Osteoporosis and Falls Flashcards Preview

Medicine II: Geriatrics > Osteoporosis and Falls > Flashcards

Flashcards in Osteoporosis and Falls Deck (52):
1

Define osteopenia

decreased radiographic density of bone

2

Define osteoporosis

decreased bone - "osteoid" tissue

3

Define osteomalacia

decreased mineralization of bone

4

What are the first bones that start to fracture?

Vertebral

5

Where are the most common vertebral crush fractures?

lumbar up to mid thoracic

6

When do vertebral fractures have a preponderance for females?

beginning in 50s

7

What do you do if the pain from a vertebral crush fracture doesn't remit?

vertebroplasty

8

What is a progression or consequence of osteoporosis?

decrease in height

9

What is the first sign of osteoporosis?

no early warnings, fracture is often first sign

10

What is dorsal kyphosis usually associated with?

"dowager's hump"

11

What are other clinical features of osteoporosis?

protuberant abdomen
chronic back pain
pulmonary dysfunction
low skeletal mass and/or atraumatic fractures

12

What percentage of women and men have suffered hip fractures?

32% of women and 17% of men will have suffered a hip fracture

13

What scares us about hip fractures?

High mortality rate, many patients never regain previous level of mobility.

14

What are the HIGH risk factors for osteoporosis?

Caucasian or asian, elderly, female and thin/petite

15

What are the increased risk factors of osteoporosis?

+ FHx, alcohol use, smoking, sedentary, low dietary calcium intake

16

In general when do you stop growing bone?

30

17

What does bone mass depend on?

age, sex, race, height, weight

18

When does bone mass peak?

approx at 35

19

What is a caveat about women with bone mass?

women lose 1% of bone mass per year after age 35 (accelerated for 5 years post menopause)

20

Theories of etiology

senile: decrease Ca+ and 1, 25 Vit D lead to a decrease in Ca absorption and increase in PTH and thus an increase in resorption

post-menopausal: decrease in estrogen leads to a decrease in calcitonin and an increase in calcium mobilization which decreases PTH and thus decreases 1, 25 Vit D and Ca absorption

21

When men age what do we have to monitor in regards to osteoporosis?

See if they have low T levels

22

With women what is the likely cause of their bone loss?

idiopathic

23

Causes of osteomalacia

malabsorption
renal failure
use of dilantin
inadequate exposure of light
renal tubular abscess
hypophosphatemia (hyperparathyroidism, Al-containing antacids)

24

How do you know if you have osteoporosis?

DXA scan, look at T score

25

What are the diagnostic categories for interpreting bone mass measurement reports?

Osteopenia (low bone mass)- more than 1 SD but less than
Osteoporosis- A value 2.5 SD or more below mean peak value

26

In general when should all females get a dxa scan?

at 65, 5 years early if you have a high risk factor

27

Difficulties in clinically studying treatment of osteoporosis:

-low fracture incidence
-uncertainty as to significance of change in bone mineral content
- alterations in bone dynamics often don't persist
- mixture of type I and II patients in treatment group

28

What are the treatments for osteoporosis?

exercise

29

Bisphosphonates

#1 perscription drugs for osteoporosis

30

What do bisphosphonates do?

bind to hydroxyapatite
Potent inhibitors of bone resorption- slow down osteoclasts and limit bone resorption
low oral availability- take on an empty stomach

rem this is what bakers wife was on, they didn't like it!

31

What are the adverse side effects of bisphosphonates?

GI disturbances are the most frequent kind of adverse experiences

32

How long does FOSAMAX stay in your bones?

Years!, works even after you stop

33

What are foods that have calcium in them?

most is in the form of milk BUT:
turnips
broccli
pork and beans
egg
wheat

34

How much calcium is an an 8oz glass of milk?

whole- 291 mg

35

What are the important take homes of Vitamin D?

first 6 month no effect BUT 18 months later huge decrease in fractures

36

Who needs the most calcium?

kids, 1300 mg

37

What is my daily requirement of calcium?

1000 mg

38

How much Vitamin D do you need up to 70 yrs old? Over 70?

600 IU
1000 IU

39

Does milk have a lot of vitamin D?

not really

40

What does estrogen do?

increase intestinal calcium absorption
increase serum 1, 25 Vit D synthesis
Increase calcitonin secretion

41

What is the main reason to give estrogen?

decrease menopausal vasomotor symptoms

42

What is a SERMs?

Selective estrogen receptor modulator

43

What does a SERM do?

Acts as estrogen agonist at certain organs (bone) but as antagonist at others (breast and uterus, worsens menopausal symptoms).

Less effect on bone than estrogen or a bisphosphonate.

44

How do you take Calcitonin?

Nasal injection

45

Compare bone loss in men to that of women

Males lose bone at approximatley 1/2 to 2/3 the rate of females

46

How do you prevent or treat osteoporosis in men?

CHECK T LEVELS (treat hypogonadism)
maintain muscle mass
keep calcium intake >800 mg/day
keep alcohol intake < 3oz/day
don't smoke
avoid hypercorticolism
check for fat malabsorption
routine Vit D supplementation in elderly

47

What is a negative side effect of SERMs?

Reduces breast cancer but increases risk of thromboembolic events.

48

What are the predisposing factors for falls that are intrinsic?

muscle weakness (ankle dorsiflexion), balance problems
impaired vision (night>day)
postural dizziness, postural hypotension (few non-syncopal falls related to arrhythmias)
neuropathology (stroke, Parkinson's, periperal neuropathy)
medication (sedatives), poly pharmacy per se
foot problems

49

Death from falls

falls have skyrocketed to be a leading cause of death in those > 70

50

What are good ways to test muscle strength for falls?

hip abductors and ankle dorsiflexion

51

What are extrinsic factors for predisposing falls?

lighting
stairs
bathroom
chairs (too low, without armrests)
footwear (soft sole, high heels)
improper walking aids (cane, walker)
loose rugs

52

How do we manage falls?

a. detect a faller before injury, ASK!!
b. observe gait and balance (get up and go, nudge test)
c. assess fall circumstances; premonitory symptoms, location
d. manage intrinsic and extrinsic factors