Osteoporosis

Brittle Bone Disease

 Age 75
Age 50
 What is Osteoporosis?
• Osteoporosis is a condition that
features loss of the normal density of
bone and fragile bone.

• This disorder of the skeleton weakens

the bone leading to an increase in the
risk of breaking bones.

• The osteoporosis condition can operate

silently for decades, because
osteoporosis doesn't cause symptoms
unless bone fractures.

• The spine, hips, and wrists are

common areas of osteoporosis-related
bone fractures.
 Factors that Determine Bone Strength
• Normally, bone density accumulates during
childhood and reaches a peak by around age
25.

• After age 35, both men and women will

normally lose 0.3 to 0.5% of their bone density
per year as part of the aging process.

• Estrogen is important in maintaining bone

density in women.

• When estrogen levels drop after menopause,

bone loss accelerates.

• Approximately 40% of persons 65 years or

older fall every year.

• 1.5M fragility fractures in the US yearly

Hip Fractures
High Prevalence:
One in six women who reach the age of 80
years will suffer a hip fracture
The incidence is rising due to:
– Aging population
– Rising age-related fracture rate
• Smoking
• More sedentary lifestyle
 Proximal femoral fracture: Causes

• Usually caused by falls indoors

• Depends on the bone strength
• Severity related to how effective the neuromuscular
response is to protect the skeleton
 Hip Abduction Orthosis
• Provide:
-support in immobilization
-optimal positioning of flexion, extension,
abduction, and adduction
-helps prevent dislocation of the hip
• Used for:
-inoperable hip patients
-post operative hip management
• Patient able to put it on themselves
 How is it made?
• No molds necessary
– Universal pelvic, thigh, and hip joints with adjustable
straps fitted separately
• Materials used
– Mesh pelvic and thigh components with padding for
comfort
– Velcro straps adjust for a perfect fit
– Adjustable metal hinge
– Silicone skin adhesion system on pelvic and thigh
cuffs to prevent rubbing and rotation
 How does it help?
• Adjustable hinge aligned with the hip joint
of patient
– Limits range of hip rotation
– Newport Hinge offers:
• 10 degree increments of flexion/extension control
• 7.5 degree increments of abduction/adduction
control
 Seat Lifts
• Assistive devices used to lift
the body from a sitting
position to a standing
position
• Greatly reduces stresses on
the hip associated with
sitting down
• Can also be used to lower
the patient to a sitting
position
 Distal Radius Fracture
(Colles’ Fracture)

• Occurs in patients with osteoporosis who

throw their hands forward in an attempt to
break their fall. The radius buckles just
above the wrist, resulting in a backward
angle.
 Wrist Orthosis
• Temporary positioning and/or
immobilization of wrist and hand fractures
• Post-cast immobilization, however can
eliminate the need for serial casting
• Some designs control wrist position, while
still allowing partial range of motion for the
wrist, elbow, and fingers.
 Maramed Colles’ Fracture Brace
How is it made?
• Prefabricated from polyethylene
– Trimming with cast scissors necessary for exact fit:
• Fit patient with orthosis and mark trim line
• Cut along line using cast scissors
• Sand surface to smooth the edges
– Reshaping Orthosis:
• Apply heat source to region needing adjustment
• Alter the shape as needed by applying pressure to the
warmed plastic
• Run cool water to freeze plastic in place
• Repeat as needed
 Maramed Colles’ Fracture
Brace
• Adjustable with Velcro
– Allows for changes in swelling associated with
fracture healing
– Compresses soft tissue while accommodating
volumetric changes
• Edges sanded smooth to minimize
discomfort
• Patient able to put it on themselves
 Vertebral Compression Fractures
(VCFs)
• Fracture resulting when the upper
body exceeds the ability of the bone
within the vertebral body to support
the load. 1
• Affects 25 percent of
postmenopausal women.2
• In 1995, the annual direct medical
cost of vertebral compression
fractures in the US estimated to be
~746 million dollars.2
 Common Types of VCFs

Figure1. Wedge Fracture. Figure 2. Burst Fracture.

 Complications and Treatment
• Only one third of vertebral fractures are
diagnosed 2,3
• Complications: acute pain, chronic pain,
physical limitation, and chronic depression.
• Treatments: surgical, pharmacological, and
non-pharmacological
 Treatments
Pharmacological :
• Calcium supplements
• Vitamin D
• Hormone Replacement Therapy
• Selective Estrogen Replacement
Modulators
• Intranasal Calcitonin
•Bisphosphonates.

Surgical:
•Vertebroplasty
•Kyphoplasty
•Fusion
http://www.aafp.org/afp/20040101/111.html
 Non-Pharmacological Treatment
• Exercise
• Physical management of pain
• Gait training 4
• Orthotic treatment:
- Acute pain immobilization
- Chronic pain increase strength of paraspinal
muscles
- Often the wrong orthosis is prescribed by the doctor
to treat the patient’s ailment
 Orthotic Treatment of VCFs

Only 2 Orthotics
scientifically studied for
efficacy:
•Spinomed®-activates back
muscles to straighten the
dorsal spine and decrease
kyphosis to treat chronic VCFs

http://www.spsco.com/press/07-12-06c.html
 Spinomed Design

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 Spinomed
• Minimal orthosis for the treatment of
osteoporosis
• Semi-rigid plastic back portion
• Extending from the tailbone to the first
cervical vertebra
• Adjusted for each patient in cold conditions
• Back pad and a strap system with Velcro
fasteners
 Posture Training Support (PTS)

• Encourages back extension through

addition of weights
- Used to treat chronic pain
• Limits flexion
• Posterior pocket holds up to two pounds
– Allows gradual progressive weight build-up
• No molds necessary due to adjustable straps
and differing sizes
– Sizing done by shoulder measurement
 PTS
• Materials used:
– Back support made of soft nylon plush bonded to
foam
– Weights made of vinyl with steel filler
– Clavicle straps are padded and have Velcro closure
for easy application and removal
 Posterior Shell Thoracolumbosacral
Orthosis (PSTLSO)5
• Restore sagittal plane standing posture
alignment
• Reduction of internal rotation of shoulders
• Improve vital capacity
• Restore heel-to-toe gait pattern
• Improve seated posture
• Indicated for chronic pain

http://www.gulfprosthetics.com/html/opbraces.html
 PSTLSO
• Pre-fabricated system of straps, soft corset
front, plastic posterior shell
– Posterior shell can be custom molded
• Shoulder strap tightness is increased to realign
the patient and pull back shoulders
• Soft corset for comfort
 Alternate Orthoses
• Lumbosacral Corset
• Dorsolumbosacral Corset
- Both recommended for
post-op, acute and chronic
pain management
• Three-Point
Hyperextension Orthoses
- Recommended for acute
pain
(From Sinaki M. Exercise and physical therapy. In: Riggs BL,
Melton LJ III, editors. Osteoporosis: Etiology, Diagnosis, and
Management. New York: Raven Press, 1988: 457-479.
Copyright Mayo Foundation.)
 References
1. Rockwood CA Jr, Green DP, eds. Fractures. Philadelphia: Lippincott,
1975.
2. Melton LJ 3d. Epidemiology of spinal osteoporosis. Spine 1997;22(24
Suppl):2S-11S.
3. Cooper C, Atkinson EJ, Jacobsen SJ, O'Fallon WM, Melton LJ 3d.
Population-based study of survival after osteoporotic fractures. Am J
Epidemiol 1993; 137:1001-5.
4. Sinaki M: Nonpharmacologic interventions – exercise, fall prevention, and
the role of physical medicine. Clin Geriatr Med 19:337-359, 2003.
5. Gavin TM, Patwardhan AV, Meade KP, Pawelczak SB, et al.: Class II
posterior shell TLSO improves treatment of thoracolumbar fractures.
Amer Pros Orth News, 5:1-4, 1999. Retrieved from
http://www.oandp.com/facilities/ia/ampro/spring994.htm.
6. Malas B, Meade KP, Patwardhan A, Gavin TM. Orthoses for Spinal
Trauma and Postoperative Care. Chapter 9.