osteoporosis

Question 1

What causes osteoporosis?

Answer 1

Fracture attributable to OP is a significant health problem that women face, especially after menopause. As estrogen and progesterone levels fall, bone strength also declines.

During adult hood and adolescent, low bone mass and OP are caused when the normal processes of bone remodeling are unbalanced and resorption rates exceed bone formation,

Question 2

Osteoporosis and Osteopenia

Answer 2

Osteopenia is similar to OP except that there is a lesser amount of bone lost.

Question 3

Two factors contribute to bone strength:

Answer 3

bone mineral density (BMD) and bone quality.

Question 4

Bone mineral density

Answer 4

BMD refers to the thickness and volume of the bone.

Question 5

What is bone quality

Answer 5

Bone quality refers to the bone architecture, mineralization, rate of turnover, and accumulated damage

. Cannot be easily measured.

Question 6

BMD is easily measured using densitometry testing such as the …………………………

Answer 6

dual-energy x-ray absorptiometry (DEXA).

Question 7

What is kyphosis

Answer 7

Kyphosis causes a permanently stooped appearance, and may be recognized when a woman has a documented loss of height.

Question 8

What are the impact of kyphosis

Answer 8

Kyphosis also causes the rib cage to slump downward, eventually coming to rest on the ischial spines, thus minimizing thoracic and abdominal cavity space for organs.

This restriction frequently leads to gastrointestinal problems, such as gastric reflux, anorexia, and constipation, and to respiratory disorders, such as shortness of breath.

Self-image can also be negatively affected because of body changes and difficulty in finding clothing that fits properly over the kyphotic deformity.

Question 9

what is osteoporosis?

Answer 9

OP is defined by BMD at the hip or lumbar spine that is 2.5 or more standard deviations below the mean BMD of a young-adult reference population

.

Question 10

what is the difference between secondary and primary OP?

Answer 10

Primary OP occurs because of causes related to age, gender, and family history. It occurs with aging and accelerates in women at menopause. EG. Low BMD at the femoral neck (T-score of −1.0 or below) is found in 21% of postmenopausal (PM) White women,

Secondary OP results from medical conditions or treatments that interfere with the attainment of peak bone mass and/or that may predispose to accelerated bone loss requiring long-term corticosteroid therapy, an increasing list of dietary, lifestyle, endocrine, metabolic, and other causes of bone mass deterioration have been identified, such as smoking, sedentary lifestyle/low physical activity, Cushing’s disease, diabetes, hyperthyroidism, and pregnancy

Question 11

Is osteoporosis painful?

.

Answer 11

OP is the most common bone disease, yet it is painless and often remains undiagnosed until a fracture occurs

Question 12

why primary OP is caused more in female?

Answer 12

Primary OP is associated with aging and affects women more than men because of the rapid increase in bone loss that accompanies the decline in estrogen and progesterone levels during the menopausal transition

Women’s Health Care in Advanced Practice Nursing (p. 686). Springer Publishing Company. Kindle Edition.

Question 13

Does Secondary Op effect males and female?

Answer 13

secondary OP can affect males or females at any age.

Question 14

Risk factors of OP?

Answer 14

Potentially Modifiable Risk

Factors Amenorrhea (caused by eating disorder or excessive exercise) Body weight less than 127 pounds, body mass index less than 21 kg/m2 Chronic diseases

Cigarette smoking (active or passive)

Frailty Low estrogen level (e.g., menopause)

Medications

Nulliparity

Poor nutrition (e.g., excessive vitamin A, excessive alcohol or caffeine intake, excessive soda intake, excessive sodium intake, inadequate calcium/vitamin D intake, protein deficiency) Sedentary lifestyle

Nonmodifiable Risk Factors Advanced age Dementia Delayed puberty Endocrine disorders (Cushing’s, thyrotoxicosis, diabetes mellitus) Family history of OP Female gender First-degree relative with history of fracture Fracture history (fracture at 40–45 years or older is associated with an increased risk for osteoporosis) Genetic factors (variations in or absence of genes that regulate protein receptors or enzymes needed for bone development) Race (Caucasian and Asian women at greatest risk, then Hispanic and African American)

Question 15

Other risk factors for OP?

Answer 15

Age (especially greater than 65 years, fracture risk doubles with each 7–8 years after 50 years) Current smoking Femoral neck raw bone mineral density (BMD) in g/cm2 Glucocorticoid use Body mass index (BMI) (height and weight, BMI less than 21 kg/m2) Parent history of hip fracture (increases risk ~130%) Personal prior fracture (risk for future fracture doubles) Rheumatoid arthritis Secondary OP Gender (females at greater risk than males)

Weakness History of falls, fainting, off balance Poor vision Neuropathy, especially lower extremities Vertigo Impaired mobility Use of medications or substances that cause drowsiness, dizziness, lightheadedness, or imbalance; use of multiple medications Neurologic disease Frailty Orthostatic hypotension Low vitamin D levels Sedentary lifestyle, Depression

Question 16

What do you look during physical examination?

Answer 16

Reductions in height can be an important first clue for painless (or “silent”) vertebral compression fractures

Question 17

Vertebral compression fracture- how do you know if it is vertebral compression fracture?

Answer 17

VCFs can be painless; however, they are often associated with significant pain

In women with OP, VCFs can be caused by normal activities of daily life, such as bending forward to pick up an item. The anterior edge of a vertebral bone crumbles in response to the increase in pressure exerted while bending forward, and changes into a wedge shape

. Over time, having multiple wedge-shaped bones on top of one another, instead of the usual square cube shape, causes the spine to curve forward, causing kyphosis.

Question 18

Diagnostic for OP?

Answer 18

DEXA testing can be done at the spine, wrist, or hip

DEXA is the gold standard for screening and diagnosing OP

Question 19

What are the criteria for DEXA?

Answer 19

All women 65 years old or older ​

Women younger than age 65 years who are PM or transitioning to postmenopause who have clinical risksa for OP

​Individuals who sustain a fracture after age 50 years

​Individuals who have a clinical condition or take medications that are associated with bone loss or decreased bone mass

Question 20

How Dexa are reported?

Answer 20

BMD results by DEXA are reported as T-scores and Z-scores

.

The Z-score indicates the number of standard deviations a woman’s bone density is above or below the mean for an age- and gender-matched cohort.

The Z-score is most often used for diagnosing bone loss in children or young adults, and is useful in identifying secondary OP.

When the Z-score is low, it indicates either that her bone mass is lower than her age cohort due to secondary OP causes or that she did not achieve peak bone mass in young adulthood.

Question 21

Define T score

Answer 21

The T-score indicates the number of standard deviations a woman’s bone density is above or below that of a young adult, gender-matched norm.

Question 22

What is Z score

Answer 22

The Z-score indicates the number of standard deviations a woman’s bone density is above or below the mean for an age- and gender-matched cohort.

The Z-score is most often used for diagnosing bone loss in children or young adults, and is useful in identifying secondary OP.

When the Z-score is low, it indicates either that her bone mass is lower than her age cohort due to secondary OP causes or that she did not achieve peak bone mass in young adulthood.

Question 23

Osteoclastin is released into the bloodstream during bone formation. Higher levels of serum osteoclastin suggest……………………………

Answer 23

higher levels of bone formation.

Question 24

example, N-teleopeptide crosslinks (NTx) are released into the blood with bone resorption and excreted by the kidneys in the urine. High levels of urinary NTx suggest

Answer 24

higher levels of bone resorption ( not good).

Question 25

T-SCORE RESULT INTERPRETATION

At or above −1.0

−1.0 to −2.5

At or below −2.5

At or below −2.5 with low-trauma

Answer 25

normal

osteopenia

osteoporosis

fracture

Question 26

Additional management to prevent OP?

Answer 26

OP prevention needs to start early in life by ingesting a diet rich in calcium, vitamin D, and minerals, which are necessary to achieve peak bone mass.

supplementation or ingestion of vitamin D-fortified foods is recommended.

Other dietary considerations include minimizing ingestion of soda and caffeinated beverages.

The phosphorus in soda and the caffeine in other beverages may interfere with bone formation and remodeling processes if consumed in very high quantities.

More important, for most people, is that frequent ingestion of these beverages can replace ingestion of calcium-rich milk, posing a greater harm to developing and maintaining bone strength.

Adequate amounts of phosphorus are needed; however, phosphorus intake must be balanced because either excessive or insufficient amounts can interfere with bone formation.

Adequate citric acid, protein, and fiber are also needed for proper bone formation.

Excessive protein or fiber intake can interfere with normal intestinal absorption of calcium.

Moderate alcohol intake can improve bone strength; however, ingestion of more than three alcohol units per day (1 U = 12 oz. of beer, 4 to 5 oz. of wine, or 1 oz. of hard liquor) interferes with normal remodeling processes

Calcium from dietary sources is preferred over supplements; however, calcium intake from dietary sources is frequently below daily recommended levels and women with lactose intolerance may not tolerate the dairy products that are richest in calcium, making supplementation necessary

Question 27

Who can get OP medication?

Answer 27

Medication therapy is recommended for postmenopausal women who present with the following:

BMD T-scores of the spine, total hip, or femoral neck of −2.5 or less (when causes of secondary osteoporosis have been ruled out)

Hip fracture(s) or clinical or incidental vertebral fracture(s) T-scores of −1.0 to −2.5 at the femoral neck, total hip, or spine together

Question 28

What is the name of the OP medication

Answer 28

Alendronate (Fosamax),

:5 mg by mouth daily or 35 mg by mouth weekly

Prevention and treatment: 10 mg by mouth daily or 70 mg by mouth weekly

Women’s Health Care in Advanced Practice Nursing (p. 693). Springer Publishing Company. Kindle Edition.

Question 29

What is the consideration while taking aldrenoate?

Answer 29

​Before any food ingestion, take oral doses in morning with 8-oz glass of plain water, remain upright, and ingest no food or drink for at least 30–60 minutes

Take oral doses 2 hour before antacids/calcium

​Caution with oral forms if upper gastrointestinal disease present; clinical association with dysphagia, esophagitis, or ulceration

​Beneficial effects may last for years after medication is discontinued

​

Women’s Health Care in Advanced Practice Nursing (p. 693). Springer Publishing Company. Kindle Edition.

Question 30

what is the name of the OP medication that does not cause GI upset?

Answer 30

zoledronic acid are not associated with gastrointestinal side effects: no limitations on timing dose around food, water, calcium, or medication intake