{"id":91,"date":"2017-07-05T10:01:19","date_gmt":"2017-07-05T07:01:19","guid":{"rendered":"http:\/\/www.ktfb.org\/?p=91"},"modified":"2017-07-05T10:01:19","modified_gmt":"2017-07-05T07:01:19","slug":"yaslilarda-osteoporoz-ve-egzersiz","status":"publish","type":"post","link":"https:\/\/ktfb.org\/?p=91","title":{"rendered":"Ya\u015fl\u0131larda Osteoporoz ve Egzersiz"},"content":{"rendered":"<p>Ang\u0131n E.<\/p>\n<p>Do\u011fu Akdeniz \u00dcniversitesi, Sa\u011fl\u0131k Bilimleri Fak\u00fcltesi, Fizyoterapi ve Rehabilitasyon B\u00f6l\u00fcm\u00fc, Ma\u011fusa, KKTC<\/p>\n<p>OP yayg\u0131n prevelans\u0131 sebebiyle ciddi bir halk sa\u011fl\u0131\u011f\u0131 problemi olarak ortaya \u00e7\u0131kmaktad\u0131r. Kemik mineral yo\u011funlu\u011fundaki (KMY) azalma prevelans\u0131 ilerleyen ya\u015fla birlikte art\u0131\u015f g\u00f6sterir. Osteoporoz d\u00fcnya \u00e7a\u011f\u0131nda en yayg\u0131n g\u00f6r\u00fclen metabolik kemik hastal\u0131\u011f\u0131 olup ,200 million insan\u0131 etkiledi\u011fi tahmin edilmektedir.<sup>1,2 <\/sup>50 ya\u015f \u00fczeri 2 kad\u0131ndan biri ve 5 erkekten biri osteoporoza ba\u011fl\u0131 k\u0131r\u0131klar ile kar\u015f\u0131la\u015fmaktad\u0131r. T\u00fcrkiye\u2019de osteoporozun g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131; sa\u011fl\u0131kl\u0131 849 kad\u0131n\u0131 kapsayan bir \u00e7al\u0131\u015fmada, 20\u201339 ya\u015f grubunda KMY de\u011ferleri normal bulunurken, 40\u201359 ya\u015f grubunda t\u00fcm lokalizasyonlarda belirgin olarak KMY\u2019nda azalma oldu\u011fu saptanm\u0131\u015ft\u0131r. Yap\u0131lan \u00e7al\u0131\u015fmalarda, T\u00fcrk kad\u0131n\u0131n\u0131n KMY\u2019nun, Amerika Birle\u015fik Devletleri ve Avrupa referanslar\u0131na g\u00f6re %5 daha d\u00fc\u015f\u00fck oldu\u011fu belirlenmi\u015ftir. ABD\u2019de yap\u0131lan \u00e7al\u0131\u015fmalarda ise, yakla\u015f\u0131k 8 milyon kad\u0131n\u0131n ve 2 milyon erke\u011fin osteoporozu oldu\u011fu ve 18 milyon ki\u015finin osteoporoz geli\u015fimi a\u00e7\u0131s\u0131ndan artm\u0131\u015f risk d\u00fczeylerinde kemik k\u00fctlesine sahip oldu\u011fu bildirilmektedir.<sup>3<\/sup> Uluslararas\u0131 Osteoporoz Derne\u011fi, 50 ya\u015f ve \u00fczeri her 3 kad\u0131ndan birinin osteoporoza ba\u011fl\u0131 k\u0131r\u0131klara maruz kald\u0131\u011f\u0131n\u0131 belirtmektedir. 2025 y\u0131l\u0131nda osteoporoza ba\u011fl\u0131 k\u0131r\u0131k vakalar\u0131n\u0131n 2 milyondan 3 milyona y\u00fckselece\u011fi tahmin edilmektedir. <sup>4, 5<\/sup><\/p>\n<p>Osteoporoz ya\u015fa, lokalizasyona, kemik tutulumuna, etiyolojiye ve histolojik g\u00f6r\u00fcn\u00fcm\u00fcne g\u00f6re s\u0131n\u0131fland\u0131r\u0131lm\u0131\u015ft\u0131r. <sup>6, 7<\/sup> (Tablo 1).<\/p>\n<p>&nbsp;<\/p>\n<p>Tablo 1. Osteoporozun S\u0131n\u0131flamas\u0131<\/p>\n<p>&nbsp;<\/p>\n<table>\n<tbody>\n<tr>\n<td width=\"612\">\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Ya\u015fa g\u00f6re\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Juvenil, Yeti\u015fkin, Senil<\/p>\n<p>Lokalizasyona g\u00f6re\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Genel, B\u00f6lgesel<\/p>\n<p>Tutulan kemik dokuya g\u00f6re\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Trabek\u00fcler, Kortikal<\/p>\n<p>Etyolojiye g\u00f6re\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Primer, Sekonder<\/p>\n<p>Histolojik g\u00f6r\u00fcn\u00fcme g\u00f6re\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 H\u0131zl\u0131 D\u00f6ng\u00fcl\u00fc, Yava\u015f D\u00f6ng\u00fcl\u00fc<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<p>Eri\u015fkin d\u00f6nemde Osteoporoz fizyolojik olarak postmenapozal (Tip 1) ve ya\u015flanmaya ba\u011fl\u0131 geli\u015fen (Tip\u20132) olarak ortaya \u00e7\u0131kar. Osteoporoz (senil osteoporoz); ya\u015flanma ile birlikte ortaya \u00e7\u0131kan primer osteoporozun alt grubudur. Genellikle 70 ya\u015f\u0131ndan b\u00fcy\u00fck ki\u015filerde g\u00f6r\u00fclmektedir. Kad\u0131n ve erkek cinsiyetlerinde e\u015fit s\u0131kl\u0131kla g\u00f6r\u00fclmekle birlikte hem kortikal hem de trabek\u00fcler kemik kayb\u0131 vard\u0131r. \u00d6zellikle femur boynu, proksimal tibia ve pelvis k\u0131r\u0131klar\u0131 senil osteoporozda s\u0131kl\u0131kla g\u00f6r\u00fclmektedir. Nadir olsa da \u00e7oklu vertebra k\u0131r\u0131klar\u0131na rastlanabilinmektedir. Ya\u015fl\u0131 populasyonda kalsiyum emiliminde bozulma, deride D vitamini sentezinde azalma, barsakta 1.25 dihidroksivitamin D rezistans\u0131, intestinal D vitamini resept\u00f6rlerinde azalma g\u00f6r\u00fclmektedir. Bu fakt\u00f6rlerin t\u00fcm\u00fcn\u00fcn sonucu olarak iyonize kalsiyumda azalma olmaktad\u0131r. <sup>2, 8<\/sup><\/p>\n<p><strong>Risk Fakt\u00f6rleri<\/strong><\/p>\n<p>Osteoporozda risk fakt\u00f6rlerinin erken tan\u0131mlanmas\u0131 ve \u00f6nleme programlar\u0131n\u0131n geli\u015ftirilmesi hastal\u0131\u011f\u0131n art\u0131\u015f\u0131n\u0131 durudurmak, k\u0131r\u0131klar\u0131 \u00f6nlemek ve sa\u011fl\u0131k bak\u0131m giderlerini azaltmak i\u00e7in gereklidir.<sup>9<\/sup><\/p>\n<p>Osteoporozdaki en \u00f6nemli risk fakt\u00f6rleri; ya\u015f, cinsiyet, v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131, menopoz, k\u0131r\u0131k hikayesi, hormonal nedenler, genetik ve \u0131rksal nedenler, kalsiyum ve D vitamini y\u00f6n\u00fcnden eksik beslenme, sedanter ya\u015fam tarz\u0131, sigara ve a\u015f\u0131r\u0131 alkol kullan\u0131m\u0131, immobilizasyon, \u00e7e\u015fitli ila\u00e7lar, inflamatuar artritler , hipertroidizm ,hiperparatroidizm\u00a0 gibi metabolik hastal\u0131klar \u015feklinde belirtilmektedir. Geriatrik bireylerde d\u00fc\u015fme riski ya\u015fla birlikte artar. D\u00fc\u015fme risk fakt\u00f6rleri ise fiziksel aktivite yoklu\u011fu, kas g\u00fc\u00e7s\u00fczl\u00fc\u011f\u00fc veya denge problemleri, fonksiyonel k\u0131s\u0131tl\u0131l\u0131k, kognitif bozukluk veya demans, ila\u00e7 kullanma ve ev tehlikelerini de i\u00e7eren \u00e7evresel etmenlerdir .<sup>10, 11<\/sup><\/p>\n<p>Osteoporoz sessiz bir hastal\u0131k oldu\u011fundan dolay\u0131 tan\u0131 konuldu\u011funda tedavisi daha zor olmaktad\u0131r. Bu y\u00fczden koruyucu fizyoterapi alan\u0131nda \u00f6n planda yer almaktad\u0131r. Bunlarla birlikte osteoporozun risk fakt\u00f6rlerinin belirlenmesinde \u00f6nem artmaktad\u0131r. D\u00fcnya Sa\u011fl\u0131k \u00d6rg\u00fct\u00fc (DS\u00d6) Metabolik Kemik Hastal\u0131klar\u0131 i\u00e7in bireylerin k\u0131r\u0131k riskini de\u011ferlendirmek i\u00e7in FRAX (The World Health Organization Fracture Risk Assessment Tool) diye bir ara\u00e7 geli\u015ftirilmi\u015ftir. Bu modelde ya\u015f, cinsiyet, v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131, \u00f6nceki ge\u00e7irilmi\u015f frajilite k\u0131r\u0131\u011f\u0131, annede k\u0131r\u0131k hikayesinin varl\u0131\u011f\u0131, sigara i\u00e7imi, uzun s\u00fcreli glukokortikoid kullan\u0131m\u0131, romatoid artrit, di\u011fer sekonder osteoporoz nedenleri ve a\u015f\u0131r\u0131 alkol t\u00fcketimi bireylerin mutlak k\u0131r\u0131k riskini belirlemede kullan\u0131lan fakt\u00f6rler olarak belirlenmi\u015ftir.<sup>12<\/sup><\/p>\n<p>KMY \u00f6l\u00e7\u00fcm yap\u0131lan alandaki kemik minerak dansitesi olup kemi\u011fin fizyolojik ve patolojik durumunun \u00f6nemli bir g\u00f6stergesidir. KMY \u00f6l\u00e7\u00fcm\u00fc OP tan\u0131s\u0131 ve kemikte k\u0131r\u0131k olu\u015fma riskinin saptanmas\u0131 a\u00e7\u0131s\u0131ndan \u00f6nemlidir.<sup>2<\/sup><\/p>\n<p><strong>Klinik Bulgular<\/strong><\/p>\n<p>Osteoporoz, yery\u00fcz\u00fcnde en yayg\u0131n olarak rastlanan metabolik kemik hastal\u0131\u011f\u0131d\u0131r. DS\u00d6 osteoporozu; kardiovask\u00fcler hastal\u0131klardan sonra hayat\u0131 tehtit eden ikinci hastal\u0131k olarak tan\u0131mlam\u0131\u015ft\u0131r. Osteoporoz ve osteoporoza ba\u011fl\u0131 k\u0131r\u0131klar giderek artan bir sa\u011fl\u0131k problemi haline gelmi\u015ftir. \u00d6zellikle osteoporoza ba\u011fl\u0131 geli\u015fen k\u0131r\u0131klar \u00f6nemli maddi kay\u0131plara yol a\u00e7maktad\u0131r. Osteoporoza ba\u011fl\u0131 k\u0131r\u0131klar en s\u0131k vertebralar, proksimal femur ve radius distalinde ortaya \u00e7\u0131kmaktad\u0131r .<sup>13, 14<\/sup><\/p>\n<p>Osteoporozda klinik belirtilerin veya komplikasyonlar\u0131n geli\u015fiminden \u00f6nce genellikle uzun s\u00fcren sessiz bir d\u00f6nem izlenmektedir. Bu d\u00f6nem asemptomatik dansitometrik osteoporoz olarak adland\u0131r\u0131lmaktad\u0131r. Tesad\u00fcfen veya genel v\u00fccut taramas\u0131 s\u0131ras\u0131nda dansitometrik incelemeler yap\u0131l\u0131rsa saptanabilinmektedir. Bu d\u00f6nemde tan\u0131 konmas\u0131 \u00e7ok \u00f6nemlidir. Osteoporoza ba\u011fl\u0131 klinik bulgular; s\u0131rt a\u011fr\u0131s\u0131, boy k\u0131salmas\u0131, spinal deformiteler, peridontal hastal\u0131klar\u0131n varl\u0131\u011f\u0131, a\u011fr\u0131 ve k\u0131r\u0131klard\u0131r.<sup>15\u00a0 <\/sup><\/p>\n<p>A\u011fr\u0131, osteoporozda klinik bulgular aras\u0131nda yer alan \u00f6nemli bir fakt\u00f6rd\u00fcr. S\u0131kl\u0131kla hareket veya a\u011f\u0131rl\u0131k kald\u0131rma s\u0131ras\u0131nda belirginle\u015fen k\u00fcnt karakterdedir. Kemiklerin palpasyon ve perk\u00fcsyonu a\u011fr\u0131l\u0131 olabilmektedir. Osteoporoza ba\u011fl\u0131 geli\u015fen post\u00fcr bozukluklar\u0131, ligamentlerde gerilme veya kronik vertebra k\u0131r\u0131klar\u0131 nedeniyle a\u011fr\u0131 ortaya \u00e7\u0131kabilmektedir.<\/p>\n<p>Osteoporotik k\u0131r\u0131klar genellikle trabek\u00fcler kemi\u011fin bask\u0131n oldu\u011fu vertebra, kal\u00e7a ve \u00f6n kol b\u00f6lgelerinde g\u00f6r\u00fcl\u00fcr. K\u0131r\u0131klar en s\u0131k olarak T12 veya L1 b\u00f6lgelerinde lokalize olmaktad\u0131r. Bu b\u00f6lgelerin d\u0131\u015f\u0131nda di\u011fer alanlarda da osteoporoza ba\u011fl\u0131 k\u0131r\u0131klar olu\u015fabilmektedir. Kompresyon k\u0131r\u0131klar\u0131 boy k\u0131salmas\u0131na neden olmakta ve multiple k\u0131r\u0131\u011f\u0131 olan hastalarda alt kostalar\u0131n kristalara yakla\u015fmas\u0131 ile torako-abdominal deformiteler intratorakal ve intraabdominal organlarda fonksiyon kayb\u0131na neden olabilmektedir. Nefes darl\u0131\u011f\u0131, egzersiz kapasitesinde azalma, konstipasyon, meteorizm ve nadir olarak sinir k\u00f6k\u00fc bas\u0131lar\u0131 ortaya \u00e7\u0131kmaktad\u0131r. Osteoporotik k\u0131r\u0131klarda a\u011fr\u0131 ile geli\u015fen psikolojik fakt\u00f6rlerin yan\u0131nda sosyoekonomik problemler de hastan\u0131n ya\u015fam kalitesini olumsuz y\u00f6nde etkilemektedir. Bunlara ek olarak uyku bozukluklar\u0131, i\u015ftahs\u0131zl\u0131k, yorgunluk, sosyal ortamda bozukluk, \u00f6l\u00fcm korkusu gibi sorunlar da eklenebilmektedir .<sup>16<\/sup><\/p>\n<p>Vertebral k\u0131r\u0131klar asemptomatik olabilmekte ve genellikle fark\u0131na var\u0131lmadan ortaya \u00e7\u0131kmaktad\u0131r. Minimal travma veya kendili\u011finden vertebral k\u0131r\u0131klar olu\u015fabilmektedir.<\/p>\n<p>El bile\u011fi k\u0131r\u0131klar\u0131, ekstansiyon pozisyonunda el \u00fczerine d\u00fc\u015fme ile radiusun bilek ekleminin hemen \u00fczerinden k\u0131r\u0131lmas\u0131 sonucu olu\u015fmaktad\u0131r. \u0130lerleyen ya\u015f ile birlikte postural stabilitenin azalmas\u0131 ile bu k\u0131r\u0131klar\u0131n g\u00f6r\u00fclme s\u0131kl\u0131\u011f\u0131 artmaktad\u0131r .<\/p>\n<p>Kal\u00e7a k\u0131r\u0131klar\u0131, osteoporozda beklenen mortalite ve morbidite a\u00e7\u0131s\u0131ndan en y\u00fcksek ve \u00f6nemli olanlar\u0131d\u0131r. Mortalitesi ilk bir y\u0131l i\u00e7inde erkeklerde %30, kad\u0131nlarda %17 olarak belirtilmi\u015ftir. Kal\u00e7a k\u0131r\u0131\u011f\u0131 vakalar\u0131n\u0131n %20\u2019si bir bak\u0131ma ihtiya\u00e7 duyarken, %40\u2019\u0131 ba\u011f\u0131ms\u0131z aktivite yapabilecek hale geldi\u011fi bildirilmi\u015ftir. Kal\u00e7a k\u0131r\u0131\u011f\u0131 osteoporozun en ciddi ve ekonomik olarak en \u00f6nemli komplikasyonudur. S\u0131kl\u0131kla femur boynunun rotasyonel g\u00fc\u00e7lerle zorland\u0131\u011f\u0131 zaman d\u00fc\u015fme sonucu olu\u015fmaktad\u0131r. Ameliyata veya immobilizasyona ba\u011fl\u0131 komplikasyonlar s\u0131kca g\u00f6r\u00fclmektedir. Yap\u0131lan bir \u00e7al\u0131\u015fmada kal\u00e7a k\u0131r\u0131\u011f\u0131 ge\u00e7iren hastalarda daha sonra herhangi bir k\u0131r\u0131k ge\u00e7irme riskinin 2,5 kat artt\u0131\u011f\u0131 bildirilmektedir.<sup>17<\/sup><\/p>\n<p><strong>Osteoporoz ve Egzersiz<\/strong><\/p>\n<p>Osteoporozda morbidite ve mortalitenin \u00e7ok y\u00fcksek olmas\u0131 nedeniyle erken ya\u015flardan itibaren osteoporozdan korunmak gerekmektedir.<sup>18 <\/sup>Tek ba\u015f\u0131na ila\u00e7 tedavisi Osteoporozun \u00f6nlenmesi ve ilerlemesinin durdurulmas\u0131nda yeterli olmad\u0131\u011f\u0131 yap\u0131lan \u00e7al\u0131\u015fmalarda belirtilmi\u015ftir. Osteoporoz rehabilitasyonunda fiziksel aktivite ve egzersizin \u00f6nemli bir yeri vard\u0131r.<sup>19,20<\/sup> Fiziksel aktivite ve egzersiz ile kemi\u011fe uygulanan mekanik g\u00fc\u00e7 osteoblastik aktiviteyi art\u0131rmaktad\u0131r. D\u00fczenli fiziksel aktivite ve egzersizin, kemik k\u00fctlesini koruyarak, d\u00fc\u015fme insidans\u0131n\u0131 azaltarak k\u0131r\u0131klar\u0131n azalmas\u0131nda yard\u0131mc\u0131 oldu\u011funu g\u00f6steren bir\u00e7ok \u00e7al\u0131\u015fma bulunmaktad\u0131r. \u00c7al\u0131\u015fmalar, sa\u011fl\u0131kl\u0131 eri\u015fkinlerde yatak istirahati ile ayda % 0,5-1 KMY azald\u0131\u011f\u0131n\u0131 g\u00f6stermektedir. Osteoporoz rehabilitasyonunda fiziksel aktivite ve egzersizin \u00f6nemli bir etkisi de \u00f6strojen art\u0131\u015f\u0131na katk\u0131da bulunmas\u0131d\u0131r. Bununla beraber ins\u00fcl\u00fcn ve androjen gibi intirinsik endokrin fakt\u00f6rleri serbestle\u015ftirerek kemik ve kas\u0131n g\u00fc\u00e7lenmesine neden olmaktad\u0131r.<sup>21<\/sup><\/p>\n<p>Ya\u015fl\u0131 Bireylerde Osteoporozda fiziksel aktivite ve egzersizin faydalar\u0131 \u015fu \u015fekilde \u00f6zetlenmektedir.<sup>22, 23,24<\/sup><\/p>\n<ul>\n<li>Kemik k\u00fctlesini ve kas g\u00fcc\u00fcn\u00fc art\u0131rarak k\u0131r\u0131k riskini azalt\u0131r.<\/li>\n<li>Kas kuvvetini art\u0131rarak denge, koordinasyon ve iskelet deste\u011fi sa\u011flar.<\/li>\n<li>Denge ve koordinasyonu art\u0131rarak d\u00fc\u015fme riskini azalt\u0131r.<\/li>\n<li>Eklem fleksibilite ve stabilitesini art\u0131r\u0131r.<\/li>\n<li>Post\u00fcr\u00fcn koruyarak deformiteleri engeller.<\/li>\n<li>Kardiorespiratuvar dayan\u0131kl\u0131l\u0131\u011f\u0131 art\u0131rarak genel performans\u0131 y\u00fckseltir.<\/li>\n<li>Psikososyal g\u00fcvenini artt\u0131r\u0131r.<\/li>\n<li>Ya\u015fam kalitesini artt\u0131r\u0131r.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p>Ki\u015filer hayatlar\u0131 boyunca \u00e7e\u015fitli fiziksel aktivite ve egzersiz \u00e7e\u015fitlerini yapabilmektedirler. Se\u00e7ilen fiziksel aktivite ve egzersiz bir\u00e7ok fakt\u00f6rlere ba\u011fl\u0131 kalmaktad\u0131r. Bu fakt\u00f6rlerden baz\u0131lar\u0131 genel sa\u011fl\u0131k durumu, v\u00fccut k\u00fctle indeksi, sigara kullan\u0131m\u0131 ve sosyoekonomik durum olarak say\u0131labilmektedir.<sup>25\u00a0 <\/sup><\/p>\n<p>Ya\u015fl\u0131l\u0131kta g\u00f6r\u00fclen Osteoporoz i\u00e7in \u00f6nerilen egzersiz t\u00fcrleri vard\u0131r. Esneklik egzersizleri; germe ve gev\u015feme \u015feklinde uygulanmaktad\u0131r. Eklemlerin fleksibilitesini sa\u011flayarak d\u00fc\u015fme ve yaralanma riskinden korumaktad\u0131r.<sup>26<\/sup> Denge ve koordinasyon egzersizleri; g\u00fcnl\u00fck ya\u015fam aktiviteleri s\u0131ras\u0131nda s\u00fcrd\u00fcr\u00fclmesine ek olarak beklenmedik eksternal dengeyi bozan kuvvetlere kar\u015f\u0131 koyabilme yetene\u011fi, reaktif postural kontrol ve ba\u011f\u0131ms\u0131z ya\u015fam i\u00e7in \u00f6nemlidir. Geriatrik bireylerde d\u00fc\u015fme riskinin azalt\u0131lmas\u0131yla k\u0131r\u0131k insidans\u0131nda azalma sa\u011flamaktad\u0131r.<sup>27<\/sup> Aerobik egzersizler, v\u00fccut a\u011f\u0131rl\u0131\u011f\u0131 ile yap\u0131lan aktivitelerdir. Tempolu y\u00fcr\u00fcy\u00fc\u015f, grup egzersizleri , \u00a0gibi aktiviteler ya\u015fl\u0131lara uygun aktiviteler olarak bu grupta yer almaktad\u0131r. Aya\u011f\u0131n yer ile temas etti\u011fi anda kemikte olu\u015fan impuls ile osteoblastik aktivitede ve kemik mineral yo\u011funlu\u011funda art\u0131\u015f ile kemik kalitesinde olumlu de\u011fi\u015fiklikler oldu\u011fu bildirilmektedir. Bu t\u00fcr egzersizler \u00f6zellikle kal\u00e7a ve omurga kemikleri i\u00e7in yararl\u0131d\u0131r. Aerobik egzersizlerin denge ve koordinasyon \u00fczerine de olumlu etkileri vard\u0131r. Postmenopozal osteoporozlu ve osteopenili kad\u0131nlar \u00fczerinde yap\u0131lan bir \u00e7al\u0131\u015fmada, solunum, \u0131s\u0131nma, germe, kuvvetlendirme, denge, stabilizasyon ve so\u011fuma egzersizlerini i\u00e7eren grup egzersiz program\u0131n\u0131n, her iki grupta da KMY de\u011ferlerinde art\u0131\u015f oldu\u011fu belirtilmi\u015ftir.<sup>28 <\/sup>Y\u00fcksek etkili egzersizler; kollar\u0131 yukar\u0131 do\u011fru uzatarak z\u0131plama veya kollar yanda iken kollar\u0131 ve bacaklar\u0131 yana a\u00e7arak z\u0131plama hareketleri olarak yap\u0131labilmektedir. Fakat ya\u015fl\u0131larda \u00f6zellikle postmenopozal d\u00f6nemde eklem sorunlar\u0131 ve d\u00fc\u015fme riski a\u00e7\u0131s\u0131ndan bu egzersizlerin premenopozal d\u00f6nemde ya da postmenopozal d\u00f6nemde ilk 12 haftal\u0131k germe, kuvvetlendirme ve denge egzersizlerinden sonra ba\u015flanmas\u0131 uygun olmaktad\u0131r. Postmenopozal kad\u0131nlarda uygulanan z\u0131plama egzersizleri ile femur boynunun KMY de\u011ferlerinde art\u0131\u015f sa\u011fland\u0131\u011f\u0131 bildirilmi\u015ftir.<sup>29<\/sup> Kuvvetlendirme (Progresif-Resistif) egzersizler, elde ta\u015f\u0131nan ve a\u011f\u0131rl\u0131k miktar\u0131 giderek artt\u0131r\u0131lan a\u011f\u0131rl\u0131klar ile yatarak veya oturarak yap\u0131lan egzersizlerdir. Egzersizler haftada 3 g\u00fcn 45-60 dakika yap\u0131lmas\u0131 \u00f6nerilmektedir. Egzersiz program\u0131na tempolu y\u00fcr\u00fcy\u00fc\u015fler de eklenmektedir. \u00d6zellikle alt ekstremiteler i\u00e7in uygulanan egzersizler mobilite, denge ve d\u00fc\u015fmelerin \u00f6nlenmesi i\u00e7in \u00f6nemlidir. Geriatrik osteoporotik hastalarda azalm\u0131\u015f kas kuvveti ile ili\u015fkili oldu\u011fu belirtilen kifoza ba\u011fl\u0131 olarak denge bozulmas\u0131 ve d\u00fc\u015fme riskinde artma olmaktad\u0131r.<sup>30<\/sup> Post\u00fcr egzersizlerinin, kifozun geli\u015fimini engelleyerek d\u00fc\u015fmeleri ve vertebra k\u0131r\u0131k riskini azaltt\u0131\u011f\u0131 g\u00f6sterilmi\u015ftir. Postmenapozal osteoporozlu kad\u0131nlarda egzersiz ile torakal kifoz a\u00e7\u0131lar\u0131nda azalma g\u00f6r\u00fclm\u00fc\u015ft\u00fcr.<sup>31,32<\/sup> Tai-Chi-Chuan Egzersizleri; g\u00f6vde ve ekstremitelerin devaml\u0131, yava\u015f, koordineli ve ritmik izometrik ve izotonik segmental hareketleri \u015feklindedir. Bir\u00e7ok y\u00f6ne a\u011f\u0131rl\u0131k aktarma, post\u00fcr d\u00fczg\u00fcnl\u00fc\u011f\u00fc hakk\u0131nda bilinci artt\u0131rma, hareketlerin \u00e7ok y\u00f6nl\u00fc koordinasyonu ve d\u00fczenli solunumdan olu\u015fmaktad\u0131r. Kemik k\u00fctlesine kar\u015f\u0131 koruyucu etkisi yan\u0131nda, n\u00f6romusk\u00fcler koordinasyon, kas kuvveti, esneklik ve endurans \u00fczerine olumlu etkileri vard\u0131r.<sup>33\u00a0 <\/sup><\/p>\n<p><strong>Sonu\u00e7:<\/strong><\/p>\n<p>Ya\u015fl\u0131 n\u00fcfusun giderek artmas\u0131yla, ya\u015fl\u0131larda osteoporoz daha da \u00f6nemli bir konu haline gelmektedir. OP\u2019un erken te\u015fhis ve tedavisi amac\u0131yla belirli aral\u0131klarla sa\u011fl\u0131k kontrollerinin yap\u0131lmas\u0131n\u0131n \u00f6nemli oldu\u011fu d\u00fc\u015f\u00fcn\u00fclmektedir. Yap\u0131lacak sa\u011fl\u0131k kontrolleri ile birlikte sa\u011fl\u0131k e\u011fitimlerine de yer verilmelidir. Osteoporoz hakk\u0131nda bilgilendirme seminerleri, korunma yollar\u0131, fiziksel aktivite ve egzersizin \u00f6nemi, beslenme programlar\u0131na yer verilmelidir. Bu kapsamda ya\u015fl\u0131lrda OP \u00f6nlenmesi ve ilerlemesinin durdurulmas\u0131 anlam\u0131nda koruyucu fizyoterapi yakla\u015f\u0131mlar\u0131 devreye girmelidir. Birinci basamak sa\u011fl\u0131k kurulu\u015flar\u0131na b\u00fcy\u00fck g\u00f6revler d\u00fc\u015fecektir. Osteoporozda risk fakt\u00f6rlerinin erken tan\u0131mlanmas\u0131 ve \u00f6nleme programlar\u0131n\u0131n geli\u015ftirilmesi; hastal\u0131\u011f\u0131n ilerlemesini engellemek, k\u0131r\u0131klar\u0131 \u00f6nlemek ve sa\u011fl\u0131k bak\u0131m giderlerini azaltmak i\u00e7in gereklidir.<\/p>\n<p><strong>Kaynaklar:<\/strong><\/p>\n<ol>\n<li>Naharc\u0131 ,M., Ko\u00e7ak , N., Doruk ,HY. Ya\u015fl\u0131da Osteoporoz.TAF Preventive Medicine Bullettin 2012; 11(4) : 471- 482.<\/li>\n<li>Daware, MA. Osteoporosis in Elderly,Vidarbha Journal of Internal Medicine 2014; 17: 19-27.<\/li>\n<li>Ovayolu, N., Ta\u015f\u00e7\u0131, S., U\u00e7an \u00d6. Osteoporozda Risk Fakt\u00f6rleri ve Korunman\u0131n \u00d6nemi. F\u0131rat Sa\u011fl\u0131k Hizmetleri Dergisi 2007 ; 2 (6): 73-86.<\/li>\n<li>Levine, JP. Identification, Diagnosis and Prevention of Osteoporosis. Am J Manag Care 2011; 17 (6) :170-176.<\/li>\n<li>Yavuz, D. Osteoporoz: Epidemiyoloji, Klinik ve Tan\u0131. T\u00fcrkiye Klinikleri J Endocrin-Special Topics 2011; 4 (2) : 28-32.<\/li>\n<li>Tuncer, T. Osteoporoz. T\u00fcrkiye Klinikleri J Orthop Travumatol-Special Topics 2010; 3 (2) : 47-55.<\/li>\n<li>Senil Osteoporoz ve Tedavisi. Ar\u0131o\u011flu MS, edit\u00f6r. Geriatri ve Gerontoloji. \u00d6zyurt Matbaac\u0131l\u0131k. Ankara: 2006. p.735-752.<\/li>\n<li>Osteoporoz. Kutsal YG, edit\u00f6r. Fiziksel T\u0131p ve Rehabilitasyon. G\u00fcne\u015f Kitabevi. Ankara: 2000. p.1872-1864.<\/li>\n<li>U\u00e7an, \u00d6., Ta\u015f\u00e7\u0131, S. ,Ovayolu , N. , Osteoporozda Risk Fakt\u00f6rleri ve Korunman\u0131n \u00d6nemi. F\u0131rat Sa\u011fl\u0131k Hizmetleri Dergisi 2007 ; 2 (6) : 73-86.<\/li>\n<li>Horan, A., Timmins, F. The Role of Community Multidisciplinary Teams in Osteoporosis Treatment and Prevention. Journal of Orthopaedic Nursing 2009; 13: 85-96.<\/li>\n<li>Nguyen, TV., Center JR., E\u0131sman, JA. Osteoporosis in Elderly Men and Women: Effects of Dietary Calcium, Physical Activity, and Body Mass Index .Journal of Bone and M\u0131neral Research 2000; 15( 2): 32<\/li>\n<li>Kanis JA on behalf of the World Health Organization Scientific Group. Assesment of Osteoporosis at the Primary Health-care Level. Tecnical Report. WHO Collaborating Centre, University of Sheffield, UK. <a href=\"http:\/\/www.shef.ac.uk\/FRAX\">http:\/\/www.shef.ac.uk\/FRAX<\/a>. Accessed, 2010.<\/li>\n<li>Kastner, M., Sawka, A., Thorpe, K., Chignel, M., Marques, C., Newton, D., Strau, SE. Evaluation of a Clinical Decision Support Tool For Osteoporosis Disease Management: Protocol For an Interrupted Time Series Design. Implement Sci 2011; 6 (77) :1-7.<\/li>\n<li>Berry, SD., Kiel, DP., Donaldson, MG., Cummings, SR., Kanis, JA., Johansson, H. et al. Application of the National Osteoporosis Foundation Guidelines to Postmenopausal Women and Men: The Framingham Osteoporosis Study. Osteoporosis International 2010 ; 21 (1) : 53-60.<\/li>\n<li>Swaim, RA., Barner, JC., Brown, CM. The Relationship of Calcium intake and Exercise To Osteoporosis Health Beliefs in Postmenopausal Women. Research in Social and Administrative Pharmacy 2008 ; 4 (2) : 153-163.<\/li>\n<li>Meadows, ES., Mitchell, BD., Bolge, SC., Johnston, JA., Col, NF. Factors Associated With Treatment of Women With Osteoporosis or Osteopenia From a National Survey. Womens Health 2012 ; 12 (1)<\/li>\n<li>Nakatani, Y., Tamaki, J., Komatsu, M., Iki, M., Kajita, E. Effect of Distributing an Evidence-Based Guideline for Prevention of Osteoporosis on Health Education Programs in Municipal Health Centers: A Randomized Controlled Trial. Japan Epidemiologial Association 2012 ; 22 (2) :103-112.<\/li>\n<li>Sirola, J., Kr\u00f6ger, H. Similarities in Acquired Factors Related to Postmenopausal Osteoporosis and Sarcopenia. Journal of Osteoporosis 2011.<\/li>\n<li>De kam, D., Smulders, E., Weerdesteyn, V., Smits-Engelsman. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int 2009 ; 20: 2111-2125.<\/li>\n<li>Sinaki, M., Pfeifer, M., Preisinger ,E., Itoi, E., Rizzoli, R.,Boonen ,S. et al. The Role of Exercise in the Treatment of Osteoporosis. Curr Osteoporos Rep 2010 ; 8 :138-144.<\/li>\n<li>Frontera, WR. Exercise in Rehabilitation Medicine. United States: Human Kinetics 1999. p.221-249.<\/li>\n<li>Morris, M., Schoo, A. Optimizing Exercise and Physical Activity in Older People. London: Butterworth-Heinemann 2004.<\/li>\n<li>Kasturi, GC., Adler, RA. Osteoporosis: Nonpharmacologic Management. American Academy of Physical Medicine and Rehabilitation 2010 ; 3 (6) : 562-572.<\/li>\n<li>Bailey, CA., Brooke-Wavell, K. Optimum Frequency of Exercise For Bone Health: Randomised Controlled Trial of a High-impact Unilateral Intervention. Bone 2010 ; 46 (4):1043-1049.<\/li>\n<li>Schmitt, NM., Schmitt, J., D\u00f6ren, M. The Role of Physical Activity in the Prevention of Ostoporosis in Postmenopausal Women- An Update. Maturas 2009 ;63 (1) : 34-38.<\/li>\n<li>Rogers, K., Gibson, AL. Eight-Week Traditional Mat Pilates Training-Program Effects on Adult Characteristics. Research Quarterly For Exercise and Sport 2009 ; 80 (3) :569-574.<\/li>\n<li>Hsu,W. Chen,C. , Tsauo ,J., Yang, R., Balance Control in Elderly People with Osteoporosis. Journal of the Formosan Medical Association 2014 ; 113 : 334-339.<\/li>\n<li>Ang\u0131n, E., Erden, Z. The Effect of Group Exercise on Postmenopausal Osteoporosis and Osteopenia. Acta Orthop Traumatol Turc 2009 ; 43 (3) :343-350.<\/li>\n<li>Snow, CM., Shaw, JM., Winters, KM., Witzke, KA. Long-term Exercise Using Weighted Vests Prevents Hip Bone Loss in Post-menopausal Women. J Gerontol A Biol Scie Med Sci 2000 ; 55 (9) : 485-491.<\/li>\n<\/ol>\n<p>30.Kanemaru, A., Arahata,K., Ohta,T. Katoh,T. Tobimatsu,H. Horiuchi,T. The efficacy of home-based muscle training for the elderly osteoporotic women: The effects of daily muscle training on quality of life (QoL). Archives of Gerontology and Geriatrics 51 2010 : 169\u2013172.<\/p>\n<ol start=\"31\">\n<li>Lui, PP., Qin, L., Chan, KM. Tai Chi Chuan Exercises in Enhancing Bone Mineral Density in Active Seniors. Clin Sports Med 2008 ; 27 (1) : 75-86.<\/li>\n<li>Ang\u0131n, E., Erden, Z. Effects of Exercise Training on Pain, Spinal Mobility, Lordosis and Kyphosis Angle in Osteoporosis: A Pilot Study. Turkish Journal of Geriatrics 2010 ;13 (2):117-124.<\/li>\n<li>Wayne, PM., Kiel, DP., Krebs, DE., Davis, RB., Savestsky-German, J., Connelly, M. et al. The Effects of Tai Chi on Bone Mineral Density in Postmenopausal Women: A Systematic Review. Arch Phys Med Rehabil 2007; 88 (5) : 673-680.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Ang\u0131n E. Do\u011fu Akdeniz \u00dcniversitesi, Sa\u011fl\u0131k Bilimleri Fak\u00fcltesi, Fizyoterapi ve Rehabilitasyon B\u00f6l\u00fcm\u00fc, Ma\u011fusa, KKTC OP yayg\u0131n prevelans\u0131 sebebiyle ciddi bir halk sa\u011fl\u0131\u011f\u0131 problemi olarak ortaya<\/p>\n<div class=\"read-more-wrapper\"><a class=\"link small\" href=\"https:\/\/ktfb.org\/?p=91\" role=\"button\">Daha fazla<span class=\"nc-icon-glyph arrows-1_bold-right\"><\/span><\/a><\/div>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-91","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/ktfb.org\/index.php?rest_route=\/wp\/v2\/posts\/91","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/ktfb.org\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/ktfb.org\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/ktfb.org\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/ktfb.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=91"}],"version-history":[{"count":1,"href":"https:\/\/ktfb.org\/index.php?rest_route=\/wp\/v2\/posts\/91\/revisions"}],"predecessor-version":[{"id":92,"href":"https:\/\/ktfb.org\/index.php?rest_route=\/wp\/v2\/posts\/91\/revisions\/92"}],"wp:attachment":[{"href":"https:\/\/ktfb.org\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=91"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/ktfb.org\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=91"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/ktfb.org\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=91"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}