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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 Dowager’s 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 .

5-1% every year of After menopause men bone mass loss >65 years The rate is slowing down . Men and woman have 4th gradual loss Women 6 times than 0.

small-framed female Removed ovaries Early menopause Endocrine disorders >50 years Smoking Alcohol abuse High protein diet Sedentary lifestyle .Who’s at risk? Fair skinned. white With family history Thin.

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 .

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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 .

family members at risk can be followed. and other causes of bone loss as osteomalacia can be elimated . 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.

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 . kyphoscoliosis. Evaluation Physical Examination Finding note generally bodily habitus.

635 mg of conjugated estrogen for 21 days. Treatments Estrogen replacement (0. 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 . 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.

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 .

. Orthose spinal selectable Jewett Brace Bivalved Shields/thoracolumbal brace. the immobilization of vertebrae can reduce muscular spasm  spasm occurs as a response from the edema on subperiosteum due to the fracture. Quite useful. Acute Pain Goals • To reduce acute pain. • Vertebral movement increases the pain. followed by spasme muscles.

In principle. The recommended Program: Avoid Physiotherapy : Bed rest less Ergonomics. the acute pain resolved immediately.exe ositioning modalities. if necessary by administering a sedative drugs and also the proper body position. or weak analgesic can be selected to avoid constipation.P therapeutic than 1 week Analgesic constipation. rcise Program massage . Analgesic medications such as codeine sulfate and its derivation.

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 .

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. Outcome Typical postmenopausal osteoporotic woman is at great risk for fracture Can be minimazed with education and appropriate & indicated drug therapy.

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

Acknowledgement With grateful acknowledgement .

THANK YOU! .