Osteoporosis&Foot Neuropathy Flashcards Preview

PTRS 746 Exam 1 Combined and Randomized > Osteoporosis&Foot Neuropathy > Flashcards

Flashcards in Osteoporosis&Foot Neuropathy Deck (82):
1

Q: What T-score indicates osteoporosis?

< -2.5

1

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

1

Content: Foot Care Education (6)

1. Check feet daily

2. ALWAYS wear shoes

3. No lotion/oil between toes

4. Keep nails clipped

5. Manage calluses

6. Report changes immediately

2

Diagram: Mechanism of Action of Bisphosphonates - Osteoclasts are targets

A image thumb
3

Content: Side Effects of Bisphosphonates (6)

1. Upper GI irritation

2. Osteonecrosis of the jaw

3. Severe musculoskeletal pain

4. HypoCa

5. Scleritis

6. Atypical femur fractures

3

Content: Foot Examination (3)

1. comprehensive foot exam should be completed at LEAST annually

2. those with neuropathy should have feet visualized every medical visit

3. those with diabetes should check their feet each day 

 

4

Q: Osteoporosis is a problem of _________ peak bone _____ and _____________ bone _____.

decreased, mass, increased, loss

4

Q: What does FRAX calculate?

10 year fracture risk, for things like hip fracture and osteoporosis fractures

5

Content: Secondary Evaluation of Osteoporosis (7)

1. Comprehensive metabolic panel

2. CBC

3. 24 hour urine for Ca, creatinine, Na

4. 25-Hydroxy Vit D

5. TSH

6. SPEP/UPEP if anemic

7. PTH

6

Q: What calcium supplements are available?

1. Calcium carbonate

2. Calcium citrate

8

Content: 3 ways to define osteoporosis.

1. Microarchitectural deterioration of bone tissue leading to decreased bone mass

2. Bone fragility

3. Susceptibility to fracture

9

Content: Four neuropathy deformities (4)

1. Prominent metatarsal heads

2. Hammer/claw toes

3. Hallux Valgus/bunions

4. Charcot Foot

10

T/F: High impact WB exercise increased BMD by 1-2% at the spine and hip.

True

11

Q: What is the recommendation for exercise to prevent osteoporosis?

30 min, most days  of running, walking, or elliptical + muscle stregnthening and balance exercises

11

Q: What are pharmacologica treatment options for low bone mass? (4)

1. Bisphosphonate

2. Teriparatide

3. Denosumab

4. Selective Estrogen Receptor Modulators

11

Content: Teriparatide (2)

1. Anabolic (bone building agent)

2. Daily injection

11

Q: What 3 pulses should you check during a foot exam?

1. Posterior tibilais

2. Dorsal pedis

3. Ankle brachial index (ABI)

12

Q: _________ involvement in foot neuropathy is __________.

Early, crucial

13

Content: Calcium carbonate (2)

1. Needs stomach acid for absorption

2. Taken with meals

14

Diagram: Vit D formation

A image thumb
15

Content: Skin (3)

1. Think, shiny, brawny and/or frail

2. Dry

3. Calluses/wounds

15

Diagram: Identify the Deformity

Q image thumb

Upper = corn

Lower = callus

15

Defn: Claw toe

Hyper extension of MTP with PIP/DIP flexion

16

Q: How do you assess fall risk?

TUG - Timed get up and go

16

Q: What medications put you at high risk for osteoporosis? (3)

1. Steroids

2. Aromatase inhibitors

3. Androgen deprivation therapy

17

Q: What are the mortality rates 1 and 5 years after amputation?

40%, 80%

19

Q: What is FRAX?

Fracture Risk Assessment Tool

20

Q: When does bone mass begin to decline?

Around 50 yo

21

Content: Charcot Arthropathy (4)

1. Progressive bone destruction and ligament damage leading to arch colllapse and impaired skin integrity

2. Affects abot 9% of those with diabetes

3. Unclear if etiology is neurotraumatic, neurovascular, or both

4. Generally treated with complete immbolizations in a total contact cast with protected WB

22

Q: How many million individuals in the US are affected by osteoporosis?

10 million

23

Content: Exercise recommendations for foot neuropathy

At least 30 min most days - consider foot integrity

25

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

26

Content: Assessment - Low Risk Foot Neuropathy (4)

1. Preserved sensation

2. No defromity

3. Intact circulation

4 Tx: Annual foot exam, education, good footwear

28

T/F: For every standard deviation below the norm, the risk of fractures triples.

False: doubles

29

Content: Goals of the foot exam (4)

1. Est. history/diagnostic factors

2. Identify risks

3. Intervention

4. Education 

30

Content: Assessment - High Risk Foot Neuropathy (6)

1. Sensory loss

2. Deformity

3. Vascular disease

4. Callus formation 

5. Hx of ulcer or amputation

6. Tx: comprehensive assessment, education, diabetic shoe

30

Content: Education (4)

1. General diabetes self care

2. Foot/skin care

3. Daily skin checks

4. Proper footwear (breathable, adjustable, wide toe box, good support)

31

Diagram: Identify the Deformity

Q image thumb

Claw toes

32

Q: What habit can increase your risk of neuropathy?

smoking (current or past)

33

Content: Risk factors for Osteoporosis (10 - general idea)

1. Genetics

2. Low Ca intake

3. Low vitamin D stores

4. Tobacco and alcohol us

5. Prior history of fracture

6. Medications

7. Malabsorpation

8. Excessive urinary calcium

9. Overactive thyroid gland

10. Other medical conditions

34

Content: Sensation assessment (2)

1. Semmes Weinstein Monofilament (10 locations)

2. Vibratory sensation (128 Hz tuning fork, latency > 10 sec = sensory loss)

35

Diagram: Identify the Deformity

Q image thumb

Hammer toe

37

Content: Types of Bisphosphonates (4)

1. Alendronate -wkly

2. Risedronate - wkly/moly

3. Ibandronate - moly/IV every 3 mo

4. Zolendronic Acid - IV annually

38

T/F: Neuropathy is implicated in 25% of non-traumatic amputations.

False, 50-75%

39

Content: Toenails (3)

1. Thickened

2. Deformed

3. Ingrown

41

Content: Primary Osteoporosis (2)

1. unrelated to chronic illness

2. Related to aging and decreased gonadal function

41

Q: What is HbA1c?

Average blood sugar over a peroid of 3 months

42

Defn: Hammer toe

Hyperextension of MTP and DIP

43

Content: glycemic control recommendations for foot neuropathy

HbA1c goal of < 6.5-7

44

Q: When does bone mass peak?

Between 20-25 yo

45

Q: What type of training increased spine BMD?

Resistance

46

Content: Causes of neuropathy (6)

1. Diabetes

2. Tumor, trauma

3. Autoimmune disease

4. Vitamin B, E, niacin deficiency

5. Exposure to toxins

6. Infection

47

Content: OE for foot neuropathy (5)

1. Condition of skin, hair, toenails

2. Deformities

3. Pulses

4. Sensation

5. Shoe wear

48

Diagram: Identify the Deformity

Q image thumb

Hallux Valgus

49

Content: Nutrition recommendations for foot neuropathy (4)

1. Montior BMI - stable or weight loss

2. Fresh fruits/veggies

3. Pre meal glucose 90-130 mg/dl

4. Post meal glucose 180 mg/dl

51

Q: What imaging is often used to identify osteoporosis?

DEXA

51

Q: For bone health how often should bone density be evaluated?

On treatment = every 1-2 years

Not on treatment = every 2 years

53

Defn: Z-score

number of standard deviations from age matched mean density

55

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

56

Content: Offloading (5)

1. Total contact casts (change ever 1-2 wks)

2. Orthotics/walking boots

3. Surgical shoes

4. Dressings

5. Cutouts

 

57

Q: How should you elevate a pts. heels?

With pillow under calves

59

Content: SE for foot neuropathy (7)

1. Contributing diagnosis

2. PMH/social factors

3. Medications

4. Complications

5. Hx of LE surgery, ulcer, amputation

6. Current or past smoker

7. HbA1c (diabetes)

60

Content: Ulcer intervention (4)

1. Debulk callus

2. Control moisture

3. Decrease infection risk 

4. Edema management

62

T/F: WB activities decrease BMD.

False

64

Q: What T-score indicated osteopenia?

-1 to -2.5

65

Q: What is BMD?

Body mass density - comes from a DEXA test

66

Q: How much Ca is in 8 oz of milk?

300 mg

67

Cotent: ABI Scale (6 parts)

> 1.2 = vessels are incompressible, consider toe brachial indexes

1.0-1.2 = normal

0.9-0.99 = acceptable

< 0.9 = arterial disease

0.5-0.8 = intermittent claudication

< 0.5 = severe arterial disease

68

Defn: T-score

number of standard deviations from the young adult mean density

69

Content: Hair

May be present or absent

70

T/F: FRAX is the treatment decision making tool in previously treated pts.

False, untreated

71

T/F: Menstraul cycle effects gains in BMD.

True

72

Q: When does the z-score apply for osteoporosis?

pre-menopausal females and males < 50

73

Content: Calcium citrate

Can be taken with or without food

74

Content: Calcium supplements (2)

1. Limit to ~500 mg in a dose

2. May cause constipation

75

Q: Who will be referred to PT for osteoporosis type treatment?

Those at increased risk or fall, unstable gait, weakness

76

Q: What % of those with diabetes will develop neuropathy?

50%

77

Q: What type of training increased hip BMD?

high impact

78

Content: Secondary osteoporosis (2)

1. Secondary to chronic illnesses/meds that cause accelerated bone loss

2. Ex. glucocorticoid use, hyperthyroidism

80

Content: 4 types of neuropathy 

1. Peripheral - UE/LE

2. Autonomic - CVS, temp reg, bowel/bladder

3. Proximal - thigh, hip, core mm

4. Focal - sudden loss in one n. or group of n.

81

Q: Who could you refer pts. with foot neuropathy to? (4)

1. Podiatry

2. Wound care

3. Nurse educator 

4. Dietician

82

Content: Denosumab  (3)

1. Inhibits osteoclast function

2. Decreases bone resorption

3. Consider in pts. with kidney dysfunction