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Women's Health > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Whta is the difference between Z scores and T scores?

A
  • Z scores are age matched controls
  • T scores are compared to young normal adults of same sex
  • There are no Z and T scores for males for bone density
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2
Q

a measure of disease that allows us to determine a person’s probability of being diagnosed with a disease during a given period of time; the number of newly diagnosed cases of a disease

A

incidence

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3
Q

a measure of disease that allows us to determine a person’s likelihood of having a disease; the total number of cases of disease existing in a population

A

prevalence

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4
Q

What is the mortality rate after 1 year following hip fracture?

A

20%

  • 25% require LT care
  • 50% are functionally impaired forever
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5
Q

What are the SD that define normal, osteopenia, osteoporosis, and severe osteoporosis?

A
  • Normal = BMD within 1 SD of “young normal” adult (T-score at -1.0 and above)
  • Osteopenia = 1-2.5 SD of “young normal” adult (t-score between -1 and -2.5)
  • Osteoporosis = >2.5 SD
  • Severe = >2.5 AND 1 or more fragility fractures exist
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6
Q

Where are the most common sights of fracture?

A
  1. distal forearm
  2. vertebral bodies
  3. hip
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7
Q

What are the determinants of peak bone mass?

A
  1. genotype
  2. mechanical stress
  3. endocrine factors
  4. nutrition
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8
Q

What has more demineralizing effect on bone than decrease in estrogen after menopause?

A

decreased physical activity

  • lose the most of trabecular bone (inner network of thin calcified trabeculae)
  • cortical = main fxn is structure and protection, forms external parts of long bone, dense, calcified tissue, calcium makes 80-90%
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9
Q

Produces bone matrix (collagen and ground substance); Bone formation

A

osteoblasts

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10
Q

orchestrator of bone remodeling through regulation of both osteoclast and osteoblast activity; compose 90% to 95% of all bone cells in adult bone

A

Osteocytes

- regulates the building

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11
Q

Responsible for bone resorption

A

osteoclasts

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12
Q 
What is the hormonal regulation of:
Decreased bone resorption
Increased bone resorption
Increased bone formation
Decreased bone formation
A
  • Decrease Bone Resorption = Calcitonin, Estrogens
  • Increase Bone Resorption = PTH/PTHrP, Glucocorticoids, Thyroid Hormones, High dose vitamin D
  • Increase Bone Formation = Growth Hormone, Vitamin D Metabolites, Androgens, Insulin, Low-dose PTH/PTHrP
  • Decrease Bone Formation = Glucocorticoids
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13
Q

what gland monitors calcium levels?

A

parathyroid gland

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14
Q

What are the types of osteoporosis?

A
  1. Postmenopausal - accelerated and disproportionate loss of trabecular bone usually in decade after menopause; 6x greater women than men; Increased bone resorption, reduced production of PTH, decreased vit D activation. From age 50-80, women’s BMD decreases 30%
  2. Age-related - 2x greater women than men; Onset for women 1 decade earlier (70-80); Rate of loss in trabecular and cortical bone equal; Hip fractures common; Gradually resorption exceeds accretion and bone loss occurs; Loss approximately .5%/year
  3. Secondary – occurs in response to certain medical conditions. Women = men (Grave’s dz, hyperparathyroidism, cushing’s syndrome, chronic renal failure, malnutrition, diabetes, SCI with immobility, RA, liver dz, malignancy and malignancy-related conditions, hypercalciuria, hyperthyroidism, alcoholism, osteogenesis imperfecta, marfan’s syndrome, turners, klinefelters, glucocoritcoids, anticoagulants, thyroid hormone (excessive), anti-seizure meds, prolonged total parenteral nutrition, radiation, cyclosporin taken for organ transplant, lithium, methotrexate and prednisone
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15
Q

What are risk factors for osteoporotic fx?

A
  1. Low bone density
  2. > 65 years
  3. Personal hx of fracture >40 with min trauma
  4. Hx of fx in first-degree relative
  5. Low body weight (<132 lbs) post-menopause
  6. Caucasian or Asian race
  7. Female
  8. Poor health/frailty
  9. Inadequate physical activity
  10. Recurrent falls
  11. Estrogen deficiency
  12. Low CA+ intake (lifelong)
  13. ETOH and smoking
  14. Impaired eyesight (despite correction)
  15. Gluco-corticoid use
  16. Stroke
  17. Current cigarette smoking
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16
Q

What is the definition of a fragility fx?

A

fracture that results from trauma less than or equal to that from a fall from a standing height

17
Q

What should your daily Ca+ and vit D intake be?

A 
Children 1-10 = 800-1200 mg
11-24 = 1200-1500
25-64 = at least 1200
Pregnant/lactating = at least 1200
Postmenopausal with HRT = at least 1000
Postmenopausal w/o HRT = at least 1500
Men/women >65 = at least 1200
Vit D 65+ years = 600-800 IU/day
18
Q

When should BMD testing be recommended?

A
  1. All postmenopausal women under 65 who have 1 or more additional risk factors
  2. All women 65 and older regardless of risk factors
  3. Postmenopausal women who present with fractures
  4. Women who are considering therapy for osteoporosis if BMD testing would facilitate the decision
  5. Women who have been on HRT for prolonged periods
  • Medicare pays for testing every 2 years
19
Q

What is the gold stander for measuring BMD?

A

DXA - only method with enough accuracy to determine change associated with drug Rx; Difficult to assess change assoc with exercise with 2 dimensional (DXA); spine/ hip

Other tests:

  • pDXA use for hyperparathyroidism as loss typically greater in cortical bone; forearm, finger, heel
  • SXA – single energy x-ray
  • RA – radiographic absorptiometry
  • QCT – quantitative computerized tomography; density of spine/hip
  • QUS - speed of sound at heel, tibia, patella
20
Q

What are clinical signs of osteoporosis?

A
  1. Loss of Height - normal only to lose 1” height
  2. Spinal changes (cervical, thoracic, lumbar)
  3. Pain (Rib Pain) <2 fingers
  4. SOB
  5. Hiatus Hernia
  6. Protuberant Stomach
21
Q

What medications are used for osteoporosis?

A
  1. Bisphosphonates (Fosamax, Boniva and Actonel, Reclast) - GI problems, osteonecrosis of jaw; Must be taken on empty stomach, remain upright 30-60 min, wait 30-60 min to eat; or IV
  2. Calcitonin - Less effective than other therapies; intranasal; Will decrease pain from vertebral fractures
  3. Estrogen/Hormone Therapy - Approved for prevention of osteo and menopausal sx; Health risks = lowest effective dose recommended; ERT 5-7x incr risk endometrial CA
  4. Estrogen Agonist/Antagonist (aka SERM) (Raloxifene, (Evista)
    Prevention and treatment in postmenopausal women; Can be associated w/increased vasomotor S/S; Is associated with decreased risk of invasive breast CA; incr risk DVT
  5. PTH (Forteo) - Approved for Rx for high risk men/women; Daily subcutaneous injection; Used maximum 2 years
  • most drugs work by decr bone resorption, but doesn’t return mass to normal (incr of 5-10%)
  • medication for jaw osteonecrosis = Fosamax
22
Q

What evidence exists for best practices for primary, secondary and tertiary prevention/wellness?

A
  1. Primary – stopping it before it starts; Starting in children! Proper nutrition, especially in teens in sports
  2. Secondary – at risk population; Women in 50s-60s; Lift weights!; Proper nutrition
  3. Tertiary – clients you see that are already diagnosed; Education on falls, preventing falls, screening for falls
23
Q

What should education on osteoporosis include?

A
  1. Risk Factors
  2. Medical/Pharmaceutical Management, Bone Densitometry, HRT
  3. Pain Management/self-help techniques
  4. ADLs - fx during this; sneezing = brace hand on one thigh; hip hinge for bending
  5. Exercise
  6. Nutritional Information
  7. Prevention of Falls
  8. Team Approach
24
Q

How does exercise build bone?

A
  1. Load with high peak forces (60-80% 1RM) and high strain rates
  2. Vary strain distributions in the bone
  3. Brief ex sessions 2-3x/week
  4. Low reps (1-3 sets of 6-8 reps)
  5. Progressive long term duration
25
Q

What are the basic principles of exercise to benefit bone health?

A
  1. Mechanical stress is site specific and load dependent
  2. Exercise must by dynamic and weight-bearing/impact or resistant in nature
  3. Exercise load must exceed normal usage
  4. Exercise should provide variable or unusual loading patterns
  5. Short, intermittent bouts are preferable to longer, continuous bouts
  6. Exercise must be accompanied by adequate energy, calcium, and vit D intake.
26
Q

What have sport specific BMD studies found?

A
  • BMD highest in high strain/odd impact sports, e.g. VB, BB, gymnastics, karate compared to repetitive impact/individual sports (distance running)
  • BMD higher in soccer, field hockey players, and runners compared to low impact sports
  • BMD lowest in swimmers and cyclists
27
Q

What should be included in PT assessment for pt with osteoporosis?

A
  1. Musculoskeletal
  2. Risk Factors (fall prevention)
  3. Current Activity Levels
  4. Balance/Coordination (20 sec. Stand, Tinetti, reach test)
  5. Current Pain Levels
  6. Mobility Analysis
  7. Cardiovascular (6 min walk)
  8. Gait (timed up and go)
  9. REEDCO - Look ahead; posture check that is specific template for examination
  10. Stadiometer
  11. Flexicurve Tracing (multiple studies, inexpensive, time efficient, patient feedback) - C7-L2; mold to spine, put onto grid for a thoracic kyphotic index divided by lumbar index
  12. Forward head measurement (tragus to wall)
  13. CROM
  14. Grid Photo
  15. Total scapular distance (sum of distance from T3 to lat. Aspect of left acromion and T3 to lat. Aspect of right acromion)
  16. Rib/iliac crest distance – 4 fingers normal
  17. lateral basal expansion – tape measure, 4-6 cm. Differential in/expiration (t-band for ex)
  18. Timed loaded standing – 3 min. with 2 lbs in each hand, shoulders 90 deg. Flexion
  19. Grip strength – assoc. with fall risk and lower BMD
  20. Abdominal Strength
  21. Trunk Extension Strength
  22. Osteoporosis QOL questionnaire
  23. Function (Functional Status Questionnaire, SF 36)
28
Q

You cannot flex high risk patients. How do we test for strength?

A
  • Isometrics
  • Modified plank maintained for __s
  • Trunk extension strength - We need them to get into prone
29
Q

What type of exercises should be prescribed with vertebral fx?

A
  • Spinal extension (back arches/lifts)
  • Spinal flexion (crunches)
  • Combined flexion and extension
  • No exercise
  • crunches = highest risk for fx
30
Q

What are LT management goals of osteoporosis?

A
  1. Maintain/Slow loss or increase BMD in at-risk patients, dg. Patients without fracture, and those with fracture
  2. Reduce Pain
  3. Prevent spinal deformity/vertebral fractures
  4. Prevention of falls/maintain mobility
  5. Education
31
Q

What are the management of vertebral fx?

A
  1. Mobility and Transfers
  2. Pain Management
  3. Bracing
  4. Surgery - Vertebroplasty (cement injection), kyphoplasty (ballon, then cement) ; greatly improve QOL with reduction in pain
32
Q

Bone adapts positively to mechanical loading by increasing mass and strength:

  • For patient and prevention care: frequent, short bouts of ______________ physical activity promote osteogenesis
  • Competitive sports: encourage ____________ on bone rather than repetitive, single plan activities
A
  • high impact/unusual strain

- cross-training for different strain

33
Q

_______ exercise plays a vital role in enhancing peak BMD during childhood/adolescence, and maintaining bone mass in adults

A

Impact

  • OA for girls in middle and HS are key
  • prevent FAT in HS athletes
  • Stress fractures in adolescent athletes multifactorial; Training error, menstrual dysfunction and low bone mass have most evidence

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