osteoporosis Flashcards
(46 cards)
remodeling
old bone reabosrbed by osteoclast and replaced by osteoblasto
osteoporosis- and what type of disease?
oversupply of osteoclasts or undersupply of osteoblasts. metabolic disease.
osteoporosis - most common places (3 of them)
Affects the whole skeleton. Vertebral column, hip, and wrist are most often affected.
osteoporosis - causes - hereditary?
Normal aging, Menopause and ↓ gonadal function
Osteoclastic activity > osteoblastic activity
Typically in lean built Caucasian and Asian women with sedentary life style
Heredity (responsible for 70% of peak bone mass)
Poor life time nutrition and calcium intake
Poor life time ↓ wt bearing activities
Pregnancies and breast feeding once thought to deplete Ca++, however new studies show breastfeeding moms rebound and replace their Ca supply
osteoporosis - normal?
yes, part of normal aging
bmd- when does it peak?
bone marrow density - peaks at age 20
Secondary Osteoporosis (5%) - causes (CCATD second)
Chronic disease
Alcoholism
Cigarette smoking
Thyroid disease
Diabetes
OSTEOPOROSIS: PATHOPHYSIOLOGY
Combination of factors:
Decreased gonadal function (menopause)
Causes increase in osteoclastic activity
Inadequate Calcium intake
Inactivity
Comorbidity (Disease and medications)
osteoporosis - what happens (3 things)
gonad decrease (menopause), osteoclasts increase, then bone loss
Typically presents with fracture - and what age
Pt usually has risk factors for primary osteoporosis
Age > than 60
Post menopausal woman, Caucasian or Asian with petite, lean build
Low lifetime calcium intake
Sedentary lifestyle, or prolonged immobility
May be a smoker and hx of high alcohol intake
OSTEOPOROSIS: ASSESSMENT OBJECTIVE DATA - spine? and height? (Down, osteo)
Classic “dowager’s hump” (Kyphosis of dorsal spine)
Shortened height (2 to 3 inches)
OSTEOPOROSIS - fast or slow?
occurs faster w/ more fractures
types of vertebral fractures (concave the wedge w/ compression)
biconcave, wedge, compression
OSTEOPOROSIS: DIAGNOSTICS AND TESTS - x-ray
X-ray: not too sensitive: changes only evident after 25 – 40% bone mineral loss
low bone mass - what number (and what is it called)
= osteopenia.1- 2.5 on standard deviation.
severe bone loss (osteoporosis) - what number? And what?
more than 2.5 on standard deviation and one or more fragility fractures
INDICATION FOR DEXA - x-ray
X-ray evidence of low bone mass
PREVENTION OF OSTEOPOROSIS - and how much ca a day?
Prevention should begin as a child
Well balanced diet rich in calcium, and vitamin D
Daily sun exposure (15 minutes/day without sunscreen) (Vitamin D)
Physical activity (wt bearing – walking, running)
Calcium intake
Normal intake in an American diet is 450 – 550 mg/ day
Recommended amount of elemental Ca++ (Ca until you’re 15)
Young adults (11 –24) 1200 – 1500 mg/d
Adults (25 – 64) 1200 mg /day
Older adults > 65 1500 mg / day
Postmenopausal > 50 y/o 1500 - 2000 mg / day
Vitamin D intake (facilitates Ca++ absorption) (you know this)
Recommended for ages 19 – 59 is 1000 IU/d
> 50 years old 1200 IU / day
Sun exposure 10 – 15 min 3x’s/ wk, milk, egg yolks, fortified foods.
Calcium Supplements
Ca Gluconate 9% 650=58mg
Ca Lactate 13% 650=85mg
Ca Citrate 21% 650=137mg
Tribasic Ca Phos 39% 650=253mg
Ca Carbonate 40% 650=260mg
(Tums)
(% of elemental Calcium)
EXERCISE - how long?
Exercise early in life contributes to higher peak bone mass
Weight bearing exercise
for at least 30 minutes
3X’s / wk ↑’s bone mass.
Walking, stair climbing,
dancing, hiking, tennis,
running, Tai Chi
EXERCISE IN THE ELDERLY
↓’s falls by as much as 25%
Improves muscle strength
↑ Coordination
↑ Balance – Tai Chi
Fall prevention: especially in the elderly: FX
Good Body Mechanics
Walking program 3-5 times per wk
Balance exercises (Tai Chi)
Safe home environment
Ambulatory aids
Hip pads
OSTEOPOROSIS:PHARMACOTHERAPY - targets what 3 areas?
Calcium and Vitamin D supplementation
Inhibiting osteoclast activity ( bone resorption)
Promoting osteoblast activity
