219
Page 218
CARDIO

35. The World’s
Osteoporosis
is
Ticking
Chan et al. Bulletin of the World Health Organization 2003, 81 (11)
Reference #15—Appendix Reference List

36. !!TAKE ACTION NOW!!
Best way to diffuse the world’s
OSTEOPOROSIS TIME BOMB
is to

37. THERAPEUTIC EXERCISE
Emphasis on:
Unloading/Decompression
Strengthening**
(Back Extensor, Lower Abdominal, Hip Support Musculature)
Weightbearing through the hip joint and
the entire skeleton
ALIGNMENT MOST IMPORTANT
(Alignment is EVERYTHING)
**Huntoon EA, Schmidt CK, Sinaki M – Significantly fewer refractures after vertebroplasty in patients who engage
in back-extensor-sternghening exercises.
**Sinaki M, Itoi E, Wahner HW, Wollan P,Gelzcer R. Mullan BP, Collins DA, Hodgson SF – Stronger back muscles
reduce the incidence of vertebral fractures: a prospective 10 year follow-up of post-menopausal women

38. PURPOSES OF BRACING
Support and protection
Control of motion
Prevent fracture
Allow weight-bearing activities
Bracing usually associated with weakening
of body part it is designed to protect

39. SPINOMED
Spinal Orthosis
for Osteoporosis

40. “The Spinomed orthosis is the single, most
significant advancement in the conservative
management of osteoporosis and compression
fracture EVER.”
Sara M. Meeks, PT, MS, GCS
 Backed up by a peer-reviewed research study - Michael Pfeifer, Bettina
Begerow, Helmut Minne 2004
 Ordered by Physician and fitted by Orthotist
 Strengthens rather than weakens – even with more wear time; begin slowly and increase
as patients can experience muscle discomfort from muscle activation
 Can fit to very severe thoracic hyperkyphosis
 Can be worn under clothing – inconspicuous
 Combine with Meeks Method of exercises for optimum results
 Orthosis should be worn when up and active, can be worn when sitting but
patient will not get the benefit of it
Goal is to Prevent the Next Fracture

41. Supine is Best

42. Prone is OK Too!

43. Be Careful with Straight leg raises

44. Don’t Forget The Hip Hinge

45. THANK YOU!!!!
 Questions?
 Interested in a class?
 Need more information? If you feel you may benefit from
physical therapy for osteoporosis and would like to schedule an
appointment, please call the number below
 dwyerm@fauquierhealth.org
 (540) 316-2680 FH Physical Medicine and Rehabilitation at the
MOB (Medical Office Building)
 www.Therapy2bYourself.blogspot.com