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Respiratory Disease and Osteoporosis
Craig KnoxPhysiotherapist
Fracture Liaison CoordinatorLismore Base Hospital
lucocorticosteroid
nduced
steoporosis
Definition:
• 'Prolonged glucocorticoid therapy' is defined as the commencement of a dosage of inhaled glucocorticoid equivalent to, or greater than, 800 micrograms beclomethasone dipropionate or budesonide per day, or a supraphysiological glucocorticoid dosage equivalent to or greater than 7.5 mg prednisolone in an adult taken orally per day for a time period that is anticipated to last for 3 months or more. The bone density scan must be during the time of Glucocorticoid therapy. Patients no longer taking steroid medication do not qualify for a Medicare benefit.
Patients at risk…
• Mr Y with COPD is on Symbicort 400/12 x2 puffs twice a day which is 1600mg per day
• Mrs R with pulmonary fibrosis on Prednisone in variable dose but currently 10 mg daily of a four months duration
• Mr H with cryptogenic organising pneumonia on long term high dose steroids above 25mg daily
• Affecting 30—50% of patients [Angeli et al. 2006; Feldstein et al. 2005; Shaker and Lukert, 2005].
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383483/#bibr6-1759720X09343729https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383483/#bibr25-1759720X09343729https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3383483/#bibr81-1759720X09343729
Cost $$$
• $140 unless lucky enough to qualify for a 12312 item number
Picture of DEXA scan
Who’s at risk ? SmokerLow BMIHigh EtOHLate menarchyEarly menopauseEarly hysterectomyHypogonadismLow calcium intakeLow vitamin DAgeFemalePoor balanceReduced exercise toleranceFamily HxFalls
Prolonged (> 3 months) use of steroid medication
What should be done?
A case of “do as I say, not as I do…”
Benefits of Exercise …
LBH exercise and
Osteoporosis brochure
stretches
You don’t NEED an expensive gym…
Challenge Their Balance
• 15-20 mins a day. Offer support initially, then wean as able.
• Heel – toe steps• Forward/backwards/sideways/figure 8 walking• Single leg stance• Tai Chi• Choose a “new” old dance step each week• Eg.
Nutbush
Work on Strengthening
• Sit – Stand• Lunges• Squats• Rhomboids – seated row, bow and arrow• Biceps curl• POSTURE is key – minimize bending and twisting the spine• ? Start with 2 sets of 10? Aim to increase weight/resistance and
decrease reps?
Improve Flexibility of Thoracic Cage
• Daily 10-20 minutes to reverse the effects of modern postures• Eg modified Savasana• Doorway stretch• Back Against wall• Don’t forget the basics – calf, hip flexors
Try this…
Modified Savasana Stretch
Any Questions?
Respiratory Disease and OsteoporosisSlide Number 2Slide Number 3Slide Number 4Slide Number 5lucocorticosteroid�nduced�steoporosisDefinition:Patients at risk…Cost $$$Picture of DEXA scanWho’s at risk ? Slide Number 12What should be done?A case of “do as I say, not as I do…”Benefits of Exercise …LBH exercise and Osteoporosis brochurestretchesYou don’t NEED an expensive gym…Challenge Their BalanceNutbushWork on StrengtheningSlide Number 22Slide Number 23Improve Flexibility of Thoracic CageTry this…Modified Savasana StretchAny Questions?