Flashcards in Care of Patients with Musculoskeletal Patients Deck (40)
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Osteoporosis:
chronic metabolic disease in which bone loss causes decreased density and possible fracture
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Bone is a dynamic tissue that is constantly undergoing changes in a process called
bone remodeling
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Osteoporosis and osteopenia (low bone mass) occur when
Osteoclastic (bone reabsorption) activity is greater than osteoblastic (bone building) activity
The result is a decreased bone mineral density (BMD): determines bone strength and peals between 25-30 years of age
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A T-score represents the
number of standard deviations above or below the average BMD for young, healthy adults
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Osteopenia is present when the T score is at
-1 and above -2.5
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Osteoporosis is diagnosed when the T score is
at or lower than -2.5
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Medicare reimburses for BMD testing every 2 yr in people ages of 65 and older who are:
Estrogen deficient
Have vertebral abnormalities
Receive long term steroid therapy
Have primary hyperparathyroidism
Being monitored while on osteoporosis therapy
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Generalized osteoporosis involves many structures in the skeleton and is further divided into 2 categories:
Primary: occurs in postmenopausal women and in men in their seventh or eighth decade of life
Secondary: result from other medical conditions, such as hyperparathyroidism; long term drug therapy, such as with corticosteroids; or prolonged immobility, such as seen w/ spinal cord injury
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Excessive ______ in the diet can cause calcium loss in the urine
caffeine
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What can also reduce bone density?
Protein deficiency
Yet, excessive protein intake may increase calcium loss in the urine
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Other risk factors of Osteoporosis:
Excessive alcohol and tobacco use
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Kyphosis:
curvature of the thoracic spine, "dowager's hump"
-2-3 in shorter w/in previous 20 years
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The most common type of osteoporotic fracture:
back pain accompanied by tenderness and voluntary restriction of spinal movement suggests one or more compression vertebral fractures
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Quality of life might also be impacted by
pain, insomnia, depression, and fallophobia (fear of falling)
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Lab assessments:
biochemical markers
Bone specific alkaline phosphate (BSAP)
Osteocalcin
N-telopeptide (NTX)
C-telopeptide (CTX)
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Imaging assessments:
Most common: Dual x-ray absorptiometry (DXA or DEXA)
-painless scan that emits less radiation than a chest x-ray
-best tool
Peripheral quantitative ultrasound (pQUS) is an effective and low cost tool that can detect osteoporosis and predict risk for hip fracture
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Nutrition therapy and lifestyle changes:
Avoid alcohol and caffeine
Lactose intolerance - choose a variety of soy and rice products
Calcium and Vit D are added to many fruit juices, bread, and cereal products
The promotion of a single nutrient will not prevent or treat osteoporosis
Exercise is important in prevention & management
Encourage active ROM
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Drug therapy:
Provider may prescribe calcium and vit D supplements, bisphosphonates, or estrogen agonist/antagonists
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Hypercalcemia can cause serious
damage to the urinary system and other body systems
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Bisphosphonates (BPs) do what?
slow bone reabsorption by binding w/ crystal elements in bone, especially spongy, trabecular bone tissue
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Oral BPs are commonly associated w/ a serious problem called
esophagitis (inflammation of esophagus)
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Osteomalacia:
loss of bone related to a Vit D deficiency
Ex. rickets = children's version
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Osteomalacia and osteoporosis can occur
at the same time
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Manifestations of osteomalacia:
Nonspecific
Muscle weakness and bone pain may be mistaken as arthritis or another connective tissue disorder
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Paget's disease or osteitis deformans:
chronic metabolic disorder in which bone is excessively broken down (osteoclastic activity) and re-formed (osteoblastic activity)
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Manifestations of Paget's disease
Common:
Fragility fractures
Different size and shape of skull: soft, thick, enlarged
Deafness
Vertigo
Changes in vision, swallowing, hearing, and speech
Less common:
Hyperparathyroidism and gout
Hyperuricemia and gout occur because increased metabolic activity of bone creates an increase in nucleic acid catabolism
Increased cardiac output
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Diagnostic assessment of Paget's disease
Serum alkaline phosphatase (ALP) and urinary hydroxyproline levels are primary lab findings
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Drug therapy for Paget's disease
Bisphosphonates = 1st line defense
NSAIDs
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Other interventions for Paget's
gentle massage
application of heat
exercise program
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Bacteria, viruses, or fungi can cause infection in bone known as
osteomyelitis
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Ischemia of bone tissue follows and results in necrotic bone. This area of necrotic bone separates from surrounding bone tissue, and what is formed?
sequestrum = prevents bone healing and causes superimposed infection, often in the form of bone abscess
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Osteomyelitis is categorized as
exogenous, infectious organisms enter from outside the body
and Endogenous
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Osteomyelitis has 2 major types:
Acute osteomyelitis: results from bacteremia, underlying disease, or nonpenetrating trauma
Ex. Salmonella infections of GI tract may spread to bone - Endogenous
Chronic osteomyelitis: develops especially in older adults who have foot ulcers when treatment is to short, delayed, or inappropriate - gram negative bacteria - Exogenous
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Poor dental hygiene and periodontal (gum) infection can be causative factors in
contiguous osteomyelitis in facial bones
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Older adults may have __________ because of lower core body temperature and compromised immune system that occur w/ normal aging
extreme temperature elevation
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What is less common in those with chronic osteomyelitis?
fever, swelling, and erythema
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What is more common in those with chronic osteomyelitis?
ulceration resulting in sinus tract formation, localized pain, and drainage
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Interventions for Osteomyelitis: nonsurgical management
Antimicrobial (antibiotics) therapy
In precense of copious wound drainage, Contact precautions are used
Oxygen therapy
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Interventions for Osteomyelitis: surgical management
Surgery is reserved for chronic osteomyelitis
Sequestrctomy may by performed to debride necrotic bone and allow revascularization of tissue
Bone grafts
Microvascular bone transfers - most common donor sites are the patient's fibula and iliac crest
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