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Bakgrund: Osteoporos har under de senaste decennierna utvecklats till en av de stora folksjukdomarna. I Sverige drabbas cirka 70 000 människor av osteoporosrelaterade frakturer varje år och av dessa är det främst kvinnor som drabbas. Risken för att en svensk kvinna någon gång under sin livstid skall drabbas av en osteoporosrelaterad fraktur är 50 %. Hur snabbt en kvinna förlorar benmassan samt hur stor benmassa hon har från början är avgörande för om hon kommer att drabbas av osteoporos och därför är prevention i ett tidigt skede viktigt. Syfte: Syftet med litteraturstudien var att belysa preventiva åtgärder för premenopausala kvinnor som kan förebygga primär osteoporos. Metod: Metoden var en litteraturstudie bestående av tio vetenskapliga artiklar baserade på kvantitativ forskning. Resultat: Resultaten visade att ett dagligt intag av gröna och gula grönsaker har en positiv effekt på benmassan. Ett års tillskott av antingen vitamin D, kalcium eller MMN-kalcium ökade Bone Mineral Density (BMD) hos kvinnor med underskott av D-vitamin. Fysisk aktivitet i form av tolv månaders high impact exercise ökade benmassan i loaded bones i nedre extremiteterna och i övre ländryggen (L1). Elitidrottare hade högre bentäthet jämfört med icke atleter och elitidrottare som utövade high impact exercise hade högre BMD än de som utövade medium impact och low impact exercie. Bentätheten ökade inte mer vid fysisk aktivitet och ett samtidigt intag av kalcium. Bentäthetsmätning och undervisning om osteoporos var effektivt för förändring av livsstil. Rökning och passiv rökning har en negativ inverkan på benmassan då de som rökte eller var utsatta för passiv rökning hade ett lägre BMD. Slutsats: Slutsatsen som drogs var att dessa resultat belyser viktiga faktorer som sjuksköterskan kan använda i det preventiva arbetet av primär osteoporos hos premenopausala kvinnor. Med kunskap från litteraturstudien kan sjuksköterskan undervisa patienter om åtgärder som är relativt enkla att ta till. Det krävs dock mer forskning för att stärka bevisen för de preventiva åtgärderna. / Background: Osteoporosis has during the last decades developed into one of the bigger common diseases. Each year around 70 000 people in Sweden suffers from fractures related to osteoporosis, with women being the majority. There is a 50 % risk that a swedish woman at some point during her lifetime will suffer from an osteoporosis related fracture. The rate at which a woman loses her bone density and how dense it initially was, determines whether she will get osteoporosis and early prevention is therefore imperative. Aim: The aim of this study was to highlight preventive measures for pre-menopausal women and prevent primary osteoporosis. Method: The method used was a literature study consisting of ten scientific articles based on quantitative research. Result: The result showed that a daily intake of green and yellow vegetables has a positive affect on density. One year of supplements with either vitamin D, calcium or MMN- calcium increased the Bone Mineral Density (BMD) in women with a lack of vitamin D. Physical activity such as twelve month of high impact exercise increased the bone density in loaded bones in the lower extremities and in upper lumbar spine (L1). Professional athletes had a higher bone density compared with non professional athletes, and professional athletes doing high impact exercise had a higher BMD than those who practiced medium and low impact exercise. The effect of physical activity on bone density is not greater when combined with calcium intake. Measuring bone density and education regarding osteoporosis showed to be an effective way for lifestyle changes. Smoking and passive smoking has showed to have a negative effect on bone density as those who smoked or were considered passive smokers had a lower BMD. Conclusion: The conclusion of the results shows important factors needed by nurses when working to prevent primary osteoporosis in pre- menopausal women. The nurse can with the knowledge from the literature study educate patients regarding measures that are rather simple to follow. However, more research is needed to strengthen and improve the evidence regarding preventive measure.

Early life factors such as birth weight have been associated with the risk of disease in adulthood, including osteoporosis. In the United States, an estimated eight million women have osteoporosis, a disease characterized by low bone mass and associated with increased risk of fracture. Peak bone mass, achieved during early adulthood, is a key determinant of risk of subsequent osteoporosis. Prior studies have suggested that an individual's birth weight is positively associated with bone mineral content (BMC) and bone mineral density (BMD) but results have differed depending on site of bone measurement and other factors considered. We assessed the relationship between birth weight and BMC and BMD using data from the University of Massachusetts Vitamin D Status Study, a cross-sectional study of 186 US women aged 18 to 30 years. Birth weight was assessed via self report and BMC and BMD were measured by dual energy x-ray absorptiometry (DXA). Multivariable linear regression and multivariable logistic regression were used to model the association between birth weight and BMC and BMD, adjusting for established risk factors for low bone density. After controlling for important factors, birth weight was positively associated with BMC and BMD, in large part due to the strong relationship between birth weight and body size. A better understanding of the physiology of the association between birth weight and adult body size and peak bone mass is needed to determine if birth weight is independently associated with peak bone mass.

Origin of renal osteodystrophy and cardiovascular complications are multifactorial. This complications are caused by disorders of calcium - phosphate metabolism already at the beginning of patient's irreversible renal failure. The factors playing the most important part in the development o renal ostedystrophy and are hypocalcemia and increasing serum phosphate levels associated with a declining glomerulal filtration. Two main types of renal osteodystrophy can be described - high turnover bone disease and low turnover disease. High turnover forms of renal osteodystrophy are characterized by rapid bone turnover caused by abnormally high PTH levels. The two types of high turnover renal osteodystrophy are predominant hyperparathyroid bone disease, and mixed uremic osteodystrophy. Low turnover forms of renal osteodystrophy are characterized by a dramatic drop in the rate of bone remodeling, caused by oversuppression of PTH and/or by aluminum accumulation. The bones become thin and overly flexible, and bowing may occur. The two types of low turnover renal osteodystrophy are low turnover uremic osteodystrophy and aluminum-related bone disease. Patients who have end-stage renal disease with increased serum phosphate levels and calciumphosphate products are associated with an increased prevalence of ectopic...

In the United States, osteoporosis results in about 1.5 million annual fractures, costing approximately $15 billion. Calcitonin is safe and effective in slowing osteoporotic bone loss, but its effect is transient. The current studies were designed to explore the dose-dependent effects of salmon calcitonin on bone turnover in ovariectomized rats and to determine if the decrease in therapeutic effectiveness of calcitonin demonstrated over time with higher doses is due to oversuppression of bone turnover. Doses of 5, 15, & 50 IU/kg BW/day of calcitonin were compared to placebo in 12-week-old ovariectomized and sham-ovariectomized Sprague-Dawley rats for 24 weeks. The spinal bone mineral content (BMC) as measured by DXA in ovariectomized subjects receiving 5 & 15 IU/kg of calcitonin was not significantly different from sham-ovariectomized subjects, while spinal BMC of subjects receiving 50 IU/kg was significantly lower than shamovariectomized subjects (p<0.05). Femoral BMC of ovariectomized subjects was significantly lower than sham-ovariectomized subjects (p<0.05), but no significant differences were noted between treatment groups. Scanning electron microscopy (SEM) demonstrated a decrease in number and density of trabeculae and in cortical thickness when comparing femurs from ovariectomized with sham-ovariectomized subjects. SEM of subjects receiving 50 IU/kg displayed greater bone loss than other groups. No significant differences were noted between groups for levels of urinary helical peptides or serum pyridinoline [ELISA], indicators of bone resorption. Urinary calcium excretion [capillary ion electrophoresis] was significantly higher in subjects receiving 50 IU/kg of calcitonin than other ovariectomized subjects (p<0.05). Serum levels of osteocalcin [RIA], an indicator of bone formation, were significantly higher in subjects receiving 5 IU/kg of calcitonin than control subjects and those receiving 50 IU/kg (p<0.05). Production of antibodies to calcitonin [ELISA] by subjects in this study did not correlate with changes in bone turnover or bone density. The results of this study do not provide evidence higher doses of calcitonin result in oversuppression of bone turnover. However, urinary calcium excretion affected bone resorption in a reverse dose-dependent manner, suggesting the calciuric effect may be responsible for less effective outcomes seen with higher doses of calcitonin.

The postpartum period represents a high-risk period for body weight retention and obesity. Several studies have investigated the role of aerobic exercise on postpartum weight retention and other body composition outcomes; however, there has been little attention given to resistance training in postpartum women. Thus, the purpose of this four-month randomized study was to determine the effectiveness of resistance training on strength, body composition, return to pre-pregnancy weight, and bone mineral density (BMD) in postpartum women. Sixty postpartum women were randomly assigned to either a resistance training group or a comparison group. The resistance training group participated in a progressive resistance training program twice weekly for four months. The comparison group participated in a flexibility program twice weekly for four months. Strength changes were assessed for the upper body (bench press), lower body (leg press), and the core (abdominal curl-ups). Body composition, including BMD, was measured by dual energy x-ray absorptiometry. Over the four-month study, the resistance training group demonstrated a 36.7% increase in bench press, a 31.1% increase in leg press, and a 222.6% increase in abdominal curl-ups (p < 0.05). The flexibility group improved by 7.7% for bench press, 6.6% for leg press, and by 43.0% for abdominal curl-ups (p < 0.05). Group*period interactions were significant for the leg press, bench press, and abdominal curl-ups (p < 0.05). Both groups decreased in body weight, body fat percentage, and fat tissue (p < 0.05). Neither group significantly changed in lean tissue, whole body BMD, and hip BMD (p > 0.05). Group*period interactions were not significant for any body composition outcome (p > 0.05). These results suggest that a twice weekly resistance training program is superior to flexibility training to increase strength; however, resistance training may not be enough to influence body composition to a greater extent than flexibility training in postpartum women. More research is warranted.

ABSTRACT The Effects of a Novel Exercise Training Suit on Cardiorespiratory Fitness, Body Composition and Leg Strength Trevor Michael Curry The physiological responses to physical activity or exercise using external load carriage systems (LCS) in the form of weighted personal protective equipment, backpacks, or vests have biomechanical and human performance implications. It remains unclear whether a new unique LCS in the form of a weighted (5.45 kg) full-bodied exercise suit can induce greater improvements in performance and body composition. Twenty-one healthy males (20±3 years; 24.9±3.6 body mass index (BMI); 25.1±6.4% total percentage body fat ( % fat); 120.1±17.3 kg lean mass; 146.2±35.4 kg leg press 1-repetition max; 1.25±0.14 g·cm-2 bone mineral density; 49.5±8.53 mLO2·kg-1·min-1 maximal oxygen consumption (VO2max)) were matched for VO2max and physical characteristics before being randomly allocated into an aerobic exercise intervention with or without the exercise suit using a treadmill at the Cal Poly Recreation Center. Participants jogged at 60%-70% of their maximum heart rate for 30 min three times a week on nonconsecutive days for six weeks. Weight was recorded before and after each session while heart rates, blood pressures, and tympanic membrane temperatures were recorded incrementally during each session. Thereafter, VO2max and the same physical characteristics were measured and used to analyze the changes before and after the 6-week program. The results indicate that there was no difference for the change in any of the variables measured during and between the exercise intervention. Future studies examining the effect of the exercise suit on these variables should strongly consider larger sample sizes and other subpopulations to gain the statistical power to measure the effects of the exercise suit.

The purpose of this literature review was to identify any adaptations that could be made to the rehabilitation process for Traumatic Transfemoral Amputees. Traumatic Transfemoral Amputation is particularly debilitating with the amputees encountering many obstacles throughout the rehabilitation process. These obstacles can prevent the return to pre-morbid functioning. With an ever-increasing number of amputees within the United States, it is imperative the rehabilitation process be addressed. This literature review addresses possible adjustments in the initial stages of rehabilitation examining the post-operative, pre-prosthetic, and prosthetic rehabilitation stage to enhance the physical functioning for the amputee. This comprehensive literature review encompassing 63 academic and medical journals analyzes the research literature regarding each of the three stages of the post-operative procedure. The literature review synthesizes the research findings to see how procedures may be adapted to reduce the risk of further co-morbidities such as loss of bone mineral density and disuse atrophy. Loss of bone mineral density and disuse atrophy are the major contributing factors to the amputees decreased mobility. Reducing this loss can be addressed within the initial post-operative, pre-prosthetic, and prosthetic rehabilitation stages. Further research is required to examine the efficacy of these alterations in relation to this specific population.

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