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bone densitometry > osteoporosis > Flashcards

osteoporosis Flashcards

(93 cards)

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1
Q

what is osteporosis

A

when the bone rebuilds slower than it is broken down so bones become weak and brittle

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2
Q

what is peak bone mass

A

usually slows down in 20’s and reaches peak by 30’s
-the later the better bc= more in the bank
-somewhat inherited in ethnic groups

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3
Q

is bone living tissue

A

yes

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4
Q

symptoms of osteo

A

-pain due to collapsed vertebrae/ fx
-slopped posture
-bones that break easier
-loss of height over time

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5
Q

risks

A

lifestyle, general, hormones, dietary, medications, disease

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6
Q

what diseases incr risk

A

IBD, celiac, RA, multiple myeloma, kidney/liver disease, cx, lupus

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7
Q

dietary risks

A

low calcium uptake or GI surgery limiting absorption or eating disorder

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8
Q

medication risks

A

coritcosteroids interfere with bone building and other meds for cx, reflux, transplant rejection, seizure do the same thing

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9
Q

thyroid risk

A

-too much thyroid hormone
-overactive thyroid
-too much medication to treat underactive thyroid

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9
Q

hormonal risks

A

breast and prostate cx treatments reduce sex hormones. decr in estrogen and testosterone

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10
Q

general risks

A

age, gender (women), fam hx, body frame (sm), race

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11
Q

lifestyle risks

A

people who sit alot or live sedentary lives
-balance and good posture incr bone strength
-excessive alc and tobacco use are bad

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12
Q

calcium intake

A

normal for 18 and up=1000 mg/day
women at 50=1200 mg/day
men at 70=1200 mg/day
-low fat dairy, dark leafy greens, canned salmon or sardines with bones, fortified juice/cereals, soy like tofu
-too much ca can cause kdieny stones and heart disease (>2000mg a day)

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13
Q

vitamin D allows for

A

calcium uptake

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14
Q

vitamin d uptake values

A

-51-70 yrs need 600IU
-80 and up need 800IU
-no mor than 4000 IU a day

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15
Q

goal of osteoporosis treatment

A

to restore balance of resorption and formation of bone

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16
Q

2 types of resorption treatment tyoes

A

1-antiresorptive=slows breakdown part of bone modeling
2-anabolic=stimulate bone growth

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17
Q

antiresorptive drugs

A

calcitonin, estrogen, biphosphonates

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18
Q

anabolic drusg

A

teriperatide, parathyroid hormone analog

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19
Q

fosamax

A

-for men and post menopausal women

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20
Q

fosamax treatment dose

A

10 mg daily or 70 mg weekly

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21
Q

fosamax preventin dose

A

5 mg daily or 35 mg weekly

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22
Q

ReClast

A

-for men and post menopausal women

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23
Q

ReClast treatment dose

A

give once a year via infusion

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24
ReClast prevention dose
give once a year every two years via IV infusion
25
Boniva
approved for post menopausal women
26
Boniva preventative dose
150 mg once monthly
27
Boniva treatment dose
IV injection 3 mg every 3 month
28
Prolia
men and post menopausal women with high risk of fx
29
Prolia treatment dose
injected every 6 months
30
denosumab
prolia
31
zolendronic acid
ReClast
32
ibandronate sodium
boniva
33
alendronate sodium
fosamax
34
axial
spine, ribs, skull, sternum
35
appendicular
extremities, scapulae, pelvis
36
cortical bone
dense outer surface of bone that forms protective layer aorund inner cavity aka compact bone which makes up nearly 80% of skeleton and imperative for structure as it is bend resistant
37
trabecular bone
aka cancellous or spongy
38
where is cortical bone found
temporal neck and forearm
39
where is trabecular bone found
ends of long bones and in pelvis bones, ribs, skull, vertebraes, and calcaneus
40
consider what type of bone your observing why
becayse some bone shows disease onset better or worse but scan multiple sites
41
what bone should you look at when observing response to therapies
trabecular because it has a greater metabolic rate
42
3 phases of bone remodeling
1-resorption=osetoclasts break down bone 2-mononuclear cells show on surface of bone 3- formation= osteoblasts lay down new bone until reabsorbed completely replaced
43
after how many years is the skeleton completely replaced
7-10 years
44
bone densitometry
dual energy xray absorptiometry (DXA/DEXA)
45
what does dexa do
quanitative measurement technique used to measure bone mass or densityhat
46
what bones are typically measured
lumbar spine, dual femurs and forearm
47
dual photon absorptiometry
quantidy degree of attenuation of a photon energy beam after passage through bone and tissue--- occurs at two energy peaks
48
how are 2 energy peaks found
one energy peak oreferentially attenuated by bone so contributions of soft tissye can be subratced mathematically
49
dual photon isotope
gadolinium 153 -2 photoelectric peaks at 44 kev and 100 kev
50
bone preferentially attenuates which photon energy
44 kev
51
the photo beams are detected through a ____ _____ _____ and quantified after oassage through ___ ____ _____ set at 44 kev and 100 kev
NaI scintiallation detector; pulse height analyzer
52
dual xray absorptiometry
x ray tube replaces isotope
53
adv of dual xray
no source decay or replacing radioactive sources, better image resolution, faster scan time, precision imporved, smalled focal spots = better beam collimation, less dose overlap between scan lines
54
t/f; xray beams prodcues a beam that spans a wide range of photon energies
true
55
maufactures need yo produce tqo distinct photo electric peaks neccesarry to separate bone from soft tissue by
k-edge filter and alternating pulses to xray spurce @ 70 and 140 kev
56
the spine beams enter
from posterior to anterior
57
L1 has the lowest BMC and BMD of
1st 4 lumbar vertebrae
58
when does BMD increase
L1-4
59
is it better to individuall report the vertebrae or do 1-4
do 1-4 for accuracy and precision
60
scanned image is used for
noting artifacts and meausrments from correct area NOT diagnosic
61
goals for spine scan
straight lumbar spine, clear verterbral seperation, level iliac crest, visible ribs
62
positioning for spine scan
have pt lay flat on center of the table then palapate pt iliac crestand simply look at pt position on table
63
artifacts for spine scan
fractures increas BMD falsely and osetophytes, aortic calcification, renal stones, gallstones, contrast agents, ingested calcium tablets, can all incr B
64
labeling vertebrae
L5-sideways I L4-H or X L3-1-U or Y
65
proximal femur goals
properly roated femur internally 20 degrees so parralell with table and size of trochanter hsould sem kinda small. should not scan hardware of previously fx femur
66
proximal femurs rois
neck, wards, troch shaft, total
67
forearm scan goal
stright unroated forearm including radial and ulnar styloids and 33%ROI. use non dominant arm is pos and ref datat with non dom arm bc dom arm usually high BMD. not previous fx or hardware, scan dominant arm but note that in report
68
forearm positioning
lay arm flat on table, bent 90% from upper arm, relaxed first (fingers curled under), include lower 2/3 scaphoid
69
% young adult
expression of pt valaue as percent of avg peak value for adults of same sex young
70
%age matched
compare pt value for an indicual the same sex and age if less then 80% not normal
71
z score
number of standard deviations above or below avg value, age matched
72
t score
number of standard deviations above or below avg value, young adult )currently used dx) (pre men women adn men under age 50 then no t score
73
osetoporsis posotive if
2.5 standard deviations away from age value so tscore of -2.5 and belownor
74
normal tscore
-1.0 or greater
75
low bone mass (osteopeniea)
t score between -1 and -2.5
76
severe osteoporosis
t score -2.5 and below PLUS a fragility fracture
77
age regression graph
pt B
78
vertebral fx assessment (VFA)
lateral spine imaging, dx of fx, low rad dose vs norm xray, 30% fx here are not felt
79
frax
tool used to rpedict future fx risk up to 10 years in advance made by WHO with or without BMD values but can be built into DEXA, 12 Q's: age gender weight height and Q 5-11 for clinical risk factors and 12 is optional femoral neck BMD value and not used at FMLH bc concern for pt honesty on questions
80
trabecular bone score TBS
relatively new method for assessing bone quality and fx risk of lumbar spine use dxa spine images, cannot dx osteoporosis but give microarchitecture
81
normal TBS
>=1.350
82
partially degreaded TBS score
1.200-1.350
83
degraded TBS score
<=1.200
84
TBS invalid in cases with
signifigant scoliosis
85
TBS value not guarenteed if
BMI is higher than 37 kg/m2
86
accuracy is importanat for
baseline study precision is importan for
87
precisions important for susequent visists to
compares
88
effective dose from natural bkg source
0.6-0.7 mrem a day
89
dexa eff dose
0.67 mrem per day
90
ap cxr dose
5 mrem
91
lateral lumbar sppinse dose
70 mrem
92

bone densitometry (1 decks)

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