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Geriatrics Exam Prep > 4 - Osteoporosis/Falls > Flashcards

4 - Osteoporosis/Falls Flashcards

1
Q

Define Osteopenia.

A

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

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2
Q

Define Osteoporosis.

A

Decreased bone - “osteoid” tissue.

2.5 SD or more below mean

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3
Q

Define Osteomalacia.

A

Decreased mineralization of the bone.

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4
Q

What are the most common fractures in women?

A
  1. Vertebrae
  2. Hip
  3. Colles’ (wrist)
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5
Q

Where do vertebrae fractures occur most commonly in women?

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

A

Lumbar up to mid thoracic

50 yrs

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6
Q

How can you treat a vertebral fracture?

A

If pain doesn’t remit, consider vertebroplasty/kyphoplasty

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7
Q

What are the clinical features of osteoporosis?

A
  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
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8
Q

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

A

CORTICAL BONE

75% cortical bone
25% trabecular bone

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9
Q

True/False

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

A

True

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10
Q

Who is at the highest risk for osteoporosis?

A

Elderly
Women
Caucasian and Asian
Thin/petite

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11
Q

What are some additional risk factors for osteoporosis?

other than sex, race, age, and size

A 
Positive family history
Alcohol abuse
Smoking
Sedentary lifestyle
Low dietary Ca intake
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12
Q

True/False

Rapid bone loss occurs with the onset of menopause.

A

True

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13
Q

Bone mass peaks at what age in women?

A

35 yrs

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

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14
Q

Bone mass is depends on what key factors?

A
  1. Age
  2. Sex
  3. Height
  4. Weight
  5. Race
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15
Q

What are the 2 theories of osteoporosis etiology?

A
  1. Senility

2. Post-Menopausal

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16
Q

What are some possible causes of Osteopenia?

A
  1. Idiopathic - this is what we focused on
  2. Endocrine
  3. Neoplastic
  4. Genetic
  5. Intestinal malabsorption
  6. Immobilization
17
Q

What are some possible causes of Osteomalacia?

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

*You’re not mineralizing the bone!

18
Q

Women should have a DXA scan at what age?

A

65 yrs

60 if risk factors

19
Q

How do you treat osteoporosis?

A 
Exercise
Ca and Vit D
Estrogen
Flouride
Calcitonin 
Bisphosphonates - newest treatment
  -> Fosamax (especially for hip and femur)
20
Q

How do bisphosphonates work (basic)?

What kind of side effects do they have?

A

Inhibits bone reabsorption

GI disturbances

21
Q

Where can a patient get major sources of Ca?

A

Dairy

I know… super easy!

22
Q

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

A

1200 mg/day

23
Q

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

A

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

24
Q

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

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

= Retards bone loss caused by osteoporosis

25
Q

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

A

Progestin

26
Q

What is a SERM?

A

Selective Estrogen Receptor Modulators

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

27
Q

True/False

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

A

False

Less effect on bone than estrogen or a bisphosphonate

28
Q

True/False

SERMs reduce breast cancer but increases risk of thromboembolic events.

A

True

29
Q

How do you treat or prevent osteoporosis in men?

A 
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
30
Q

What are some predisposing factors for falls (medical)?

A
  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
31
Q

What are some predisposing factors for falls (environmental)?

A 
Lighting
Stairs
Bathroom location
Chairs (too low, no arm rests)
Footwear
Improper walking aids
Loose rugs
32
Q

What are the best methods for managing falls?

A
  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
33
Q

Woop! Woop! DONE!!

A

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. =)

Geriatrics Exam Prep (5 decks)

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