Common Geriatric Problems- pt 2 Flashcards

(39 cards)

1
Q

what are the 3 MC fracture sites associated with osteoporosis?

A

hip
vertebral
wrist

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2
Q

what is primary osteoporosis?

A

term used to describe osteopenia that is dt advanced age and/or menopause

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3
Q

what is secondary osteoporosis?

A

implies that the decreased bone mass is dt other conditions, medications, malabsorption or prolonged immobilization

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4
Q

RFs for osteoporosis?

A
increasing age
early menopause (before 50 yo)
caucasian
low body wt
EtOH- more than 3 a day
inadequate physical activity
tobacco use
family Hx
poor health/frailty
recurrent falls
poor nutritional status
dementia
anti-seizure medications 
prolonged immobilization
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5
Q

conditions that can cause increased risk for osteoporosis?

A
hyperthyroidism
excess supplemental thyroid
Cushing's dz
glucocorticoids use
hyperparathyroidism
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6
Q

at what point can you finally see osteoporosis on xray?

A

only once 30-40% of bone has been lost

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7
Q

what can you measure in the blood, that give limited use, to dx osteoporosis?

A

serum calcium, phosphorous or alkaline phosphatase

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8
Q

what is the best way to dx osteoporosis?

A

DEXA scan

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9
Q

what is a T score? what is a normal T score? osteopenia? osteoporosis? at what levels is prophylactic tx for osteoporosis begun?

A

of standard deviations above or below a healthy 30 yo of the same sex, ethnicity
normal: greater than -1
osteopenia: between -1 and -2.5
osteoporosis: below -2.5
begin prophylactic tx at T score less than -2
begin prophylactic tx at T score less than 1.5 w/known RFs for osteoporosis

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10
Q

what is a Z score?

A

of standard deviations above or below the mean for the pts current age, sex and ethnicity

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11
Q

what is NTx?

A

a small, cross-linked portion of collagen’s amino terminus that is a stable and specific breakdown product of bony collagen
can help predict osteoporosis and response to tx

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12
Q

what does an elevated NTx level indicate? how can you measure?

A

diminishing bone over time

can be measured either in urine or serum

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13
Q

what is FRAX?

A

diagnostic tool used to evaluate 10 yr probability of bone fracture risk
integrates clinical risk factors w/bone mineral density at femoral neck to calc 10 year probability of hip, spine, shoulder or extremity fracture

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14
Q

RFs used in FRAX calculator?

A

pts age, sex, prior fx hx, EtOH use, tobacco use, use of glucocorticoid drugs, hx of RA, hx of dzs known to contribute to osteoporosis, T-score results of pts last DEXA

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15
Q

out of 4, how many post-menopausal women are estimated to have osteoporosis?

A

1 in 4

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16
Q

how do men respond to osteoporosis medications?

A

generally not as good b/c men usu do not begin tx until osteoporosis is more advanced

17
Q

tx options for osteoporosis?

A

regular wt bearing exercise
discont tobacco use
moderate EtOH intake
calcium: 1 g/d if pre-menopausal, 2 g/d if post-menopausal
predominantly plant based diet (after 60 yo rate of bone loss in non-vegetarians has been found to be greater than that of vegetarians)

18
Q

lifestyle recommendations to prevent osteoporosis?

A
wt bearing exercise
quit smoking
eliminate or moderate EtOH use
eliminate soft drinks
reduce or eliminate coffee
decrease or eliminate red meat intake
19
Q

what 3 forms of calcium could be more readily absorbed in pts w/diminished stomach acid?

A

calcium citrate, calcium lactate, calcium gluconate

20
Q

is milk a good source of calcium for osteoporosis prevention?

A

possibly not- nurses study showed those who drank 2 glasses of milk/d actually had higher rates of fractures than those who drank less

21
Q

aside from supplementing with calcium, what other supplements could one use?

A
vit D
magnesium
boron
strontium
multi-vit and/or B complex to ensure adequate levels of B6, B12 and folic acid
22
Q

why is vit D good to supplement with?

A

necessary for calcium absorption from the GI

in order to protect against osteoporosis need to combine with calcium

23
Q

why might strontium be esp good to supplement with?

A

has been shown to not only diminish bone loss but to also increase bone density in areas of bone loss

24
Q

what dz has a correlation with HRT?

A

has been shown that women who have been on HRT have statistically significant higher rates of heart dz

25
what do bisphosphonates do? when do you prescribe it?
inhibit osteoclast activity, increase bone mass primary drug used to tx osteoporosis in postmenopausal women and in ppl taking corticosteroids or hormonal agents that suppress estrogen
26
benefits of bisphosphonates?
have been shown to reduce risk of spinal and hip fractures including women who have had prior bone fxs
27
ADRs of bisphosphonates?
esophagitis, stomach ache, heartburn, nausea, osteonecrosis of the jaw, myalgias
28
medication that has been approved for both prevention and tx of osteoporosis?
raloxifene
29
drug that has been approved to treat osteoporosis?
calcitonin
30
synthetic PTH analogue approved for the tx of osteoporosis in postmenopausal women and men who are at higher risk for fx?
teriparatide
31
what tx has been shown to have same benefits of estrogen in regards to bone density but doesn't increase the risk of development of hormone-related CAs?
selective estrogen-receptor modulators
32
what two drugs can be used to prevent and treat osteoporosis?
raloxifene, alendronate
33
what 2 drugs can only be used to treat osteoporosis?
calcitonin, calcimar
34
what 6 drugs can be used to prevent osteoporosis?
``` E conjugated premarin esterified estratab menest estradiol estrace estropipate ortho-est ogen ```
35
ADRs of raloxiphene?
hot flashes, arthralgias, myalgias, edema, pruritis, small risk for DVT or PE
36
drug indicated for postmenopausal women w/osteoporosis at high risk for fracture? what must be achieved before starting on it?
denosumab pt must have sufficient calcium and vit D levels before starting therapy c/i in pts w/hypocalcemia
37
MOA of calcitonin?
acts to significantly inhibit osteoclastic activity
38
T/F: calcitonin is used for the prevention and tx of osteoporosis?
NO- just for treatment of osteoporosis
39
MOA of synthetic parathyroid hormone?
inhibits osteoclast activity and stimulates new bone formation in both spine and hip