Abstract
HISTORY: 70 year old female with Osteoporosis was referred to Physical Therapy for gait and balance training. The patient denies any prior history of cancer, diabetes, neurological history, prior orthopedic injuries/surgeries, or major cardiac events/surgeries. Her current prescribed medications include Lipitor, Norvasc, Hyzaar and Lexapro. The patient further mentions a history of osteopenia, but a recent DEXA scan classified the patient as Osteoporotic at femoral neck with a T-score of -2.5. The patient was prescribed 70 mg of Fosamax QD and continued with supplemental Calcium with Vitamin D. The patient reported reduction of balance with day to day activities and reported a fear of falling, but denied any falls.
PHYSICAL EXAMINATION: Postural assessments demonstrated excessive forward head posture, with increased thoracic kyphosis along with excessive lumbar lordosis. Neurological assessment and ROM at the lumbar spine and hips were all within normal limits. Limited muscular strength was noted in bilateral lower extremities. Deficits in static balance were also noted with tandem stance.
TEST AND RESULTS:
Dynamic Gait Index Score of 15/24, consistent with an increased fall risk.
DEXA results at femoral neck: T-Score: -2.5; BMD: .572 gr/cm2
DEXA results at lumbar spine: T-Score: -2.2; BMD: .807 gr/cm2
INTERVENTION: A Progressive Resistive Functional Power based exercise program was conducted an average two times per week for one year. A treadmill warm-up followed by progressive functional activities such as sit to stands for speed, forward step ups for speed, hip abduction and hip extension for speed were included. Progressions consisted of increased resistance and increased speed of movement.
OUTCOMES: DEXA scan demonstrated BMD improvements of 29% (742 gr/cm2 ) and 24% (1.003 gr/cm2), as well as improvements in T-score to -2.1 to -1.5 at her femoral neck and lumbar spine, respectively. The changes attenuate fracture and mortality risk. Furthermore, a 7 point change in her Dynamic Gait Index score was noted post intervention, resulting in a decreased risk of falling. The patient has continued to be independent with a home exercise program along with continued use of her prescribed medications.