Osteo s.w Flashcards
(20 cards)
any major weightloss you will loose bone
unless you take supplements, it can also bounce back
there are many levels of evidence for studies of treatment and intervention and they are graded - how are they graded
1+ being the best (systematic overview of meta-analysis of Randomized control trials) to 6 being the worst (case reports of case series of less than 10 patients
there are also grades that can be assigned to recommendation
level a: needs level 1 or +1 evidence plus consensus
B: needs supportive level 2 or 2+ evidence plus consensus
c: need supportive level 3 evidence plus consensus
d: any lower level of evidence supported by consensus
what is the point of gathering client history
Provides background information
Assess whether person likely to have risk for fracture – even answering YES once
prior fragility fractures, hip fractures, glucocorticoid use, smoker ….
Physical Exam
Weight loss
Height loss
Physical ability
what are the most significant risk factures that can predict a fall
History of falls in the lastyear is one of the mostsignificant risk factors forpredicting future fall1-6
Dementia and poor physicalfunction have also beenfound to be associated withfalls and fractures in olderadults2,4,5
A history and physical examination should be performed with several objectives:
3
1) to identify factors (some of which may be reversible) that may be contributing to bone loss; 2) to identify factors that may be predictive of future fractures; and 3) to exclude secondary causes of osteoporosis.1-3
what is considered a significant wt loss since the age of 25
more than 10%
In men > 50 years and postmenopausal women, the following are associated with low BMD and fractures
Low body weight (< 60 kg)
Major weight loss (> 10% of weight at age 25)
what techniques can be used to measure height and can indicate vertebral fractures
Measure height annually (prospective loss > 2cm)
(historical height loss > 6 cm)
Measure rib to pelvis distance < 2 fingers’ breadth
Measure occiput-to-wall distance (for kyphosis) > 5cm
it is better to measure annualy to see the progression. once you start to hunch it is impossible to go back to normal as the vertebraes are brokem
when should a lateral thoracic and lumbar spine x-ray be done
when significant height loss has occured
Prospective loss of > 2 cm over three years should be investigated by a lateral thoracic and lumbar spine X-ray.
how should height be measured
For the most accurate measurement of height, one should use a wall-mounted stadiometer. The patient should be measured without shoes, with
the heels, buttocks, and back to an upright board. The subject’s head should face directly forward; the back of the head does not necessarily touch the vertical board.
Instruct the patient to take a deep breath, hold it and stand straight. The observer can then apply bilateral pressure to the mastoid processes of the patient to hold the head in position. The patient is then asked to relax and exhale, at which point height can be recorded.
what is the rationale , method and interpretation of a rib-pelvis distance
it identifies lumbar fractures
to do this test you measure the distance between the coastal margin and the pelvic rim on the mid-axillary line
Interpretation: less than 2 fingerbreaths is associated wih vertebral fracturest
what is the rationale , method and interpretation of a occiiput-to-wall distance
it helps identify thoracic spine fractures
to do this test The measurement is made as the individual stands straight with heels and back against the wall. Vertebral fractures should be suspected if distance between the wall and the occiput is > 5 cm.2,3
what percentage of fractures are not reported
Height loss should trigger further investigations including a lateral thoracic and lumbar spine radiograph. A Canadian study of emergency department radiographs found that only 55% of vertebral fractures were mentioned in the radiology report.1 Osteoporotic vertebral fractures are best defined on radiograph as 25% or greater vertebral height loss with end-plate disruption.2 Radiographic examinations of the spine that may be helpful for investigation of height loss and vertebral fracture detection are presented here.
References
what are the secondary of osteoarthritis
GI disorders Genetic disorders Endocrine disorders Hypogonadal states Miscellaneous
Anything that disrubts your normal hormones , for example cushing disease- increases gluticorticoids
do we measure biochemical data
Simple biochemical investigation should be considered in all patients prior to initiating pharmacologic treatment for osteoporosis
in men do they test testosterone
Testosterone testing is not recommended (as assay quite variable) for men with osteoporosis unless there are clinical features of hypogonadism
how prevalent is secondary osteoporosis
In primary care, the prevalence of secondary osteoporosis is unknown, but is probably less than 20% in women1,2 and possibly as high as 50% in men.3 Many diseases that contribute to low BMD have specific therapies, and it is appropriate to assess for and treat these conditions before making a diagnosis of osteoporosis solely on the basis of low BMD.4,5
what are the recommendations in biochemical tests
what grade do they have
Patients with osteoporosis need only limited laboratory investigations performed: complete blood count, calcium corrected for albumin, creatinine, alkaline phosphatase, and thyroid stimulating hormone
Serum protein electrophoresis should be performed in individuals with vertebral fractures
Measurement of serum 25-OH-D is recommended among individuals with the following conditions: treatment with pharmacologic therapy for osteoporosis, recurrent fractures, bone loss despite osteoporosis treatment, or those with co-morbid conditions that affect vitamin D absorption or action
In selected patients, based on clinical assessment, additional biochemical testing should be considered to rule out secondary causes of osteoporosis
they all have D as a grade
There is not a lot that your blood is going to say about osoporosis , except a few another disease that can cause secondary osteoporosis
Recommended Biochemical Tests forPatients Being Assessed for Osteoporosis
Calcium, corrected for albumin Complete blood count Creatinine Alkaline phosphatase Thyroid stimulating hormone (TSH) Serum protein electrophoresis for patients with vertebral fractures 25-hydroxy vitamin D (25-OH-D)*
Simple biochemical screening should be considered in all patients with documented osteoporosis prior to initiating pharmacologic treatment. Recently published Osteoporosis Canada guidelines for vitamin D have emphasized the high prevalence of vitamin D insufficiency in the population and the importance of recommending supplements to ensure optimal vitamin D status. Vitamin D insufficiency should be considered in any patient with osteoporosis, particularly when there are recurrent fractures, bone loss despite therapy or with co-morbid conditions such as celiac disease or gastric bypass that affect vitamin D absorption or action. In individuals receiving pharmacologic therapy for osteoporosis, measurement of serum 25-OH-D should follow three to four months of an adequate supplementation dose and should not be repeated if optimal level > 75 nmol/L) is achieved.
