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25-hydroxy D total
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25-hydroxy D total - January 16, 2006 7:13:00 AM
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SJBird55
Posts: 2309
Joined: May 10, 2004
From: Michigan
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I've been doing some searching and not coming up with specific answers. I had a lady attend therapy back in October and I felt she was at a high risk of falling, but I didn't have time to truly assess her for that because she was attending therapy for a humerus fracture and she was complaining of hip/groin pain (history of total hip arthroplasty 8 years ago).
Anyways, she fell the day after she saw me and she was hospitalized with 2 fractures in her lower extremities (L tibial and R fibular) and one in her upper extremity (L radial Fx). Well, I had told her daughter that while she was in the hospital the fall should be addressed. Nothing was done. I contacted her primary care physician before Christmas regarding her fall, hospitalization and my concern about the risk of falling again being very high. Anyways, the patient began physical therapy again just last week (for all those fractures).
So, she comes in and she's quite anxious. Her family physician did end up having a follow-up appointment with her sometime in December. The patient brought in her lab report (which just got mailed to her last week) - so now she's very anxious because of the results.
25 Hydroxyvitamin D and D3
D3: 8.5 (normal 10-24)
D Total: 22 (normal 25-80)
PTH-1-84 Bio-Intact
82 (interpretation > 35 = highly suggestive of primary hyperparathyroidism).
She had all the red flags for an endocrine problem and she has had those symptoms for 3-4 years AND her primary care physician was aware of all her complaints.
So, I have some lab questions, but since they aren't anything I can change or do about, I'll ask the more pertinent question. I can't find anything in literature, but she has not been on anything for osteoporosis; she has not been on any kind of hormone replacement therapy; she has not been on any vitamin D supplementation. I can't find anything in the literature tying exercise and risk of fracture with her lab values.... She need to improve her strength, she needs to work on her balance, and and she needs to work on her endurance. What do I use for my guidelines to progress her safely? As I said, I haven't found anything in literature on exercise progression with a risk of fracture, so if anyone can point me in a direction, that would be great. I try to use common sense, but in this case, I do not believe that there would be any warning signs, but insead another fracture. I'm going to keep on looking, but if anyone can assist, I'd appreciate it.
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Re: 25-hydroxy D total - January 16, 2006 10:30:00 AM
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FLAOrthoPT
Posts: 1011
Joined: May 8, 2004
From: West Palm Beach
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well aqua would prob be best bet, but since no pool around justs tick with the basics...weight bearing functional exercises. No long lever arm loads, no high velocity maneuvers, weight bearing through full range through slow speeds. Have fun
Ben
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Re: 25-hydroxy D total - January 16, 2006 11:44:00 AM
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SJBird55
Posts: 2309
Joined: May 10, 2004
From: Michigan
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She's going to need some long lever arm loads AND she's going to need closed chain exercises through her shoulders.
I talked to the surgeon's MA and the surgeon felt that the only way she'd fracture is if she fell.
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Re: 25-hydroxy D total - January 16, 2006 4:08:00 PM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
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Yeah...I have to agree.
As for the testing, well she is old, of northern european ethnicity, and she is thin yes?
Whammo, I just saved her $300 in testing.
Why order a friggin test if you already know the outcome of the test? I don't get PCPs...
Anyway, SJ try not to do any "mixed martial arts" training with her...keep her in the pool.
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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Re: 25-hydroxy D total - January 17, 2006 1:22:00 AM
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SJBird55
Posts: 2309
Joined: May 10, 2004
From: Michigan
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She's in her early 80's and she's short and obese.
I don't have a pool... and I was being serious as to whether anyone has heard of an interpretation of the scores that reflect risk of fracture with exercise. Of course, I know if she falls, she's going to fracture. But... just from a mechanical viewpoint - what is the allowable stress before failure of the altered bony material? I guess maybe I'm the only one that wonders things like that?
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Re: 25-hydroxy D total - January 17, 2006 3:36:00 AM
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Dr.Wagner
Posts: 1237
Joined: January 24, 2003
From: Indianapolis
Status: offline
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80s and obese...what is going to get her first, pneumonia from a fractured hip or an MI/CHF?
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
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