Chapter 13

The purpose of this chapter is to describe common musculoskeletal and integumentary pathologies and the evidence found in the literature regarding their influence on the cardiopulmonary system. Impairments of bony structures, joints, skin, fascia, and musculature of the thorax may lead to a decrease in cardiopulmonary function. These impairments will lead to impaired circulation, aerobic capacity/endurance, ventilation, and respiration/gas exchange by restriction of movement of structures in the body. This results in decreased functional mobility of the patient and disability. This chapter will also describe the evidence in the literature as it relates to the interventions commonly associated with these pathologies.

The first edition of this chapter was written by John S. Leard.

### Osteoporosis (Practice Patterns 4A, 4B, 4C, 4F, 4G; ICD-9-CM Code: 733.0)

#### Introduction

Osteoporosis is a general term for a decrease in the mass of normal bone per unit volume and leads to an increase risk of fracture. Many conditions and diseases may be involved in the etiology of developing osteoporosis including metabolic disorders of osteoclastic versus osteoblastic activity, endocrine disease, bone disuse, genetic factors, and postmenopausal state. Bone loss is generally associated with advancing age in both sexes but proceeds at a faster rate in women, especially following menopause.1,2

The current intervention strategy is prevention of normal bone loss per unit volume by increasing peak bone mass by the third decade through diet, weight-bearing exercise, and cessation of smoking. Inherited factors account for an estimated 60% to 80% of the variability in peak bone mass. Diet, physical activity, and hormonal status are important modifiers of bone accrual.3 Reversal of widespread osteoporosis is extremely difficult to achieve.

Classic spinal deformities associated with osteoporosis are increased kyphosis with loss of height, thoracic vertebral body fractures, and back pain.4,5 The increased kyphosis is related to thoracic wedge fractures but also has nonskeletal contributing factors.6 One of these factors is the intervertebral disc shape.7 The loss of height does not seem to be due to the patient having small vertebral bodies but instead is due to the wedging, which causes an increase in the kyphosis.8 Besides osteoporosis, there are many reasons why thoracic vertebral body fractures occur in patients older than 50 years. Metastases, multiple myeloma, and trauma9,10 are associated with these fractures as well. In Finland, fractures occur in men and women with equal frequency, and gradually increase with age. At age 65, the frequency sharply increases in women. This is attributed to the pattern of age-related osteoporosis between the sexes due to menopause. In a study of 942 women in Rochester, Minnesota, increasing age was also associated with vertebral fractures.11 The level of peak frequency for spinal fractures occurs at T7-T8 and T11–T12.8 Vertebral body fractures have radiological characteristics that are different from fractures associated with osteoarthritis. Osteoporotic fractures have a ...

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