3.1.1 The “Typical” Osteoporosis Patient
Osteoporosis has been called a paediatric disease with geriatric consequences. However, it is easy to assume that an older, frailer person with a kyphotic posture is clearly a ‘typical’ osteoporosis patient. The danger of this assumption is that in fact you may be missing crucial populations who really need to be screened and/or receive clinical intervention by you and your medical colleagues!
Consider these populations who are known to be affected by osteoporosis:
Post-menopausal women with a fragility fracture Medication-induced osteoporosis (eg., chronic glucocorticoid usage) Female athlete triad (disordered eating, amenorrhea, low BMD) Anorexia nervosa (90% have low BMD at 1 site) Systemic diseases (bowel disorders, RA, endocrine disorders, uncontrolled diabetes, long-term asthmatics Low sex hormone levels in both men and women Men (aged 50-79, approximately 5% have OP, while over 80 that increases to 20%) Pediatric populations eg., children with CP, spina bifida Duchennes MD, those on long-term glucocorticoid therapy or immobilized.
Can you think of a patient you have seen in the last 3-6 months who may have fallen into one of these categories?
Did you ask them about their bone health? Did you ask about risk factors (Module 1)? Did you prescribe exercise for them?
Consider what you might do differently next time, now that you know what a ‘typical’ person with osteoporosis could really look like!
What does the person look like in your clinical setting, typically? Consider the following characteristics of your patient with osteoporosis:
Age Comorbidities Cognitive abilities Balance impairment/falls risk Postural changes With or without presence of fractures Soft tissue alterations Strength losses Presence of low-trauma fractures Location Severity Affect on ADLs Presence of Secondary Osteoporosis Contributors? Risk factors for fracture? Why do the above factors matter?
Consider the following three scenarios and for each one, decide how your exercise recommendations would vary and why:
Two women diagnosed with osteoporosis (exact same BMD) but one is aged 45 and one is aged 71. Two men diagnosed with osteoporosis, same age, one with confirmed vertebral fractures & kyphotic posture, one without. Two women, same age, with a similar kyphotic posture, neither with any confirmed fractures, one with a BMD of -1.2 , the other with a BMD of -2.4.