Flashcards in 27 Osteoporosis Lieu Deck (161)
When does the primary diagnosis of osteoporosis usually occur?
Fracture of hip, spine, wrist, or humerus that occurred spontaneously or after a fall from no greater than standing hight
What is osteoporosis characterized by?
Low bone mass. Deterioration of bone tissue. Disruption of bone architecture. Compromised bone strength. Increase in risk of fracture
What are the consequences of osteoporosis?
Fractures: vertebrae (spine), proximal femur (hip), distal forearm (wrist), others. Followed by full recovery or by chronic pain, disability, death
What population has the highest incidence of osteoporosis?
Non-Hispanic Caucasian and Asian, aged 50 and older
What is Trabecular bone (cancellous bone)?
Forms porous interior structure of bone. Primarily: vertebrae, distal forearm, hip. Fastest rate of turnover (more metabolically active)
What is Cortical bone?
Forms hard outer shell of skeleton. Predominates: long bones (proximal femur, distal radius)
What type of bone do skeletal bones consist of?
20% trabecular, 80% cortical
What is Type 1 Osteoporosis?
Predominant loss of trabecular bone (up to 25%) associated with menopause. Leads to an increase in "crush" type vertebral fractures, distal forearm fractures, ankle fractures
What is Type 2 Osteoporosis?
Loss of cortical and trabecular bone associated with aging. Leads to an increase in hip fractures
What are the general characteristics of osteoporosis?
Loss of trabecular and cortical bone mass. Reduction in skeleton load carrying capacity --> bone fragility. Significant bone loss evident only after vertebral or hip fracture occurs. Not an "old woman's disease"
Why is early diagnosis of osteoporosis important?
Early osteoporosis is asymptomatic. Osteoporosis can develop undetected for decades until fracture occurs
What are the odds of osteoporosis related fractures in remaining lifetime after 50 years of age?
Approximately 1 in 2 women and 1 in 4 men
What are some characteristics of Hip Fractures?
Women with him fracture: 4-fold greater risk of second one. 2-3 times higher rate in women vs. men. Following hip fracture: 1-year mortality nearly twice as high for men vs. women (within 1 year 24% of patients > 50 years old die)
What are the complications of vertebral fractures?
Back pain, height loss, kyphosis (postural changes, limit bending and reaching). Mortality increased
What can multiple thoracic fractures cause?
Restrictive lung disease
What can lumbar fractures cause?
Constipation. Abdominal pain. Distention. Reduced appetite. Premature satiety
When does osteoporosis prevention begin?
In childhood (even before, in utero). Bone mass attained during childhood is perhaps the most important determinant of life-long skeletal health
What are the major determinants for the risk of osteoporosis?
Peak bone mass. Bone loss thereafter
What is Peak Bone Mass?
Maximum amount of bone tissue an individual attains. Bone mineral density increases with age (20-25 years). Peak bone mass is achieved by the late 20s or early 30s in men and women, after cessation of linear growth. Largely genetically determined (80%)
What is Peak Bone Mass influenced by?
Body weight, physical activity, normal pubertal development, mechanical loading, adequate nutrition
How does Bone Mass change?
Usually, removal (osteoclasts) and formation (osteoblasts) of bone are in balance and maintain skeletal strength and integrity. After ~age 30, bone resorption begins to outpace bone formation --> bone mass gradually declines
What do decreased estrogen levels in women cause?
Increase in bone loss. Begins several years prior to onset of menopause. Women can lose up to 20% of their bone mass in the 5-7 years following menopause. Also, prior to menopause, during ovulatory disturbances
What is Bone Mass Density (BMD) like for women?
Decline in BMD: approx 50% during average lifetime. Magnitude of bone loss: greater for some women, less for others
What is Bone Mass Density (BMD) like for men?
Bone loss at approx 1/2 rate of women. Decline in BMD: approx 35% during average lifetime
What are some risk factors of osteoporosis and fractures?
Female. Older age. FHx. Being small/thin. History of broken bones. Low sex hormones. Smoking. Alcohol (> 3 drinks/day). Diet. Inadequate physical activity. Immobilization. Falls. Certain medications. Certain diseases and conditions
What falls under "low sex hormones" for a risk factor for osteoporosis?
Low estrogen in women, including menopause. Missing periods (amenorrhea). Low levels of testosterone and estrogen in men
What falls under "diet" for a risk factor for osteoporosis?
Low calcium intake. Vitamin D insufficiency. Excessive intake of protein, sodium, caffeine, Vitamin A
What are some example conditions and diseases that cause or contribute to osteoporosis and fractures?
Cystic fibrosis. Anorexia/Bulimia. DM. Celiac disease. Leukemia. RA. Alcoholism. CHD. ESRD
What are some modifiable risk factors for osteoporosis?
Cigarette smoking. Excessive alcohol consumption. Excessive caffeine consumption. Prolonged immobilization. Low levels of physical activity. Lack of weight-bearing exercise. Lack of sun exposure. Inadequate calcium intake. Inadequate vitamin D status. Elevated homocysteine level