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Geriatric > Osteoporosis and Falls > Flashcards

Osteoporosis and Falls Flashcards

(45 cards)

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1
Q

This is decreased radiographic density of bone.

A

Osteopenia

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2
Q

This is decreased bone “osteoid” tissue

A

Osteoporosis

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3
Q

This is decreased mineralization of bone

A

Osteomalacia

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4
Q

Location of common fractures

A
  1. Vertebrae
  2. Hip
  3. Colle’s
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5
Q

What are the most common locations of vertebral crush fractures?

A
  • Lumbar to mid thoracic
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6
Q

When do women start being prone for vertebral crush fractures?

A

50s

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7
Q

When do you consider a vertebroplasty?

A

When pain doesn’t remit

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8
Q

Clinical Features of Osteoporosis

A
  • No early warnings; fracture is often first sign
  • Gradual height loss
  • Dorsal kyphosis with “dowager’s hump”
  • Protuberant lower abdomen
  • Chronic Back Pain
  • Pulmonary dysfunction
  • Low skeletal mass and/or atraumatic fractures
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9
Q

T/F: Men have a greater chance of hip fracture than women.

A

False, women are more prone

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10
Q

Hip fractures have a ______ mortality rate.

A

High, many never regain previous level of mobility.

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11
Q

Vertebral crush fractures are (bone composition)

A

30% cortical bone

70% trabecular bone

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12
Q

Hip fractures are (bone composition)

A

75% cortical bone

25% trabecular bone

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13
Q

Highest Risk Factors for Osteoporosis

A
  • Caucasian or Asian
  • Elderly
  • Female
  • Thin or petite
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14
Q

Increased Risk Factors for Osteoporosis

A
  • Positive Family Hx
  • Alcohol Abuse
  • Smoking
  • Sedentary Lifestyle
  • Low dietary calcium intake
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15
Q

After menopause, there is a ______ loss of bone mass with a _________ loss as you get older.

A

Rapid; Continuing

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16
Q

What is bone mass dependent on? When does Bone Mass Peak?

A
  • Age
  • Sex
  • Race
  • Height
  • Weight

Peaks at 35

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17
Q

Women lose ___% of bone mass per year after age 35 (accelerated for 5 years post-menopause)

A

1

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18
Q

Senile Etiology of Osteoporosis

A
  • Dec. Dietary Calcium
  • Dec. 1,25 Vitamin D
  • Dec. Calcium Absorption
  • Inc. PTH
  • Inc. Resorption
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19
Q

Post-Menopausal Etiology of Osteoporosis

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A
  • Dec. Estrogen
  • Dec. Calcitonin
  • Inc. Calcium Mobilization
  • Dec PTH
  • Dec 1,25 Vitamin D
  • Dec. Calcium Absorption
20
Q

Endocrine Causes of Osteopenia

Study These Flashcards
A
  • Endogenous Hypercortisolism (Cushing’s Syndrome)
  • Exogenous Hypercortisolism (Steroid Ingestion)
  • Hyperthyroidism
  • Hypogonadism
  • Hyperparathyroidism
21
Q

Neoplastic Causes of Osteopenia

Study These Flashcards
A
  • Multiple Myeloma
  • Leukemia
  • Lymphoma
22
Q

Genetic Causes of Osteopenia

Study These Flashcards
A
  • Homocystinuria
  • Osteogenesis Imperfecta
  • Ehlers-Danlos Syndrome
23
Q

Idiopathic Causes of Osteopenia

Study These Flashcards
A
  • Postmenopausal or senile

- Juvenile

24
Q

Other Causes of Osteopenia

Study These Flashcards
A
  • Intestinal Malabsorption

- Immobilization

25
Causes of Osteomalacia
- Malabsorption - Renal Failure - Use of Dilantin - Inadequate Exposure to Sunlight - Renal Tubular Acidosis - Hypophosphatemia (hyperparathyroidism, aluminum-containing antacids)
26
Bone Mass Criteria: More than 1.0 SD but less than 2.5 SD below mean peak value
Osteopenia
27
Bone Mass Criteria: 2.5 SD or more below mean peak value
Osteoporosis
28
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 a treatment group
29
Treatment of Osteoporosis
- Exercise - Calcium - Vitamin D - Estrogen - Fluoride - Calcitonin - Other
30
This type of drug binds to hydroxyapatite and is a potent inhibitor of bone resorption. It have low oral bioavilability, and adversely causes GI disturbances most frequently.
Bisphosphonates
31
T/F: Fosamax 10 mg has been shown to have no effect on increasing bone mass.
False; has a considerable effect compared to placebo
32
Do we get enough calcium in food?
No, you need a supplement
33
Average Daily Requirements of Calcium
- < 16 yo: 1300 mg/day - 16-50 yo: 1000 mg/day - 50+ yo: 1200 mg/day
34
Average Daily Requirements of Vitamin D
- 600 IU/day up to age 70 - 1000 IU/day over 70 yo *May need to check 25-OH vitamin D level
35
T/F: Estrogen Therapy (Progestin) has been shown to prevent bone loss
True
36
Effects of Estrogen on the body
- Inc. Calcium Absorption - Inc. Serum 1,25 Vitamin D Synthesis - Inc. Calcitonin Secretion
37
Current Perspective on Oral ERT (HRT)
- Controls menopausal vasomotor symptoms - Relieves atrophic vaginitis - Retards osteoporotic bone loss - Addition of progestin to regimen reduces risk of endometrial hyperplasia
38
This type of drug acts as an estrogen agonist at certain organs (bone) but as antagonist at others (breast and uterus, worsens menopausal symptoms).
SERMs (Selective Estrogen Receptor) *Raloxifene
39
T/F: SERMs have a greater effect on bone than strogen or bisphosphonates.
False, lesser effect
40
SERMs reduce the risk of _____. But increases the risk of _______.
Breast cancer; thromboembolic events
41
T/F: Males lose bone at approximately 1/2 to 2/3 the rate of females
True
42
How do you prevent or treat Osteoporosis in Men?
- Maintain Muscle Mass - Keep Calcium Intake 800+ mg/day - Treat hypogonadism - Keep alcohol intake < 3 oz/day - Don't smoke - Avoid hypercortisolism - Check for fat malabsorption
43
Predisposing Factors for Falls (Instrinsic)
- Muscle weakeness (ankle dorsiflexion), balance problems - Impaired vision (night > day) - Postural Dizziness, Postural Hypotension (few non-syncopal falls are related to arrhythmias) - Neuropathology (stroke, Parkinson's, peripheral neuropathy) - Medication (sedatives), polypharmacies - Foot problems
44
Predisposing Factors for Falls (Extrinsic)
- Lighting - Stairs - Bathroom - Chairs (too low, without armrests) - Footwear (soft sole, high heels) - Improper Walking Aids (cane, walker) - Loose Rugs
45
Management of Falls
- Detect of faller before injury -- ask?! - Observe gait and balance (get up and go, nudge test) - Assess fall circumstances; premonitory symptoms, location - Manage intrinsic and extrinsic risk factors

Geriatric (9 decks)

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