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One in three women and one in five men will experience a fracture due to osteoporosis in their lifetime. The clinical significance of osteoporosis is largely due to increased fracture rates, particularly in the hip and spine, that may lead to immobility and subsequent hospitalization. This may increase the risk of cardiac complications, pneumonia and pulmonary embolism, significantly impacting in-hospital mortality. It is a major health issue, with an osteoporotic fracture occurring every 3 seconds worldwide. Exercise is often recommended for people with osteoporosis and has been shown to maintain bone mass and reduce falls with fewer side effects. Although exercise has multiple benefits, adherence to this activity is poor, with 50% of those registered in a program dropping out within the first 6 months. One method to increase adherence to exercise is to identify the facilitators, barriers and preferences to physical activity. Identification of these facilitators and barriers may allow researchers and clinicians to design better exercise programs that increase motivation. This dissertation discusses the development of a new tool that can measure the factors that affect exercise adherence and calculates the content and construct validity and the test-retest reliability of the measure in the osteoporosis population. This tool has potential applications in both the research setting and in clinical practice. Investigators can use this tool to survey their population of interest and use this information to leverage the facilitators and limit the barriers in their methodologies when designing activity programs, while clinicians can identify and design better exercise prescriptions for individual clients. / Thesis / Master of Health Sciences (MSc)

Thesis / Master of Science (MS)

In osteoporosis treatment, current interventions suffer from challenges of guaranteed efficacy for patients. Electrical stimulation has been shown to improve bone mass in animal models of disuse, but there have been no studies of the effects of electrical stimulation on bone loss in a hormone deficiency model. The purpose of this study was to explore the effects of electrical stimulation on bone mass in the ovariectomized (OVX) rat model. We developed a custom electrical stimulation device capable of delivering a constant current, 15 Hz sinusoidal signal. We used 30 female Sprague Dawley rats (12-13 weeks old). Half were OVX, and half underwent sham OVX surgery (SHAM). These rats were divided into baseline, stimulation (stim), and no-stimulation (no-stim) groups. Stimulation groups received transdermal electrical stimulation to the right knee, while the left knee served as a non-stimulated contralateral control. The no-stimulation groups had electrodes placed on the right knee, but not connected. Rats underwent the procedure for one hour per day for six weeks. Rats were sacrificed (CO2) after six weeks. Femurs and tibias were scanned by microCT. MicroCT data were analyzed for trabecular and cortical bone measures. Femurs and tibias from OVX rats had significantly less trabecular bone than SHAM. In the distal femur of OVX-stim rats, bone volume fraction was significantly greater in the stimulated right than the non-stimulated contralateral (left). There were no differences between stim and no-stim groups for tibial trabecular measures, or cortical bone measures in either the femur or the tibia. This study presents novel findings that electrical stimulation can partially mitigate bone loss in the OVX rat femur, a model of human post-menopausal bone loss. Further work is needed to explore why there was a differential response of the tibial and femoral bone, and to better understand how bone cells respond to electrical stimulation. / Thesis / Master of Applied Science (MASc) / In osteoporosis treatment, current interventions, including pharmaceutical treatments and exercise protocols, suffer from challenges of guaranteed efficacy for patients and poor patient compliance. Moreover, bone loss continues to be a complication factor for conditions such as spinal cord injury, prescribed bed-rest, and space flights. A low-cost treatment modality could improve patient compliance. Electrical stimulation has been shown to improve bone mass in animal models of disuse, but there have been no studies of the effects of electrical stimulation on bone in the context of bone loss under hormone deficiency such as in post-menopausal osteoporosis. To explore whether electrical stimulation could positively affect bone mass, we developed and tested a custom electrical stimulation device in the ovariectomized rat model of post-menopausal osteoporosis.

Bone densitometry is the only clinically acceptable and objective method for the accurate measurement of bone mineral density (BMD), bone mass, and the prediction of bone fracture risk. Dual energy X-ray absorptiometry (DXA) is the primary diagnostic bone densitometry tool used in clinical settings. A growing need exists to determine how health care professionals and women use the information obtained from DXA scans in the management of osteoporosis. Few studies have investigated physicians' recommendations and women's compliance related to detection and treatment of osteoporosis after receiving BMD results by DXA. No studies have investigated actions that women have taken after receiving BMD test results conducted by DXA. This descriptive, exploratory study assessed actions that women took and what they perceived their physicians did after receiving BMD results. Using a telephone survey, actions of 138 women, who participated in a previous study of bone health, were evaluated regarding osteoporosis detection, prevention, and treatment. Many women (62%) shared their BMD test results with health professionals. However, 75% of women with low BMD status and who shared their results with health care professionals reported that they did not receive recommendations for advanced tests. Moreover, these women did not receive recommendations for dietary intake changes (60%), medication use (72%), or other lifestyle changes (60%). Yet 58% of these women self-initiated behavioral changes after receiving their BMD test results. Of the women who changed their behaviors, 67% of postmenopausal women increased exercise. Ninety-two percent of these women indicated they would engage in BMD testing again. / Master of Science

Osteoporosis is caused by a multitude of factors. An individual’s risk for experiencing a bone fracture as a senior citizen increases without early intervention. Healthcare professionals do not have access to validated survey tools to identify young adults in need of osteoporosis prevention education, although survey tools to identify postmenopausal women at high risk for low bone mass are available. The purposes of this study were to evaluate three of these survey tools for use in a younger population, and to determine if young adults with osteoporosis risk factors received bone health education from a health professional. Forty-two men and 41 women completed surveys and health questionnaires; responses were compared to bone mineral density (BMD) and content (BMC) measurements. Healthcare professionals discussed bone health with only 13% of participants. Chi-square analysis revealed that health professionals were not more likely to discuss osteoporosis with subjects based on age or gender. Participants with T-scores ≤ -1.0 were not more likely to receive bone health education. Area under the receiving operating characteristic (AUROC) curves analysis revealed that no survey tools were able to identify moderate-risk participants at T-scores ≤ -1.0, and AUROC curves for all surveys did not exceed 0.525 at this level. Two surveys detected participants at high risk for bone disease with identical AUROC curves of 0.821 at a T-score ≤ -2.0, and 0.813 at a T-score ≤ -2.5. The AUROC curves indicate that current tools designed for older women do not detect young adults with moderately low T-scores. / Master of Science

京都大学 / 新制・課程博士 / 博士(医学) / 甲第25185号 / 医博第5071号 / 新制||医||1072(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 山本 洋介, 教授 寺田 智祐, 教授 柳田 素子 / 学位規則第4条第1項該当 / Doctor of Agricultural Science / Kyoto University / DFAM