HLTH2510 Lecture Notes - Lecture 8: Ibuprofen, Tramadol, Malabsorption
HLTH2510
Exercise, Health & Disease
Osteoporosis & Non-Specific Lower Back Pain
Australia Statistics
In 2012, 4.74 million Australians considered to have poor bone health
22% affected by osteoporosis
78% affected by osteopenia
Greater prevalence in women
5.5% of all women v 1.4% of all men
Greater prevalence with age
+75 years; 1/5 women v 1/14 men
Total costs relating to osteoporosis estimated at $2.75billion per year
Bone Health
◼ Osteoporosis
◼ a skeletal disease haateised lo oe ass and microarchitectural
deterioration of bone tissue with a consequent increase in bone fragility and
suseptiilit to fatue
Definition
Osteoporosis - A disorder which is characterised by LOW bone density → weakness
of bone
> Calcium loss in bones
Less dense → decrease of strength → increase in fractures
T-score <2.5
Osteopenia - Bone mineral density below average. Generally a precursor to
osteoporosis
T-score between 1-2.5
Diagnosis
Loss of bone mass can be made by a physician through a bone mineral density test
(BMD).
Use Dual-Energy X-ray Absorptiometry (DEXA) to measure bone density in the spine,
wrist, and/or hip
Bone growth
Peak bone mass is achieved is achieved at around 25-30yrs of age
Bone mass can be optimised in adolescents through exercise loading
Adoleset eeise a ↑ BMD up to % i 6 oths (Hid & Buo,
2007)
Load bearing exercises critical for BMD change and maintenance with age
Note: Structured exercise helps,
ut ↓ sedeta ehaiou
agual oe ipotat…
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Pathophysiology
Bone health is a balance of bone deposition and resorption
Bone health declines when there is a decrease in deposition and an increase in
resorption.
Osteoblasts - cells that build up and strengthen the new bone tissue
(deposition)
Osteoclasts - cells that remove and resorb the old bone (resorption).
With age osteoblast activity can
be reduced to a greater extent than
osteoclasts. Leading to BMD.
Risk Factors
Female/Menopause/Early menopause (before 45)
Direct Relative – heredity (Heney et al., 2000)
Linked to vitamin D receptor and number of skeletal cytokines
Inadequate amounts of dietary calcium
Recommended <18yrs & >50yrs 1,300mg/day, otherwise 1,000mg
Vitamin D levels
800 units of vitamin D.. Around 10-20min of sun exposure
Cigarette smoking
Alcohol intake > two standard drinks per day
Caffeine intake > than three cups of tea, coffee or equivalent per day
Lack of physical activity
Conditions associated with;
Conditions that place people at a higher risk of osteoporosis include;
Thyroid disease or an overactive thyroid gland
Rheumatoid arthritis
Chronic liver and kidney disease
Coh’s disease
Coeliac disease and;
Poor energy balance – anorexia and athletes
Other inflammatory bowel conditions – irritable bowel syndrome (ITB).
Pathophysiology – 3 Types
Primary - Type I Osteoporosis
Oestrogen deficiency (type 1) → increased bone-resorbing cells at rates that exceed
bone reformation
Females only
Decrease in oestrogen that occurs during menopause results in accelerated
bone loss.
During the first five years after menopause, the average woman loses up to
10 per cent of her total body bone mass.
Primary - Type II Osteoporosis
Aging process
Not limited to females only
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Secondary - Type III Osteoporosis
Loss of bone caused by environmental agent or disease process or medications that
can disrupt normal bone formation;
Alcohol abuse
Smoking
Corticosteroid use (respiratory conditions)
Symptoms/Presentation
Asymptomatic
Loss of height – Dowagers Hump
Extreme Kyphosis
Back pain from vertebral compression and fractures
Stress fractures Falls
Hip fractures
Falls
Some Factors Contributing to Falls
Dementia
Neurological disorders impairing gait and balance
Poor eyesight
Muscle weakness
Joint deformities
Environmental hazards
Sedatives
Hip Fractures
Hip and vertebral fractures in the elderly were once considered a normal part of
ageing.
High rate of mortality – 20-25% >1yr following fracture
Higher risk of DVT and pulmonary embolism
Failing health and increasing frailty
Disability → loss of functional status
Fracture Risk and Osteoporosis
Having a spine fracture substantially increases the risk for sustaining additional spine
fractures within one year (Lindsay et al. 2001).
Management
Medications are an integral part of management.
5-15 min Sunlight, 4-6 x/wk
Nutritional
Vitamin D, Calcium, Magnesium, B vitamins, vitamin K, Zinc
Diets high in sugar, alcohol, salt caffeine-containing drinks seem to
reduce bone density (whether on own or due to malabsorption)
Exercise (weight bearing exercise) has also been shown to be beneficial in
combination with dietary modification. Also,
muscle strength → coordination/balance → fall risk!!
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Document Summary
In 2012, 4. 74 million australians considered to have poor bone health. 5. 5% of all women v 1. 4% of all men. +75 years; 1/5 women v 1/14 men. Total costs relating to osteoporosis estimated at . 75billion per year. (cid:862) a skeletal disease (cid:272)ha(cid:396)a(cid:272)te(cid:396)ised (cid:271)(cid:455) lo(cid:449) (cid:271)o(cid:374)e (cid:373)ass and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility and sus(cid:272)epti(cid:271)ilit(cid:455) to f(cid:396)a(cid:272)tu(cid:396)e(cid:863) Osteoporosis - a disorder which is characterised by low bone density weakness of bone. Less dense decrease of strength increase in fractures. Osteopenia - bone mineral density below average. Loss of bone mass can be made by a physician through a bone mineral density test (bmd). Use dual-energy x-ray absorptiometry (dexa) to measure bone density in the spine, wrist, and/or hip. Peak bone mass is achieved is achieved at around 25-30yrs of age. Bone mass can be optimised in adolescents through exercise loading. Adoles(cid:272)e(cid:374)t e(cid:454)e(cid:396)(cid:272)ise (cid:272)a(cid:374) bmd (cid:271)(cid:455) up to (cid:1005)(cid:1004)% i(cid:374) 6 (cid:373)o(cid:374)ths (hi(cid:374)d & bu(cid:396)(cid:396)o(cid:449),
