REHB1001 Chap.10 Osteoporosis, Fractures, Falls and Paget's Disease
Osteoporosis, Fractures, Falls and Paget's Disease
The Week 5 lectures link fragile bone, falls and fractures, and the Week 8 lecture adds Paget's disease.
This chapter places the WHO T-score bands on one scale, lists fracture sites and the warning that most vertebral fractures are painless, separates exercise that builds bone from exercise that only maintains strength, draws the four overlapping stages of fracture healing, summarises the falls evidence, and sets out Paget's disease with the precaution its fragile bone creates for mobilisation.
Practice items cover T-score boundaries and a viva-style question on mobilising a patient with Paget's disease after a hip fracture.
What this chapter covers
- 01
Osteoporosis as a silent disease
- 02
DXA and the WHO T-score bands
- 03
Fragility fractures and their sites
- 04
Exercise that builds or protects bone
- 05
Four stages of fracture healing
- 06
Falls risk and prevention
- 07
Paget's disease and its precautions
Worked example · free
Placing T-scores on the WHO scale
- +1Minus 1.0 is normal, because the normal band is minus 1 or higher.
- +1Minus 2.4 is osteopenia, between minus 1 and minus 2.5.
- +1Minus 2.8 is osteoporosis, at or below minus 2.5.
- +1For osteoporosis, add progressive weight-bearing, balance and strength work and prone back extensor training, since swimming alone does not increase bone density.
Key terms
- T-score
- A DXA bone density result compared with a young adult reference, classified by WHO bands.
- Osteopenia
- Low bone density with a T-score between minus 1 and minus 2.5.
- Fragility fracture
- A fracture from low-energy trauma, such as a fall from standing height or less.
- Bony callus
- Woven bone laid down during the third stage of fracture healing.
- Alkaline phosphatase
- A bone-related enzyme whose blood level helps confirm Paget's disease.
- Remodelling
- The final, long stage of fracture healing in which callus becomes mature bone.
Osteoporosis, Fractures, Falls and Paget's Disease FAQ
Why is osteoporosis called a silent disease?
Because it is not painful until a fracture occurs, and even then about 70% of vertebral fractures are painless. The lecture advises suspecting one when a person has lost 3 cm of height or developed a marked kyphosis. That is why physiotherapists screen for it as a comorbidity in older patients.
Does exercise prevent fractures in osteoporosis?
The lecture says exercise improves the two main risks for minimal-trauma fracture, falls and low bone density, and can maintain or increase bone density, but direct evidence that it reduces fractures is lacking. Balance and strength work, Tai Chi and group or home programmes do reduce falls.
What does Paget's disease mean for a physiotherapist mobilising a patient?
The new bone in Paget's disease is weak and prone to fracture, so the lecture lists bone fragility as a precaution for physical activity. Mobilise with falls prevention in place: a safe environment, a suitable gait aid and close supervision, and support the person's self-management.
What are the four stages of fracture healing?
The Week 5 lecture names haematoma formation immediately after injury, granulation tissue starting within two weeks, a bony callus forming over weeks and lasting months, and remodelling that continues for months to years. It stresses that the stages overlap significantly rather than following one another neatly.
How much does exercise reduce falls in older adults?
The falls lecture reports that exercise reduces falls in high-risk groups by 23%, falls causing fracture by 27% and falls needing medical attention by 39%. It also lists home safety changes, medication review and vision, podiatry, cognition and continence assessment as parts of a multifactorial plan.
Which bones fracture most often in osteoporosis?
The lecture lists the vertebral bodies, distal radius, proximal humerus, pelvis and proximal femur, and singles out hip fractures as the most concerning because of their high morbidity and mortality. Fractures of the fingers, toes, skull or face usually have other causes.
Exam move
Draw the T-score scale and the healing timeline from memory. Learn the exercise rules as pairs: which type builds bone, which reduces falls, which protects the spine. Memorise the three falls-prevention percentages with their meanings, and practise answering the Part B style of educator questions aloud for Paget's disease.
Make a falls-prevention checklist under environmental, biological and task-related headings, and use it on one case from the tutorials.
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