Abstract

Osteoporosis is a skeletal disorder characterized by reduced bone mass and disruption of the
micro-architecture of bone. Trabecular bone is more affected than cortical bone. Typically, these are
the lower thoracic and upper lumbar (T6 to L1). In the United States, osteoporosis affects one in
four women older than 60 years, and vitually all white women by the age of 90. After menopause,
women are six times more affected than man. Women lose 0.5% to 1% of their peak bone mass
yearly for approximately 20 years after menopause. There is as yet no standard for bone mass
measurent, and little to be gained by obtaining routine lateral x-ray sorptiometry. Diagnosis is
usually made on symptoms of gradual or sudden onset backache and/or change in bodily habitus. It
may take up to 4 weeks for an acute compression fracture to become apperent on routine x-ray
film. Treatment encompasses two aspects: medications for those known to be risk and
rehabilitative management of the patient who has general back pain or who has experience an
acute spinal vertebral fracture. A posture training support (PTS) by CAMP may used to improved
posture in an effort to prevent or lession osteoporotic skeletal problems. Other rehabilitative
treatments that can be used are back support device, proper back exercise, deep breathing exercise,
pectoral stretching, and thoraxic spine extention.
Keyword: osteoporosis, menopause, medical rehabilitation
 Definition

Skeletal Disorder

Bone Mass
Bone Strength Fracture

Micro-Architecture
 Anatomy

Mostly trabecular Lower Thoracic

T6 to L1
Upper Lumbar

Higher than
Neoplasm
Thantis
 Wedge shape Dowagers hump
Thoracic
fracture kyphoscoliosis

Lumbar Crush fracture

 Epidemiology

40% female more than

USA
60 years

White female more

than 90 years

White 30% hip fracture

Death 12-20%
female annually
 Etiology and Pathophysiology

Bone Remodeling 10-30% of skeletal each year

Increasing of Age Decreasing of Bone mineralization

Early adult Mostly built than absorbed

 Men and woman have
4th
gradual loss

Women 6 times than 0,5-1% every year of

After menopause
men bone mass loss

>65 years The rate is slowing down

Whos at risk?

Fair skinned, white

With family history Thin, small-framed
female

Removed ovaries Early menopause Endocrine disorders

>50 years Smoking Alcohol abuse

High protein diet Sedentary lifestyle

Others risks

Osteomalacia Hyperparathyroidism Immobilization

Multiple Myeloma Metastatic Chronic anemia

Estrogen Fight against bone loss

PTH
Bone formulation and
resorption
Calcitriol

Adequate intake of
Help Premenopause 800-1000 mg/day
Calcium

Postmenopause 1200-1500 mg/day

Vit D Deficiency Decreasing of Ca absorption

Hyperparathyroid Increasing Ca excretion

Parathyroid Maintain Ca level in plasma

Lack of Ca in plasma Osteoclast

 Detection of Osteoporosis

Single photon wrist of

heel (cortical bone)
Routine radiographic
evaluation is not helpful
Why??
photon absorptiometry
Bone loss must exceed 30%
before it becomes apperent
Dual photon spinal
vertebra assessment
 Determined the diagnosis

symptoms of gradual or sudden onset backache and/or

change in bodily habitus

it may take up to 4 weeks for an acute compression fracture

to become apperent on routine x-ray film

a timely diagnosis be made

bone trauma and resultant pain can be minimazed, family

members at risk can be followed, and other causes of bone
loss as osteomalacia can be elimated
 Evaluation

Physical Examination Finding

note generally bodily habitus, kyphoscoliosis, and any other scoliosis
no tenderness diractly over the vertebral spinosus process
cervical or lumbosacral paravertebral muscle may be in chronic spasm
observe gait for shuffling or poor balance
unable to sit or stand for a prolonged period because of pain
pain may be radiculer in a thoracic pattern related to the level of the fractured
vertebrae
 Treatments

Estrogen replacement (0,635 mg of conjugated estrogen for 21

days, follow by 7 day of progestin) perimenopausal period
Drug
Objective
Therapy Calcitonin reduced bone turnover by inhibiting osteoclasts

Supplemental calcium is controversial

decrease the rate of

bone loss and increase Vitamin D if only there is deficient. Sodium fluoride, 40 to
the rate of new bone 100 mg/day.
formation
Etidronate (didronel) increase bone mineral content and
decrease the rate of new vertebral fractrures
Rehabilitative

A Posture Training Support (PTS) by CAMP improved posture in an effort to

prevent or lession osteoporotic skeletal problems

Back support device can be used (semirigid dorsolumbar support with shoulder
straps or custom-made jacket)

Proper back exercise emphasize extention and omit flextion manuvers

 Acute Pain

Goals
To reduce acute pain, the immobilization of vertebrae can
reduce muscular spasm spasm occurs as a response
from the edema on subperiosteum due to the fracture.
Vertebral movement increases the pain, followed by
spasme muscles. Quite useful, Orthose spinal selectable
Jewett Brace Bivalved Shields/thoracolumbal brace.
In principle, the acute pain resolved immediately, if necessary by administering a
sedative drugs and also the proper body position.
Analgesic medications such as codeine sulfate and its derivation, or weak analgesic
can be selected to avoid constipation.

The recommended
Program:

Avoid Physiotherapy :
Bed rest less Ergonomics,P therapeutic
than 1 week
Analgesic constipation,exe
ositioning modalities,
rcise Program massage
 Chronic Stadium

Compression fracture of
vertebral deformities kyphosis scoliosis

Improved posture Relieve pain

Brace Better ADL

Malice orthose Weaken extensor of Advanced program before

spinal muscle vertebrae using brace
 Outcome

Typical postmenopausal osteoporotic woman is at great risk for fracture

Can be minimazed with education and appropriate & indicated drug therapy.

Should be followed perimenopausally to assess the need for estrogen replacement.

Encourage young women to routinely perform weigh-bearing exercise and obtain sufficient daily intake
of dietary calcium.
 Follow Up

For management of
The patient with
sporadic acute injuries, education and
postmenopausal
prescription of psychologist support is
osteoporosis requires
therapies, and necessery.
intermittent follow-up
instruction
 Acknowledgement

With grateful acknowledgement

THANK YOU!