Best Practice Case Studies-Case 113 Asset 8 Exercise and Osteoporosis

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Osteoporosis is a bone disease in which the normal cycle of bone breakdown and rebuilding shifts toward less bone formation and poorer bone quality. The main consequence is weaker, more brittle bones and a higher risk of fractures, often from minor injuries. It is commonly associated with aging (“primary osteoporosis”), particularly in women after menopause, though “secondary osteoporosis” can occur at any age in either sex due to certain diseases or medications.<br /><br />Risk factors include being female, older age, low body weight, long-term steroid (glucocorticoid) use such as prednisone, smoking, rheumatoid arthritis, heavy alcohol use, endocrine or absorption disorders (e.g., diabetes, hyperthyroidism, malabsorption), certain ethnic backgrounds (e.g., Caucasian), and nutritional/hormonal deficiencies (low calcium, low vitamin D, low estrogen). Young athletes with low energy availability—burning more energy in training than they consume—are also at risk; menstrual irregularities and low estrogen in females further increase risk.<br /><br />Osteoporosis usually has no symptoms until a fracture occurs. Common fracture sites include the spine, hips, and wrists, and injuries may seem unexpectedly minor given the severity of the break. Because it can be silent, screening and diagnostic testing are important.<br /><br />Diagnosis is commonly made with a DEXA scan, which measures bone mineral density and reports results as T or Z scores compared with healthy or age-matched controls. Scores between about -1.1 and -2.4 indicate osteopenia, and below -2.5 indicate osteoporosis. Clinicians also consider fracture history and may order blood tests to look for underlying causes, as well as assess diet, exercise habits, and energy availability.<br /><br />Treatment and prevention emphasize adequate calcium and vitamin D intake, weightbearing and moderate-impact activity (walking/jogging), strength training, and balance/coordination exercises to reduce falls. Smoking cessation and limiting alcohol help. Medications such as bisphosphonates may be used in men and postmenopausal women (not typically for women of childbearing age). Athletic participation is generally allowed; after fractures, full healing and rehabilitation are needed before return.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 113

Topic Ankle

Keywords

osteoporosis

bone mineral density

DEXA scan

fracture risk

postmenopausal women

secondary osteoporosis

bisphosphonates

calcium and vitamin D

glucocorticoid (steroid) use

weightbearing exercise

4th Edition

Ankle

4th Edition, Case 113