4 - Osteoporosis/Falls

Question 1

Define Osteopenia.

Answer 1

Decreased radiographic density of bone.
“low bone mass”
>1.0 SD but < 2.5 SD below mean peak

Question 2

Define Osteoporosis.

Answer 2

Decreased bone - “osteoid” tissue.

2.5 SD or more below mean

Question 3

Define Osteomalacia.

Answer 3

Decreased mineralization of the bone.

Question 4

What are the most common fractures in women?

Answer 4

1. Vertebrae
2. Hip
3. Colles’ (wrist)

Question 5

Where do vertebrae fractures occur most commonly in women?

What is the age we start to see a lot of vertebral fx in women?

Answer 5

Lumbar up to mid thoracic

50 yrs

Question 6

How can you treat a vertebral fracture?

Answer 6

If pain doesn’t remit, consider vertebroplasty/kyphoplasty

Question 7

What are the clinical features of osteoporosis?

Answer 7

1. No early warning signs/ Often fx is first sign
2. Gradual height loss
3. Dorsal kyphosis -> Dowager’s hump
4. Protuberant lower abdomen
5. Chronic back pain
6. Pulmonary dysfunction
7. Low skeletal mass/ atraumatic fractures

Question 8

Is a hip fracture more common in the cortical bone or trabecular bone?

Answer 8

CORTICAL BONE

75% cortical bone
25% trabecular bone

Question 9

True/False

Hip fractures are associated with a high mortality rate, many patients never regain previous level of mobility.

Answer 9

True

Question 10

Who is at the highest risk for osteoporosis?

Answer 10

Elderly
Women
Caucasian and Asian
Thin/petite

Question 11

What are some additional risk factors for osteoporosis?

other than sex, race, age, and size

Answer 11

Positive family history
Alcohol abuse
Smoking
Sedentary lifestyle
Low dietary Ca intake

Question 12

True/False

Rapid bone loss occurs with the onset of menopause.

Answer 12

True

Question 13

Bone mass peaks at what age in women?

Answer 13

35 yrs

women lose 1% per year after 35, men lose bone mass at a much slower rate

Question 14

Bone mass is depends on what key factors?

Answer 14

1. Age
2. Sex
3. Height
4. Weight
5. Race

Question 15

What are the 2 theories of osteoporosis etiology?

Answer 15

1. Senility

2. Post-Menopausal

Question 16

What are some possible causes of Osteopenia?

Answer 16

1. Idiopathic - this is what we focused on
2. Endocrine
3. Neoplastic
4. Genetic
5. Intestinal malabsorption
6. Immobilization

Question 17

What are some possible causes of Osteomalacia?

Answer 17

1. Malabsorption
2. Renal Failure
3. Dilantin use
4. Inadequate sun exposure
5. Renal tubular acidosis
6. Hypophosphatemia

*You’re not mineralizing the bone!

Question 18

Women should have a DXA scan at what age?

Answer 18

65 yrs

60 if risk factors

Question 19

How do you treat osteoporosis?

Answer 19

Exercise
Ca and Vit D
Estrogen
Flouride
Calcitonin 
Bisphosphonates - newest treatment
  -> Fosamax (especially for hip and femur)

Question 20

How do bisphosphonates work (basic)?

What kind of side effects do they have?

Answer 20

Inhibits bone reabsorption

GI disturbances

Question 21

Where can a patient get major sources of Ca?

Answer 21

Dairy

I know… super easy!

Question 22

What are the Average Daily Requirements of Calcium for the elderly?

Answer 22

1200 mg/day

Question 23

What are the Average Daily Requirements of Vitamin D for the elderly?

Answer 23

600 IU/day up to age 70, perhaps 1000 IU/day for over age 70

Question 24

What are the physiological effects of estrogen replacement on the bones?

Answer 24

1. Increased intestinal Ca absorption
2. Increases serum 1,25 Vit D synthesis
3. Increased calcitonin secretion

= Retards bone loss caused by osteoporosis

Question 25

What can you give in addition to estrogen to reduce the risk of endometrial hyperplasia?

Answer 25

Progestin

Question 26

What is a SERM?

Answer 26

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

Question 27

True/False SERMs have more of an effect on bone than estrogen or a bisphosphonate.

Answer 27

False Less effect on bone than estrogen or a bisphosphonate

Question 28

True/False SERMs reduce breast cancer but increases risk of thromboembolic events.

Answer 28

True

Question 29

How do you treat or prevent osteoporosis in men?

Answer 29

``` Maintain muscle mass Ca intake > 800 mg/day Treat hypogonadism No smoking and keep alcohol intake low Keep cholesterol low Check for fat malabsorption Consider Vit D supplement ```

Question 30

What are some predisposing factors for falls (medical)?

Answer 30

1. Muscle weakness 2. Balance problems 3. Impaired vision 4. Postural dizziness or hypotension 5. Neuro problems (Parkinson's, etc.) 6. Medications (esp polypharmacy) 7. Foot problems

Question 31

What are some predisposing factors for falls (environmental)?

Answer 31

``` Lighting Stairs Bathroom location Chairs (too low, no arm rests) Footwear Improper walking aids Loose rugs ```

Question 32

What are the best methods for managing falls?

Answer 32

1. Assess for risk before the fall occurs! 2. Observe gait and balance 3. Assess fall circumstances - identify cause 4. Manage intrinsic and extrinsic factors

Question 33

Woop! Woop! DONE!!

Answer 33

This objective was stuck in on this lecture but not covered: Define the USPSTF recommendations for cancer screening tests (breast, cervical, colon, prostate, oral, skin and lung). I suggest looking in Bate's. I think it was covered in the reading. =)