Module 2 - Case
Jacqueline M Wright |
Osteoporosis is a condition characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones. Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge. This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones. Osteopenia is a condition of bone that is slightly less dense than normal bone but not to the degree of bone in osteoporosis. Normal bone is composed of protein, collagen, and calcium, all of which give bone its strength. Bones that are affected by osteoporosis can break (fracture) with relatively minor injury that normally would not cause a bone to fracture. The fracture can be either in the form of cracking (as in a hip fracture) or collapsing (as in a compression fracture of the vertebrae of the spine). The spine, hips, ribs, and wrists are common areas of bone fractures from osteoporosis although osteoporosis-related fractures can occur in almost any skeletal bone. (1) A routine X-ray can reveal osteoporosis of the bone because the bones appear much thinner and lighter than normal bones. Unfortunately, by the time X-rays can detect osteoporosis, at least 30% of the bone has already been lost. In addition, X-rays are not accurate indicators of bone density. Thus, the appearance of the bone on X-ray often is affected by variations in the degree of exposure of the X-ray film. The bone density of the patient is compared to the average peak bone density of young adults of the same sex and race. This score is called the
"T score," and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass. It is important to note that while osteopenia is considered a lesser degree of bone loss than osteoporosis, it nevertheless can be of concern when it is associated with other risk factors (such as smoking, cortisone steroid usage, rheumatoid arthritis, family history of osteoporosis, etc.) that can increase the chances for developing vertebral, hip, and other fractures. In this setting, osteopenia may require medication as part of the treatment program. In the U.S., 44 million people have low bone density (10 million have osteoporosis, and 34 million have osteopenia). This amounts to 55% of the U.S. population aged 50 years and older. (1) One in two Caucasian women will fracture a bone due to osteoporosis in her lifetime. In the
U.S., direct health-care costs from osteoporosis fractures amount to a billion dollars, without even taking into account the indirect costs, such as lost days at work and productivity.
Approximately 20% of those who experience a hip fracture will die in the year following the fracture. One-third of hip-fracture patients are discharged to a nursing home within the year after fracture. Only one-third of hip-fracture patients regain their pre-fracture level of function. With the aging of America, the number of people with osteoporosis-related fractures will increase exponentially. The pain, suffering, and overall impact on health and economic costs will be enormous. (1) Exercise has a wide variety of beneficial health effects. However, exercise does not bring about substantial increases in bone density. The benefit of exercise for osteoporosis has mostly to do with decreasing the risk of falls, probably because balance is improved and/or muscle strength is increased. Research has not yet determined what type of exercise is best for osteoporosis or for how long it should be continued. Until research has answered these questions, most doctors recommend weight-bearing exercise, such as walking, preferably daily.
It is important to avoid exercises that can injure already weakened bones. In patients over 40 and those with heart disease, obesity,