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Julie Ronnebaum, PT, DPT, GCS, CEEAA

Osteoporosis Cases Block I Clinical Applications; DPT Class of 16

Osteoporosis:
Readings/ Resources:
APTAs Guide to Physical Therapist Practice. 4A, 4B, 4C, 4F, 4G.
Goodman et al. Pathology: implications for the Physical Therapist.
Jarvis, Physical Examination and health assessment.
Kisner C, Colby L. Therapeutic Exercise foundations and techniques.
National Osteoporosis Foundation
www.NOF.org
Foundation for Osteoporosis Research and Education
www.fore.org
NIH Osteoporosis and Related Bone Diseases
www.osteo.org
Arthritis Foundation
www.arthritis.org

Osteoporosis: Program Development In A Community Center


Project Objectives: Upon completion of this project, students should be able to:
Examination
Recognize the prevalence of osteoporosis in a practice population and in
the population at large.
Name medical tests available to screen for the presence of osteoporosis.
Evaluation/ Diagnosis
Describe the basic biomedical concepts related to bone health.
List at least three risk factors associated with osteoporosis including
medical diagnoses that would increase the risk of development of
osteoporosis.
Evaluate the impact of osteoporosis on an individual.
Evaluate barriers to intervention.
Intervention
Identify strategies to prevent osteoporosis throughout the life span that
could be addressed during patient consultation.
Develop an exercise program appropriate for an individual with
osteoporosis.
Employ individual and group teaching strategies in development of a
community-based osteoporosis program.
Discuss nutritional, exercise and hormonal issues that relate to bone health
at different stages of life, different genders, and different cultural groups.
Develop a therapeutic plan for a patient.
Demonstrate a variety of education strategies.
Compare the roles and responsibilities of various health professionals in
the prevention, and management of osteoporosis.
Re Examination
Monitor outcomes of an individual participating in the community
program or during an individual consultation.

Project Instructions:
The class will be divided into groups to work on outlining an osteoporosis
program that could be based in a community center. Each group will receive a
case study. The patient in your case will be attending the community-based
program which you have developed in addition to receiving an individual
consultation from you. Using the recommended readings as well as other
sources, each group will work as a team to prepare a 15-20 minute presentation
on the community-based program which they have developed including
incorporation of the ten items listed below for your groups case.
1. List the osteoporosis risk factors for the patient in your case.
2. What other information about this individual will influence your intervention
or their participation in your program?
3. How will you have this individual track their outcomes in the program?
4. List three areas that would be addressed during an individual
consultation with the patient in your case.
5. List teaching strategies and components of your program that would be
best presented to your patient on an individual basis and strategies and
components that would be best if delivered to your patient when part of a
group. Please justify your answer.
6. In considering osteoporosis throughout the lifespan, describe where the
patient in your case fitswill this impact your teaching strategies or
program development when working with a larger group of program
participants?
7. What primary prevention strategies would you recommend to this
individual?
8. What special considerations should be taken into account when
developing an exercise program for this individual? Please justify.
9. Would health professionals in addition to PTs be involved in the program
that you have developed? Who would they be and how would they be
involved with the patient in your case?
10. Briefly describe the program that you would developtarget audience,
structure, delivery methods, content areas, other.

Osteoporosis Case Studies


Case 1:
Patient name: Nancy Age: 19

Height: 54

Weight: 98 pounds

Nancy is a college sophomore with excellent academic records and athletic performance
records throughout high school and college. She has been dieting for 4 years and has
become obsessive about her eating habits. She refuses to eat any dairy foods, fats, red
meat, or poultry. She eats fish only rarely.
Nancy feels as though she is fat and exercises 1 to 2 hours daily in attempts to
control her weight, however, her friends tell her she is just skin and bones. She is on
the swim team and works out in the gym with exercise equipment.
Her parents and physician have suggested professional help to regain her normal weight
and eating patterns, but she refuses. She has not told them that she has had no menstrual
periods for the past two years.
Nancys swimming coach has seen a decline in Nancys performance over the past year
as she has lost weight. The coach has convinced Nancy to contact Student Health
Services and has asked her to make an appointment with her primary care physician.
Osteoporosis Case Studies
Case 2:
Patients name: Cornelia
Age: 70

Height 52

Weight: 111 pounds

Cornelia is a pleasant, widowed, Caucasian female living in a small apartment near the
shopping area of her small town. She complains of back pain and stiffness, fatigue, and
difficulty sleeping. Cornelia was 57 and weighed 151 pounds at high school
graduation. She married at age 19 and was widowed at age 60; she has no children and
no relatives nearby.
Her medical history includes two miscarriages followed by a major depression for which
she was hospitalized for four weeks at age 29. She has had no subsequent depressive
episodes. At age 43, she had a complete hysterectomy and bilateral oophorectomy. She
was given estrogen but took it for only 3 or 4 months. She has been on antihypertension
medication since her late 40s.
Cornelia had a 34 pack year history of smoking but quit 10 years ago. She reports
drinking 1 or 2 ounces of alcohol before dinner and the same before bed if her pain is
bad. She has had a low dietary calcium intake.
At age 58, she had a Colles fracture post mild trauma and at age 61 she had a
compression fracture of L1 while vacuuming and 4 more compression fractures over a
period of 7 years. She also fractured two ribs while coughing.

Cornelias bone density measurement is three standard deviations below the young adult
normal value. She has done no weight-bearing exercise because she is afraid that it will
cause fractures. Her physician has supported this decision.
Cornelia currently reports feeling blue and alone. Her back pain no longer responds to
Percocet or Tylenol #3. She is having trouble doing her routine chores; she cannot lift
pots and pans in her kitchen and settles for TV dinners often. A meticulous housekeeper,
she can no longer vacuum or dust and is unwilling to let her friends come in to see her
mess. She also has some difficulty dressing and undressing.
Osteoporosis Case Studies
Case 3:
Patients name: Ron
Age: 39

Height: 56

Weight: 125 pounds

Ron lives in a ranch-style house with his wife and 10-year-old daughter. They have many
relatives and friends in town. His wife works at the public library. Ron is not currently
working due to his severe rheumatoid arthritis and receives disability benefits. He had
been employed as a respiratory therapist which required him to be on his feet most of the
day.
Ron was once active in sports, but has not been able to participate due to his illness. He
has been taking prednisone for 23 years since his RA was diagnosed.
Episodes with Rons illness vary in severity, however, two years ago during a particularly
severe episode; his physician increased his prednisone dose. Ron was confined to a
wheelchair at that time, but is now able to walk again with a straight cane. He credits his
daughter with providing the inspiration that he needed to get back on his feet.
Ron had noticed increasing frequency of backaches, so his physician ordered a bone
density test. His bone mass was 2.5 standard deviations below the young adult mean. An
x-ray indicated several vertebral compression fractures.
The new findings have frightened Ron. Ron worries about being able to return to work
and if he could work, what type of job he would be able to handle. He doesnt want to be
a burden to his family and is concerned about having money to send their daughter to
college.
Osteoporosis Case Studies
Case 4:
Patients name: Stephen

Age: 68

Height: 58

Weight: 150 pounds

Stephen is a 68-year old African American man who was diagnosed with prostate cancer
1 years ago. He has been treated with gonadotropin releasing hormone (GnRH)
analogs.

Stephen slipped on the ice and suffered a proximal fibular fracture 8 years ago; he has no
limitations from this injury but does have osteoarthritis in both knees which makes
squatting and going up and down stairs painful. He does not have a history of any other
medical problems. He does not smoke. Stephens mother had osteoporosis and passed
away at age 85 from complications following a hip fracture.
Stephen is a retired elementary school teacher who enjoys yard work and going on walks
with his wife, although he hasnt had the energy or motivation to do either of these since
his illness. He and his wife live in a 2-story home. They have a son and 3 grandchildren
who live 3 hours away.
Stephen hasnt had much of an appetite lately. He and his wife enjoy a cup of coffee with
toast in the mornings, share a sandwich or salad at noon, and have a small meal in the
evening.

Osteoporosis Case Studies


Case 5
Patients name: Pat
Age: 57

Height: 55

Weight: 135 pounds

Pat is a 57-year-old Asian woman who presents with osteoporosis. Her DEXA scan
revealed a BMD T-score of -2.5 at the lumbar spine and -2.2 at her hip.
She entered physiological menopause at age 52 and has never used hormone replacement
therapy. Last year she sustained a vertebral fracture (T10) when lifting a milk jug from
her shopping cart.
Pat has been on bisphosphonate therapy and a daily calcium supplement. Pat was recently
diagnosed with celiac disease.
Pat includes dairy products in her diet. She states she has been told to avoid gluten in her
diet although this is difficult because she enjoys cooking and sharing new recipes with
neighbors. Pat is employed as a data entry clerk. Since her fracture, Pat has been afraid
to exercise and has discontinued her fitness center membership. She misses the social
interaction that she had in her aerobics class.