Osteoporosis Flashcards Preview

Clin Med-Endocrine > Osteoporosis > Flashcards

Flashcards in Osteoporosis Deck (51):
1

The world health organization classifies osteoporosis as what

a bone density that falls 2.5 STD dev below the mean for a young healthy adults of the same sex (t-score -2.5)

2

women of what time frame of their menstrual cycle and what bone density score put them at risk for what?

postmenopausal who fall between -1.0 and -2.5 also have low bone density and are at risk of developing osteoporosis

3

what are the values for a person to have osteopienia

between -2.5to 1.0

4

what is the correlation between mortality with osteoporosis

very high due to the complications of treatment of fractures

5

when are fractures of the radius most common

before the age of 50 and plateau by 60 w/ only a modest age related increase

6

what is the incidence rate for hip fractures

doubles every 5 years after 70years old

7

What types of fracture complications are their with osteoporosis

wrist fractures
hip fractures
vertebral fractures

8

what are the complications that come with hip fractures

high incidences of DVT and PE (20-50%)
mortality rate between 5-20% during the 1st year after surgery

9

what are the complications that arise with vertebral fractures

relatively asymptomatic
associated with long term morbidity and slight increase in mortality rates due to pulmonary disease
can cause loss of height and kyphosis and secondary pain and back discomfort'
thoracic fractures can be associated with restrictive lung disease

10

what is a colles fracture

a fracture of the distal radius when a person attempts to break a fall using hands and arms

11

what is primary type 1 osteoporosis

postmenopausal causing rapid bone loss w/in 6 years of menopause, mainly trabecular bone (spongy bone)

12

what is primary type 2 osteoporosis

senile (men and women > 75 yrs of age) slow progression, both cortical and trabecular bone

13

what is secondary types of osteoporosis

sex hormone deficiency (hypogonadism, prolactinoma, orchiectomy (removal of testes) for prostate cancer)
hormone excess (hyperthroidism, hyperparathyroidism, corticosteroids)
Increased bone resorption/formation ration: immoblilization, space flight, long term heparin, cancer
multifactorial(renal failure, anorexia athletic amenorrhea, ETOH use

14

what are risk factor for osteoporosis (non modifiable)

woman (postmenopausal)
white race
advanced age
personal history of fractures as adult
history of fractures in a first degree relative
dementia

15

what are risk factors that are modifiable

Low body weight
current cigarette smoking
ETOH abuse
Low Calcium intake
Vitamin D deficiency
lack of physical activity

16

what are chronic disease states that put people at risk for osteoporosis

rheumatologic and autoimmune
hypogonadal states, anorexia, DM, Cushings syndrome, hyperthyroidism
Celiac, gastric bypass, chrohn's, malabsorption
Multipe Myeloma, Lymphoma, leukemia
Epilepsy, Muscular sclerosis, Dementia, parkinsons, poor eye sight

17

what medications will put you at risk

most common is glucocorticoids
anticonvulsants, immunosuppressants, aromatase inhibitors, heparin lithium, hormone therapies, PPI, ICS in elderly

18

What is the pathophysiology for normal bone growth?

skeleton increases in size by linear growth and by apposition of new bone tissue on the outer surface of the cortex which is known as modeling. the modeling allows the long bones to adapt and shape to the stress placed on them
Puberty require increased sex hormone production which is required for maturation

19

What happens to bone mass in adulthood

bone mass remain constant after peak bone mass is achieve in adulthood- equal balance

20

what are the two primary functions of bone remodeling?

repair microdamage with in skeleton to maintain strength
to supply calcium from the skeleton to maintain normal serum calcium

21

what regulated bone remodeling

estrogen, androgen, vitamin D, PTH,

22

what happens to bone remodeling at ages 30-40

resorption exceeds formation
due to menopause
or increase osteoclast activity or decrease osteoblast activity

23

what are the signs and symptoms of osteoporosis

usually painless unless the patient sustains a fracture
height loss
increased kyphosis of thoracic spine with a secondary protuberant abdomen
bone pain or deformities from fractures

24

how is osteoporosis diagnosed

made clinically in the setting of a fragility fracture regardless of T-score

25

how is osteoporosis diagnosed in men and women

post menopausal women and men greater than 50years old with no fragility fracture diagnosed by bone density testing

26

What labs are ordered to rule out secondary causes of osteoporosis?

CBC
Calcium if elevated hyperPTH low Vit D def or GI malabsorption
phosphorus level
Cratinine
TSH

27

what is the gold standard in diagnosis a person with osteoporosis?

DEXA scan

28

what does a DEXA scan measure?

measure bone density w/minimal radiation exposure
focuses mainly on the spine and hip

29

how are DEXA scan values reported

T-scores
it compares the values of the individual results to those of a healthy 30 year old of the same race and

30

what is a t-score of less than -2.5 in the lumbar, spine, femoral neck or total hip

this is classified at osteoporosis

31

what is the t-score less than -1.0 but greater than -2.5 is considered

osteopenia

32

what are the approved testing guidelines for osteoporosis

for postmenopausal women and men>50years old
measure height annually

33

What are the requirements for a dexa scan

all women>65yr
all men>70
post menopausal women7.5mg of prednisone or duration of tx>3months
primary hyperPTH
monitoring osteoporosis meds

34

what is the treatment for hop fractures

require open reduction and internal fixation with rehab and pain mgmt

35

what is the treatment for vertebral fx

acute pain mgmt if symptomatic
vertoplast/kypoplasty

36

what is the treatment for wrist fractures

may or may not require pinning, ORIF or manual reduction, acute pain mgmt

37

what is the treatment for osteoporosis by reducing underlying modifiable risk factors

d/c meds
smoking cessation
alcohol abuse treatment
environmental safety in the home( eliminate throw rugs, move wires, remove tripping hzds)
treat vision impairment
specialized care for pts with dementia

38

what was can you treat osteoporosis?

improve nutrition
calcium supplements
Vitamin D
weight bearing exercise ( do not increase bone mass but prevents bones loss)

39

how is exercise a good treatment for osteoporosis

prevents bone loss, but does not increase bone mass
improves coordination, strength, and balance
needs to be at least 3x/week

40

what are the normal values for calcium levels

8.5-10.5

41

what is 1st line treatment for osteoporosis what are additional treatments

bisphosphonates
SEMS selective estrogen receptor modulators
calcitonin
PHT
Testosterone

42

what is the MOA of bisphophonates

inhibit osteoclast-induced bone resorption
increases bone density and reduce incidence of both vertebral and nonvertebral fx
prevents corticosteroid osteoporosis

43

when should oral agents for osteoporosis be taken

in the am w/ 8oz of water and 40 min prior to consuming anything else, need to remain upright to prevent esophagitis

44

what are side effects of bisphosphonates

osteonecrosis of jaw, esophagitis, esophageal cancer

45

how long is the treatment for bisphophonates?

1/2 life is 10 yrs there fore it is now recommended to d/c after 5 years of tx

46

how does estrogen work to fight osteoporosis

reduces bone turnover, prevents bone loss and causes small increases in bone mass of the spine, hip, and total body

47

what are some long term side effects of estrogen therapy

increased risk of CV events, breast cancer, storkes, endometrial hyperplassia, DVT, PE

48

how do serms work to prevent osteoporosis

used in postmenopausal women
prevents bone loss and reduces bone turn over

49

how does PTH work for people with osteoporosis

works on osteoblasts
favors bone formation over resorption, produces increase in bone tissue and restores the micoarchitecture

50

what is an example of PTH medication

teriparatide
given sub q daily for 2 years
not as effective as with pts who used bisphosphonates
best as mono therapy

51

when is testosterone use for treatment

in hypogonadal men