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Medicine II: Geriatrics COPY > Osteoporosis and Falls > Flashcards

Osteoporosis and Falls Flashcards

1
Q

Define osteopenia

A

decreased radiographic density of bone

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2
Q

Define osteoporosis

A

decreased bone - “osteoid” tissue

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3
Q

Define osteomalacia

A

decreased mineralization of bone

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4
Q

What are the first bones that start to fracture?

A

Vertebral

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5
Q

Where are the most common vertebral crush fractures?

A

lumbar up to mid thoracic

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6
Q

When do vertebral fractures have a preponderance for females?

A

beginning in 50s

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7
Q

What do you do if the pain from a vertebral crush fracture doesn’t remit?

A

vertebroplasty

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8
Q

What is a progression or consequence of osteoporosis?

A

decrease in height

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9
Q

What is the first sign of osteoporosis?

A

no early warnings, fracture is often first sign

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10
Q

What is dorsal kyphosis usually associated with?

A

“dowager’s hump”

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11
Q

What are other clinical features of osteoporosis?

A

protuberant abdomen
chronic back pain
pulmonary dysfunction
low skeletal mass and/or atraumatic fractures

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12
Q

What percentage of women and men have suffered hip fractures?

A

32% of women and 17% of men will have suffered a hip fracture

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13
Q

What scares us about hip fractures?

A

High mortality rate, many patients never regain previous level of mobility.

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14
Q

What are the HIGH risk factors for osteoporosis?

A

Caucasian or asian, elderly, female and thin/petite

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15
Q

What are the increased risk factors of osteoporosis?

A

+ FHx, alcohol use, smoking, sedentary, low dietary calcium intake

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16
Q

In general when do you stop growing bone?

A

30

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17
Q

What does bone mass depend on?

A

age, sex, race, height, weight

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18
Q

When does bone mass peak?

A

approx at 35

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19
Q

What is a caveat about women with bone mass?

A

women lose 1% of bone mass per year after age 35 (accelerated for 5 years post menopause)

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20
Q

Theories of etiology

A

senile: decrease Ca+ and 1, 25 Vit D lead to a decrease in Ca absorption and increase in PTH and thus an increase in resorption

post-menopausal: decrease in estrogen leads to a decrease in calcitonin and an increase in calcium mobilization which decreases PTH and thus decreases 1, 25 Vit D and Ca absorption

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21
Q

When men age what do we have to monitor in regards to osteoporosis?

A

See if they have low T levels

22
Q

With women what is the likely cause of their bone loss?

A

idiopathic

23
Q

Causes of osteomalacia

A 
malabsorption
renal failure
use of dilantin
inadequate exposure of light
renal tubular abscess
hypophosphatemia (hyperparathyroidism, Al-containing antacids)
24
Q

How do you know if you have osteoporosis?

A

DXA scan, look at T score

25
Q

What are the diagnostic categories for interpreting bone mass measurement reports?

A

Osteopenia (low bone mass)- more than 1 SD but less than

Osteoporosis- A value 2.5 SD or more below mean peak value

26
Q

In general when should all females get a dxa scan?

A

at 65, 5 years early if you have a high risk factor

27
Q

Difficulties in clinically studying treatment of osteoporosis:

A
  • low fracture incidence
  • uncertainty as to significance of change in bone mineral content
  • alterations in bone dynamics often don’t persist
  • mixture of type I and II patients in treatment group
28
Q

What are the treatments for osteoporosis?

A

exercise

29
Q

Bisphosphonates

A

1 perscription drugs for osteoporosis

30
Q

What do bisphosphonates do?

A

bind to hydroxyapatite
Potent inhibitors of bone resorption- slow down osteoclasts and limit bone resorption
low oral availability- take on an empty stomach

rem this is what bakers wife was on, they didn’t like it!

31
Q

What are the adverse side effects of bisphosphonates?

A

GI disturbances are the most frequent kind of adverse experiences

32
Q

How long does FOSAMAX stay in your bones?

A

Years!, works even after you stop

33
Q

What are foods that have calcium in them?

A 
most is in the form of milk BUT:
turnips
broccli
pork and beans
egg
wheat
34
Q

How much calcium is an an 8oz glass of milk?

A

whole- 291 mg

35
Q

What are the important take homes of Vitamin D?

A

first 6 month no effect BUT 18 months later huge decrease in fractures

36
Q

Who needs the most calcium?

A

kids, 1300 mg

37
Q

What is my daily requirement of calcium?

A

1000 mg

38
Q

How much Vitamin D do you need up to 70 yrs old? Over 70?

A

600 IU

1000 IU

39
Q

Does milk have a lot of vitamin D?

A

not really

40
Q

What does estrogen do?

A

increase intestinal calcium absorption
increase serum 1, 25 Vit D synthesis
Increase calcitonin secretion

41
Q

What is the main reason to give estrogen?

A

decrease menopausal vasomotor symptoms

42
Q

What is a SERMs?

A

Selective estrogen receptor modulator

43
Q

What does a SERM do?

A

Acts as estrogen agonist at certain organs (bone) but as antagonist at others (breast and uterus, worsens menopausal symptoms).

Less effect on bone than estrogen or a bisphosphonate.

44
Q

How do you take Calcitonin?

A

Nasal injection

45
Q

Compare bone loss in men to that of women

A

Males lose bone at approximatley 1/2 to 2/3 the rate of females

46
Q

How do you prevent or treat osteoporosis in men?

A 
CHECK T LEVELS (treat hypogonadism)
maintain muscle mass
keep calcium intake >800 mg/day
keep alcohol intake < 3oz/day
don't smoke
avoid hypercorticolism
check for fat malabsorption
routine Vit D supplementation in elderly
47
Q

What is a negative side effect of SERMs?

A

Reduces breast cancer but increases risk of thromboembolic events.

48
Q

What are the predisposing factors for falls that are intrinsic?

A

muscle weakness (ankle dorsiflexion), balance problems
impaired vision (night>day)
postural dizziness, postural hypotension (few non-syncopal falls related to arrhythmias)
neuropathology (stroke, Parkinson’s, periperal neuropathy)
medication (sedatives), poly pharmacy per se
foot problems

49
Q

Death from falls

A

falls have skyrocketed to be a leading cause of death in those > 70

50
Q

What are good ways to test muscle strength for falls?

A

hip abductors and ankle dorsiflexion

51
Q

What are extrinsic factors for predisposing falls?

A 
lighting
stairs
bathroom
chairs (too low, without armrests)
footwear (soft sole, high heels)
improper walking aids (cane, walker)
loose rugs
52
Q

How do we manage falls?

A

a. detect a faller before injury, ASK!!
b. observe gait and balance (get up and go, nudge test)
c. assess fall circumstances; premonitory symptoms, location
d. manage intrinsic and extrinsic factors

Medicine II: Geriatrics COPY (10 decks)

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