Content: 3 ways to define osteoporosis.
1. Microarchitectural deterioration of bone tissue leading to decreased bone mass
2. Bone fragility
3. Susceptibility to fracture
Q: Osteoporosis is a problem of _________ peak bone _____ and _____________ bone _____.
decreased, mass, increased, loss
Q: How many million individuals in the US are affected by osteoporosis?
Q: When does bone mass peak?
Between 20-25 yo
Q: When does bone mass begin to decline?
Around 50 yo
Q: What imaging is often used to identify osteoporosis?
Q: What is BMD?
Body mass density - comes from a DEXA test
number of standard deviations from the young adult mean density
number of standard deviations from age matched mean density
Q: What T-score indicates osteoporosis?
Q: What T-score indicated osteopenia?
-1 to -2.5
T/F: For every standard deviation below the norm, the risk of fractures triples.
Q: When does the z-score apply for osteoporosis?
pre-menopausal females and males < 50
Q: What is FRAX?
Fracture Risk Assessment Tool
Q: What does FRAX calculate?
10 year fracture risk, for things like hip fracture and osteoporosis fractures
T/F: FRAX is the treatment decision making tool in previously treated pts.
Content: Primary Osteoporosis (2)
1. unrelated to chronic illness
2. Related to aging and decreased gonadal function
Content: Secondary osteoporosis (2)
1. Secondary to chronic illnesses/meds that cause accelerated bone loss
2. Ex. glucocorticoid use, hyperthyroidism
Content: Risk factors for Osteoporosis (10 - general idea)
2. Low Ca intake
3. Low vitamin D stores
4. Tobacco and alcohol us
5. Prior history of fracture
8. Excessive urinary calcium
9. Overactive thyroid gland
10. Other medical conditions
Content: Secondary Evaluation of Osteoporosis (7)
1. Comprehensive metabolic panel
3. 24 hour urine for Ca, creatinine, Na
4. 25-Hydroxy Vit D
6. SPEP/UPEP if anemic
Q: How do you assess fall risk?
TUG - Timed get up and go
Content: TUG (5)
1. Stand from a seated position
2. Walk ~10 ft
3. Turn around
4. Return to seated position in chair
5. Normal time < 10 seconds
Content: Life choices and bone health (5)
1. Adequate Ca intake (~1200 mg/day)
2. Optimal Vit D levels
3. WB exercise
4. Avoid tobacco use
5. Avoid excessive alcohol use
Q: How much Ca is in 8 oz of milk?
Q: What calcium supplements are available?
1. Calcium carbonate
2. Calcium citrate
Content: Calcium carbonate (2)
1. Needs stomach acid for absorption
2. Taken with meals
Content: Calcium citrate
Can be taken with or without food
Content: Calcium supplements (2)
1. Limit to ~500 mg in a dose
2. May cause constipation
Content: Vitamin D supplementation (5)
1. Vit D2 - ergocalciferol
2. Vit D3 - cholecalciferol
3. supplementation guided by 250HD value
4. Can be taken with or without food
5. Safe upper limite = 2,000IU
Diagram: Vit D formation
Q: What is the recommendation for exercise to prevent osteoporosis?
30 min, most days of running, walking, or elliptical + muscle stregnthening and balance exercises
T/F: WB activities decrease BMD.
T/F: High impact WB exercise increased BMD by 1-2% at the spine and hip.
Q: What type of training increased spine BMD?
Q: What type of training increased hip BMD?
T/F: Menstraul cycle effects gains in BMD.
Q: Who will be referred to PT for osteoporosis type treatment?
Those at increased risk or fall, unstable gait, weakness
Q: What are pharmacologica treatment options for low bone mass? (4)
4. Selective Estrogen Receptor Modulators
Content: Types of Bisphosphonates (4)
1. Alendronate -wkly
2. Risedronate - wkly/moly
3. Ibandronate - moly/IV every 3 mo
4. Zolendronic Acid - IV annually
Diagram: Mechanism of Action of Bisphosphonates - Osteoclasts are targets
Content: Side Effects of Bisphosphonates (6)
1. Upper GI irritation
2. Osteonecrosis of the jaw
3. Severe musculoskeletal pain
6. Atypical femur fractures
Content: Teriparatide (2)
1. Anabolic (bone building agent)
2. Daily injection
Content: Denosumab (3)
1. Inhibits osteoclast function
2. Decreases bone resorption
3. Consider in pts. with kidney dysfunction
Q: What medications put you at high risk for osteoporosis? (3)
2. Aromatase inhibitors
3. Androgen deprivation therapy
Q: For bone health how often should bone density be evaluated?
On treatment = every 1-2 years
Not on treatment = every 2 years