Case 2: Osteoporosis Flashcards
(38 cards)
Define osteoporosis
- Reduction in bone mass
- Disruption of skeletal micro-architecture
- Fragility of skeleton
What is a person with osteoporosis at increased risk for?
Fracture 2/2 decreased bone strength
What happens to the trabecular bone with increasing age?
Continuous trabecular network begins to breakdown there is thinning of horizontal trabecula, eventually the vertical trabecula is unsupported.
RF:
- Women>men
- White or Asian
- Low body wt <127lbs or BMI <20
- Fhx or personal hx of fragility fx
- Long-term glucocorticoids
- Estrogen deficiency- postmenopausal
- Testosterone deficiency
- Increasing age
- *lifetime osteoporotic fx risk for a women who reaches 50 is 50%.
Causes of secondary osteoporosis
- Meds- steroids, anti epileptics
- Vit D deficiency
- Low Ca intake
- Alcohol >2-3 drinks/day
- Sedentary lifestyle
- Current tobacco use
What does FRAX calculate?
- Fracture risk assessment tool
- Calculates pt’s 10y fx probability
Who can you calculate FRAX score on?
- Postmenopausal women and men age 40-90
- *only validated for untreated pts, DXA scan input needed.
What is the gold standard for bone density testing?
DXA of lumbar spine and hip
Who gets a DXA scan?
- Women ≥65 years old
- ?men ≥70 years old- no consensus
- Younger but at risk for osteoporosis or osteomalacia
- Pathologic fractures
- Radiographic evidence for diminished bone density
What determines the interval between scans?
Based on T score
What is the interval between DXA scans for: T score -1.0 to -1.5 T score -1.5 to -2.0 T score < -2.0
T score -1.0 to -1.5: every 5 years
T score -1.5 to -2.0: every 3-5 years
T score < -2.0: every 1-2 years
T score range for normal, osteopenia, osteoporosis, severe/established osteoprorosis?
- Normal: w/in 1 SD, T score > -1
- Osteopenia: b/w 1 and 2.5 SD below NL, -1 to -2.5
- Osteoporosis: 2.5 SD or more below, T score < -2.5
- Severe/Established: 2.5 SD or more below with 1 or more fragility fractures
What is a z score?
bone density as standard deviation from age-matched, race-matched, and sex-matched.
Who is Z score used in?
Premenopausal women, younger men, and kids
what is the first sign/symptom of osteoporosis?
asxs/silent until fx occurs
Clinical manifestations of a vertebral fx:
- Height loss or kyphosis
- Acute episodes may be associated with pain
- Often no preceding trauma or minor trauma (ie: speed bump, standing up)
- Acute back pain with sudden lifting, coughing, bending
- Usually pain localized to midline spine, variable quality - May refer into flank, anterior abdomen, posterior superior iliac spine, radiation into legs rare
- May have pain on palpation/percussion of affected vertebrae
Xray findings:
- Radiolucency
- Cortical thinning
- Occult fx
Bone loss has to be greater than __% to be detected?
30%
Life style modification for osteoporosis
- Smoking cessation
- Limit alcohol intake
- Regular weight bearing and muscle-strengthening exercise- At least 30 mins, 3x/week
- Consume at least 1200 mg of calcium/day
- Adequate calorie intake
- Take measures in the home to avoid falls
- Wearing a brace
When should a pt be started on pharmacological tx?
- Hx of hip fx or vertebral fx
- T-score < -2.5 (DXA) at femoral neck or spine, after evaluation to exclude 2/2 cause
- T-score b/w -1 and -2.5 at femoral neck or spine, 10 yr probability hip fx > 3%, or other fx > 20%
What should total Ca and vit D daily intake be?
- Ca 1200mg/day
- Vit D 800 units
Calcium SE:
Supplements ↑ risk nephrolithiasis, may ↑ CV disease (controversial- data points away), dyspepsia, constipation. Interfere with iron & thyroid hormone absorption (take at different times)
Vit D SE:
- Excessive amounts- hypercalcemia, hypercalciuria, nephrolithiasis
- Chronically high levels of Vit D linked to ↑cancer, mortality, and falls
- Measure vitamin D levels with 25(OH)D
1st line tx for osteoporosis
Bisphosphonates
