Flashcards in Care of Patients with Musculoskeletal Patients Deck (40)
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1
Osteoporosis:
chronic metabolic disease in which bone loss causes decreased density and possible fracture
2
Bone is a dynamic tissue that is constantly undergoing changes in a process called
bone remodeling
3
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
4
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
8
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
9
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
11
Other risk factors of Osteoporosis:
Excessive alcohol and tobacco use
12
Kyphosis:
curvature of the thoracic spine, "dowager's hump"
-2-3 in shorter w/in previous 20 years
13
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
14
Quality of life might also be impacted by
pain, insomnia, depression, and fallophobia (fear of falling)
15
Lab assessments:
biochemical markers
Bone specific alkaline phosphate (BSAP)
Osteocalcin
N-telopeptide (NTX)
C-telopeptide (CTX)
16
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
17
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
18
Drug therapy:
Provider may prescribe calcium and vit D supplements, bisphosphonates, or estrogen agonist/antagonists
19
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
21
Oral BPs are commonly associated w/ a serious problem called
esophagitis (inflammation of esophagus)
22
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
24
Manifestations of osteomalacia:
Nonspecific
Muscle weakness and bone pain may be mistaken as arthritis or another connective tissue disorder
25
Paget's disease or osteitis deformans:
chronic metabolic disorder in which bone is excessively broken down (osteoclastic activity) and re-formed (osteoblastic activity)
26
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
27
Diagnostic assessment of Paget's disease
Serum alkaline phosphatase (ALP) and urinary hydroxyproline levels are primary lab findings
28
Drug therapy for Paget's disease
Bisphosphonates = 1st line defense
NSAIDs
29
Other interventions for Paget's
gentle massage
application of heat
exercise program
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