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CLINDX Unit 2 UFCOM > G. Osteoporosis/Osteoarthritis/RA > Flashcards

G. Osteoporosis/Osteoarthritis/RA Flashcards

(53 cards)

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1
Q

What is Osteoporosis?

A

Low bone mass & microarchitecture deterioration –> fragile bones

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2
Q

What is the prevelence of osteoporosis in post-menopausal women?

A

30%

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3
Q

What are the outcomes for hip fracture?

A

20% die
20% return to normal
20% instituitionalized
20% need a lot of assistance

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4
Q

What % of bone mass & bone remodeling does trabecular & cortical bone account for?

A

Trabecular = 20% mass & 80% turnover

Cortical is the opposite

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5
Q

What age has peak bone density?

A

28

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6
Q

Patients with severe osteoporosis tend to present with what posture?

A

Keyphosis
Rib cage dropped down to pelvis
Stomach pushed out
Overall height decreased

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7
Q

How is the trend of bone density different in men & women?

A

Both peak at 28, but peak is higher in men

Both decrease after 28, but men decrease linearly & women have a big decrease around menopause

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8
Q

Risk factors for Osteoporosis?

A 
Female
White
Low body weight
Low calcium intake
Sedentary lifestyle 
Steroid deficiency 
Alcohol & smoking
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9
Q

Lab tests for osteoporosis work up?

A 
Ca
P
Alkaline phosphatase 
24 hour urinary Ca
Testosterone if makle
Creatine
Albumin
CBC
TSH
Estradiol, prolactin, FSH & LH
Serum protein electrophloresis 
PTH
Vit D 
24 hour urinary Free cortisol
Carotene
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10
Q

How are bone densities reported?

A

T = difference between patient & idealized 28 yo

Z = difference between patient & idealized age matched patient

-1 to -2.5 standard deviations from idealized 28 yo = Osteopenia
> -2.5 = osteoporosis
> -2.5 + fractures = severe osteoporosis

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11
Q

How do the lifetime risk of fractures in males & females compare?

A

Women about 40% & men about 10%

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12
Q

How is osteoporosis prevented?

A

Primary Prevention =

  • Good nutrition (Ca)
  • Stop smoking
  • Exercise
  • Hormone Replacement Therapy

Secondary Prevention = preventing fractures by preventing falls

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13
Q

What drug interferes with Ca absorption?

A

H2 blockers

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14
Q

What causes osteoporosis pain?

A

Acute fractures & muscle spasms associated with spinal deformity

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15
Q

Osteoporosis drug therapy?

A 
Ca
Vit D
Estrogen
Calcitonin
Anabolic steroids
Bisphosphonates
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16
Q

Why do elderly need more Ca?

A

Ca absorption is decreased?

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17
Q

Why do elderly need more Vit D?

A

They create less via sun exposure

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18
Q

What frequently coexists with osteoporosis?

A

Osteomalacia (Vit D)

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19
Q

What is the standard of care treatment for osteoporosis? When to use? Efficacy?

A

Estrogen
10% increased bone mass & 50% fewer fractures
Debate over increased risk of malignancy

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20
Q

Decreased Ca absorption can be overcome with supplementation of what?

A

Vit D in high doses

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21
Q

What forms of Vit D are available for supplementation?

A

Vit D
1,25 dihydroxy Vit D3 (If dont think kidney & liver can convert precursor)

Need pharmacologic doses

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22
Q

What form of Ca has the highest levels of elemental Ca? Which type is better for people with achlorhydria (H2 blocker or PPI)?

Study These Flashcards
A

Ca Carbonate

Ca Citrate

23
Q

What supplement reduces bone resorption? Outcome?

Study These Flashcards
A

Bisphosphonates

Increase bone mass 10% & reduce fractures 50%

24
Q

When to take bisphosphonate supplement?

Study These Flashcards
A

30 minutes before eat when first wake up

25
How to Glucocorticoids lead to osteoporosis?
``` Increase Ca excretion by kidneys Decrease Ca absorption by intestine Increase bone breakdown Decrease bone synthesis Decrease LH ```
26
How are Glucocorticoids used correctly?
``` Give minimal necessary dose Encourage weight bearing exercise Eliminate smoking & alcohol Supplement Ca & Vit D Measure 24 hour urinary Ca ```
27
What are the different definitions for osteoarthritis listed in order of prevalence?
Cartilage changes at autopsy (almost 100% at 50) Osteoarthritis at autopsy Osteoarthritis by X ray (50% by 50) Symptomatic Osteoarthritis Chronic disabling Osteoarthritis (10% by 70)
28
Clinical definition for osteoarthritis?
``` Enlarged tender joints No joint warmth Crepitus (grating sound with movement) Morning stiffness Age >50 ```
29
Radiographic findings for Osteoarthritis?
Osteophytes Joint space narrowing Subchondral cysts & sclerosis Malalignment
30
What are the 2 major classifications for Osteoarthritis?
Idiopathic = localized, general or Ca crystal associated Secondary = Trauma, congenital/developmental or other diseases
31
Swelling of the DIP & PIP due to osteoarthritis are called what?
``` DIP = Haverdens Node PIP = Bouchard's Node ```
32
Osteoarthritis of what finger(s) tend to be painful?
most fingers aren't painful, but osteoarthritis of the thumb can be very painful
33
What is the pathosphysiology of osteoarthritis?
Aging or immobilization --> chondrocyte malnutrition --> chondrocyte injury --> matrix degeneration
34
How is weight bering physical activity related to chondrocyte nutrition?
The chondrocytes are avascular, they only get nutrients when they are compressed --> forces fluid out --> "sucks" in new nutrient rich fluid
35
Intrinsic risk factors for osteoarthritis?
``` Age Sex Bone density Joint Mechanics Heredity Metabolic ```
36
How is weight correlated with Osteoarthritis?
Only men with weight in the highest quintile have increased risk Risk is more dispersed gradually over the quantiles for women Women will benefit from small weight reduction. Men only benefit if they are obese & lose a lot of weight
37
Which joints are disproportionately represented in each sex?
``` Men = hip Female = knee ```
38
What are the 3 most important determining factors for osteoarthritis?
Age Weight Genetics
39
In 2 words, what is the basis of osteoarthritis?
Chondrocyte dysfunction
40
What is the prevalence of RA? Effect on lifespan?
1% | Shortens lifespan by 3-18 years
41
What age groups & sex get RA most often?
Young (30-50) | Women
42
What HLA Gene Complexes are associated with RA?
DRB1 | DR3
43
Clinical criteria for RA?
Morning stiffness 3 or more joints Symmetric Hands involved
44
What cytokines are related to the pathophysiology of RA?
TNF alpha IL-1 Imbalance of these cytokines & anti-inflammatory cytokines (Soluble TNF receptor, IL1 receptor agonist & IL-10)
45
What is the predominant microscopic appearance of the synovium in RA?
Inflammatory infiltrate
46
What joints are usually effected in RA?
Spine & DIP not effected Other than those small distal joints are traditionally effected more than proximal (hand & feet more so than knees & elbow)
47
What finger positions are associated with RA? Cause?
Swan Neck = flexed DIP Boutenneires = Flexed PIP Tendon destruction
48
What are the 2 main organs outside of the joints that can effected by RA?
Eyes | Lungs
49
What is Rhuematoid Factor?
Autoantibody directed against Fc portion of IgG
50
How accurate is the RF test for RA?
Not very Only 80% of RA patietns test + (low specificity) Can get false + from infection (TB, hep, endocarditis, viral & parasitic), neoplasms, healthy elderly & a lot of other stuff
51
What two tests should be performed if RA is suspected? What is the combined specificity? When do these markers present as +?
RF & anti-CCP 99.5% CCP is early & RF is later (once symptomatic)
52
Ways to differentiate RA from OA?
RA is younger patients RA pain gets better through day RA affects small joints RA has elevated ESR, RF/CCP, anemia, luekocytosis
53
How accurate is anti-CCP test for RA?
Very specific

CLINDX Unit 2 UFCOM (8 decks)

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