Recent literature put in mind ofs ...

Recent literature put in mind ofs that patients awaiting and following lung transplantation are at significant risk for osteoporosis. The decrease in bone density also increases the risk of skeletal fractures, which can have a significant impact forward the functional activities and quality of life of these individuals. The management of osteoporosis in lung transplant patients has focused forward drug treatment interventions. Current physic therapy is reviewed. However, exercise plays an important part in the physical therapy management of the patient with lung transplant and osteoporosis. A framework for managing the patient with osteoporosis and fracture is readyed Exercise, in the form of weight bearing and strengthening programs, is beneficial in as well-as; not only-but also; not only-but; not alone-but improving and maintaining bone density and improving functional status in patients with osteoporosis. In addition, spinal state and movement patterns are important considerations in the incidence of vertebral fractures. Physical therapy intervention is discussed for the patient pretransplant, as well as after transplant. Rehabilitation approaches should incorporate exercise and education approaches in the management and treatment of osteoporosis into existing lung transplantation pulmonary rehabilitation programs. This article provides guidelines for exercise for physical therapists to utilize in their approach to these manifold patients.

Key Words: medically complicate exercise training, bone density

INTRODUCTION

Recent literature allude tos that patients awaiting and following lung transplantation are at significant risk for osteoporosis. The decrease in bone density also increases the risk of skeletal fractures, which can have a significant impact onward the functional activities and quality of life of these individuals.The identification and treatment of osteoporosis in lung transplant patients has focused forward drug treatment interventions. This approach, however, does not adequately address other sequelae of osteoporosis. Osteoporosis, with resulting functional limitations including fractures, compromises the functional limitations that already exist in patients with transplant. While there is single a little known about osteoporosis in patients with organ transplant, long is known about osteoporosis in general. This information, coupl with an appreciation of the lung transplant proces provides physical therapists with an choice basis to address these patients' functional limitations and improve their participation in daily activities.

Osteoporosis can lead to decreased height and progressive kyphosis.1 The physical changes of kyphosis may cause decreased lung bodys and loss of spinal mobility with question s in standing, bending, carrying aims or personal hygiene.2 A revolution of time of inactivity may occur, in which decreased activity to be ascribed to limited spinal mobility contributes to muscle weakness, which leads to increased pain, which further limits physical activity. Decreased activity is associated with an increased incidence of falls, which can lead to fracture, further impairing function. Because decreased function is associated with osteoporosis, the patient with the two lung transplant and osteoporosis is at greater risk of declining function proper to the additional effects of anti-rejection medications and decreased activity flats during rejection episodes.

The approach to patients with osteoporosis in conjunction with lung transplant is based upon intervention of any patient with osteoporosis and fracture. The clinical effects of vertebral fractures from any cause, not specifically lung transplant related, may be clustered into the 3 categories of pain, physical impairments, and psychosocial declines.1 Pain associated with vertebral fractures may be acute or chronic, and is associated with regular use of analgesics and fret with walking, bending, and decreased bottom levels. A case-control study demonstrated that patients with vertebral fractures compared with superintends had pain scores 68% higher, twice as abundant difficulty with activities, took 33% longer to walk 6 meter had decreased functional reach (associated with risk of falling), and complet 15% fewer mobility skills. They also had impairments including decreased spinal range of motion and strength3 Patients with decreased mobility are more reluctant to participate in social or enjoyable activities, potentially contributing to psychosocial declines and decreased quality of life.

The drifts of this article are to: (1) review the incidence of osteoporosis and fractures in patients with lung transplant, (2) review rife treatment approaches for osteoporosis, (3) summarize the rehabilitation approach at the University of Colorado Hospital, and (4) based forward this approach, propose a specific gauge for physical therapy (PT) management of patients with lung transplant and osteoporosis.

OSTEOPOROSIS AND LUNG TRANSPLANT

Lung transplantation is now an accepted intervention for patients with end-stage pulmonary disease for which other therapies are ineffective.4 Although medications have evolv to increase the survival rate, these medications have detrimental actions forward bone metabolism and contribute to the risk of fractures in patients post-transplant. to be paid to the pulmonary disease processe patients receiving lung transplants may be at higher risk for osteoporosis than other patients undergoing organ transplants.4 Patients with emphysema, chronic obstructive lung disease (COPD) idiopathic pulmonary fibrosis (IPF), and interstitial lung disease (ILD) are routinely and chronically treated with prednisone, a glucocorticoid.5 Use of glucocorticoids is a risk factor for osteoporosis because they decrease osteoblast recruitment and inhibit collagen synthesis, which in divert inhibits bone formation. Glucocorticoids also increase bone resorption by dint of increasing osteoclast activity. Thus, the medications used for lung transplant also mystify a risk for osteoporosis.