ORTHOSES FOR OSTEOPOROSIS

Pathophysiology of osteoporosis
 Osteoporosis is a disorder in which mineralized bone
density is below normal, resulting in a bone structure that
is vulnerable to fractures.

 Osteoporosis is the most common of the metabolic bone

diseases described as osteopenia, meaning "too little
bone."
 Types of osteoporosis

 Type I
 Affects women and is associated with estrogen deficiency occurring
5 to 10 years after menopause
 Trabecular osteogenesis is primarily affected and results in a
diminished capacity to support compressive loads.
 vertebral bodies, the distal radius, and the hip are common sites at
greater risk for fractures.
 Type II
 osteoporosis affects both males and females.
 It is due to calcium deficiency and is associated with aging.
 Both trabecular and cortical bone are affected.
 Because cortical bone provides support, especially for bending and
torsional loads, the femoral neck, proximal tibia, humerus, pelvis,
and vertebral bodies are at higher risk for fractures.
 Vertebral compression fractures (VCFs)

 Can present with acute pain, or they can be silent and have
no associated pain.

 Nearly one third of the latter patients will experience

chronic pain.

 VCFs typically are caused by falls, but they may result from
as a cough or sneeze.

 VCFs lead to progressive sagittal deformity hyperkyphosis

(dowager's hump)

 In the case of muscle imbalance, the kyphotic deformity

progressively elongates the paraspinal muscle extensors
 Orthotic treatment
 Posture training support (PTS)
 Posture training support (PTS)

 Called a "weighted kypho-orthosis," provides a weight

suspended just inferior to the scapulae
 Is indicated in cases of excess dorsal kyphosis

 Mechanisms of action
 Anterior compression forces on the spine are reduced by the
countermoment produced by the posterior weight.
 The device encourages active back extension through
proprioceptive input and helps increase back extensor strength.
Dorsolumbosacral corset
 Dorsolumbosacral corset
 They increase the intracavity pressure and provide
resistance to axial loading.
 They also serve as a kinesthetic reminder in all three
anatomical planes.

 Possible orthotic goals of these devices include:

 reduction of pain by axial unloading
 reduction of muscle strain
 improvement of standing balance by moving the position of the
center of gravity posteriorly.
Three-point hyperextension orthoses
 Spinomed (TLSO-sagittal plane control)

 Weighs approximately 450 g,

 Consists of a metallic "back pad"

that can be molded by hand
without heating and a system of
hook-and-loop straps

 Worn similar to how a backpack is

worn
 Spinomed
 The Spinomed can
 Increase body height

 Strength of the back extensors

and abdominal flexors

 Relaxed vital capacity

 Overall well-being.

 Significant decreases in
kyphosis angle, postural sway
magnitude and velocity, and
pain also were observed by
using of Spinomed.
Posterior shell TLSO
 Posterior shell TLSO
 consists of
 a plastic posterior shell,
 a soft corset front,
 and a system of straps
 Similar to the Spinomed, the shoulder straps provide
posteriorly directed forces that help correct the unbalanced
anterior posture in the sagittal plane

 However, unlike the Spinomed, the plastic posterior shell is

not designed to be in total contact
 at the superior portion in the initial phase of orthotic treatment,
but it may achieve contact in the later phase of orthotic
treatment.