Osteoporosis and Falls Flashcards Preview

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Flashcards in Osteoporosis and Falls Deck (45):
1

This is decreased radiographic density of bone.

Osteopenia

2

This is decreased bone "osteoid" tissue

Osteoporosis

3

This is decreased mineralization of bone

Osteomalacia

4

Location of common fractures

1. Vertebrae
2. Hip
3. Colle's

5

What are the most common locations of vertebral crush fractures?

- Lumbar to mid thoracic

6

When do women start being prone for vertebral crush fractures?

50s

7

When do you consider a vertebroplasty?

When pain doesn't remit

8

Clinical Features of Osteoporosis

- 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

9

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

False, women are more prone

10

Hip fractures have a ______ mortality rate.

High, many never regain previous level of mobility.

11

Vertebral crush fractures are (bone composition)

30% cortical bone
70% trabecular bone

12

Hip fractures are (bone composition)

75% cortical bone
25% trabecular bone

13

Highest Risk Factors for Osteoporosis

- Caucasian or Asian
- Elderly
- Female
- Thin or petite

14

Increased Risk Factors for Osteoporosis

- Positive Family Hx
- Alcohol Abuse
- Smoking
- Sedentary Lifestyle
- Low dietary calcium intake

15

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

Rapid; Continuing

16

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

- Age
- Sex
- Race
- Height
- Weight

Peaks at 35

17

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

1

18

Senile Etiology of Osteoporosis

- Dec. Dietary Calcium
- Dec. 1,25 Vitamin D
- Dec. Calcium Absorption
- Inc. PTH
- Inc. Resorption

19

Post-Menopausal Etiology of Osteoporosis

- Dec. Estrogen
- Dec. Calcitonin
- Inc. Calcium Mobilization
- Dec PTH
- Dec 1,25 Vitamin D
- Dec. Calcium Absorption

20

Endocrine Causes of Osteopenia

- Endogenous Hypercortisolism (Cushing's Syndrome)
- Exogenous Hypercortisolism (Steroid Ingestion)
- Hyperthyroidism
- Hypogonadism
- Hyperparathyroidism

21

Neoplastic Causes of Osteopenia

- Multiple Myeloma
- Leukemia
- Lymphoma

22

Genetic Causes of Osteopenia

- Homocystinuria
- Osteogenesis Imperfecta
- Ehlers-Danlos Syndrome

23

Idiopathic Causes of Osteopenia

- Postmenopausal or senile
- Juvenile

24

Other Causes of Osteopenia

- 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