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WCS > 5. MSK 2 Fibromyalgia, Osteoporosis > Flashcards

5. MSK 2 Fibromyalgia, Osteoporosis Flashcards

1
Q

What is primary osteoporosis?

A

Includes idiopathic osteoporosis occurring in children and young adults with unknown etiopathogenesis and involutional osteoporosis related to aging

Involutional osteoporosis is divided into type I and type II.

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2
Q

What are the two types of involutional osteoporosis?

A
  • Type I: postmenopausal osteoporosis, affects women 51-75 years
  • Type II: senile osteoporosis, occurs in persons over 75 years

Type I is characterized by rapid bone loss, while Type II involves loss of trabecular and cortical bone.

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3
Q

What percentage of osteoporosis cases are classified as secondary osteoporosis?

A

Less than 5%

Secondary osteoporosis results from a disease or the use of medications.

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4
Q

During menopause, what deficiency leads to increased bone remodeling?

A

Estrogen deficiency

This deficiency causes loss of bone density.

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5
Q

What are common presentations of osteoporosis?

A
  • Asymptomatic in uncomplicated cases
  • Pain from osteoporotic fractures
  • Deformities
  • Multiple vertebral compression fractures

Can result in thoracic kyphosis and cervical lordosis.

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6
Q

What nutritional factors contribute to the development of osteoporosis?

A
  • Deficient calcium intake
  • Vitamin D deficiency
  • Excessive protein intake
  • Excessive phosphate intake
  • Excessive salt intake

These factors can increase urinary calcium loss.

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7
Q

What lifestyle factors contribute to osteoporosis?

A
  • Sedentary lifestyle
  • Chronic pharmacological treatment
  • Caffeine
  • Alcohol
  • Smoking
    Excess mechanical load bodyweight endocrine factors including late Manosh or menstrual cycle alterations

These factors can negatively impact bone health.

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8
Q

What is the role of body weight in bone mineral density (BMD)?

A

Responsible for 15% to 30% of variations in BMD at any age and in any measured bone region

Higher body weight generally correlates with better bone health.

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9
Q

What are the two classes of bone cells involved in maintaining bone matrix and calcium homeostasis?

A
  • Osteoprogenitor cells
  • Osteoclasts

Osteoprogenitor cells are mesenchymal stem cells that differentiate into osteoblasts and osteocytes.

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10
Q

Who is most at risk for osteoporosis

A

Increased risk each decade 1.4 to 1.8 times
Caucasian and Asian greater than black and Polynesian

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11
Q

What are the stages of bone remodeling?

A
  • Activation
  • Resorption
  • Reversion
  • Formation
  • Mineralization

The cycle begins with resorption and ends with mineralization.

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12
Q

What is the most recommended technique for the diagnosis of osteoporosis?

A

Dual X-ray absorptiometry

This technique can predict fracture risk and monitor treatment effects.

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13
Q

What T-score indicates osteoporosis?

A

BMD < −2.5 SD t-score

2.0 in presence of ED?

Established osteoporosis is defined as BMD < −2.5 SD t-score + fragility fracture.

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14
Q

What are common areas of high fracture risk in osteoporosis?

A
  • Proximal ends of the femur
  • Humerus
  • Distal end of the radius
  • Spine

These areas are most susceptible to osteoporotic fractures.

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15
Q

What are some treatment options for osteoporosis?

A
  • Cell therapy
  • Injectable agents
  • Nutritional habits
  • Lifestyle choices
    Medication’s: selective oestrogen receptor modulators, calcitonin, biphosphates, RANKL antibody

Treatment strategies can vary based on individual patient needs.

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16
Q

What is the role of vitamin D in bone health?

A

Essential for the absorption and regulation of calcium in the intestine
Vitamin D and calcium supplementation significantly decrease the risk of fracture in patients with and without osteoporosis

Vitamin D levels depend mainly on sunlight exposure and diet.

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17
Q

Fill in the blank: Osteocalcin (OC) is the most abundant _______ present in the bone matrix.

A

non-collagenous protein
Existence of bone formation markers include alkaline phosphate ALP, Osteopontin OP, osteocalcin OC, collagen type one

Osteocalcin plays a role in bone formation.

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18
Q

What effect will low production of estrogen cause?

A

Low production of estrogen cause prolonged maintenance of osteoclasts while osteoblastic cells deteriorate leading to imbalance

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19
Q

What effect does exercise have on bone formation?

A

Promotes osteogenesis and the cell differentiation of MSCs into osteoblasts
important hormonal effect by regulating estrogen, PTH and glucocorticoid levels, which are involved in bone metabolism
constant practice of physical exercise promotes the proliferation of estrogens (bone protectors since they slow down the production of osteoclastic cytokines, favor the proliferation of osteoblasts and decrease osteocyte apoptosis)

Exercise helps in maintaining bone density.

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20
Q

True or False: Smoking has no impact on osteoporosis risk.

A

False

Smoking increases oxidative stress and the risk of falls, negatively affecting bone health.

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21
Q

What are the effects of moderate alcohol consumption on bone health?

A

mod-min intake Could have a protective effect by suppressing bone resorption

Excessive alcohol disrupts nutrient uptake.

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22
Q

What is the relationship of BMR with BMD

A

Direct relationship with BMD. The higher the basal metabolic rate the better bone health is expected. Cardiovascular and resistance exercise increase BMR level

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23
Q

What types of training modalities are best for osteoporosis

A

Resistance training proprioceptive training

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24
Q

What is the duration of widespread pain required for a fibromyalgia diagnosis?

A

Longer than 3 months

Pain must be accompanied by tenderness on at least 11 of 18 specified tender points.

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25
Q

According to ACSM guidelines, how often should aerobic exercise be performed for fibromyalgia treatment?

A

At least 3 days per week

This is part of the recommended exercise regimen for managing fibromyalgia.

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26
Q

What is the recommended intensity range for aerobic exercise in fibromyalgia treatment?

A

40% to 85% of heart rate reserve or 64% to 94% of predicted maximum heart rate

This intensity is crucial for effective exercise training.

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27
Q

What is the minimum duration for each aerobic exercise session as per ACSM guidelines?

A

At least 20 minutes

20-60 mins

Sessions can be continuous or spread throughout the day in blocks of 10 minutes or more.

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28
Q

What type of activities should aerobic exercise involve for fibromyalgia patients?

A

Use of major muscle groups in rhythmic activities

This mode is essential for effective aerobic exercise.

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29
Q

How long should the total exercise period last for aerobic exercise in fibromyalgia treatment?

A

At least 6 weeks

This duration is important for achieving health benefits.

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30
Q

What is the recommended frequency for strengthening exercises in fibromyalgia treatment?

A

2 to 3 days per week

This frequency helps in managing fibromyalgia symptoms.

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31
Q

What is the minimum number of repetitions recommended for strengthening exercises?

A

A minimum of one set of 8 to 12 repetitions

This helps in building strength progressively.

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32
Q

What is the recommended frequency for flexibility exercises?

A

≥ 2 days per week

Flexibility is an important component of the exercise regimen.

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33
Q

What is the recommended intensity for flexibility exercises?

A

Position of mild discomfort

This ensures safe and effective stretching.

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34
Q

What is the recommended duration for each stretch during flexibility exercises?

A

10 to 30 seconds

Holding stretches for this duration is beneficial.

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35
Q

True or False: Short-term aerobic exercise training has been shown to have medium-size positive effects on global well-being and physical function for fibromyalgia patients.

A

True

Moderate quality evidence supports this claim.

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36
Q

What type of evidence exists regarding the impact of strength training on fibromyalgia outcomes?

A

Limited evidence

Strength training may improve pain, global well-being, and physical function.

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37
Q

What is the evidence regarding flexibility exercise effects on fibromyalgia?

A

Insufficient evidence

There is not enough data to support its effectiveness.

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38
Q

What are osteoclasts responsible for in bone physiology?

A

Osteoclasts reabsorb bone.

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39
Q

What role do osteoblasts play in bone health?

A

Osteoblasts replace and create new bone.

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40
Q

What is the function of osteocytes?

A

Osteocytes work with an extensive canalicular network that senses both mechanical loading and focal bone damage.Osteocytes secrete molecules that regulate both the location of and the rate of bone remodeling, including RANK.

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41
Q

What hormonal factors regulate osteocyte activity?

A

Mechanical loading and circulating hormones including parathyroid hormone (PTH) and estrogen.

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42
Q

What is the average annual rate of bone loss in postmenopausal women?

A

About 2% per year.

Average BMD loss of 10 to 12% in spine and hip across menopause

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43
Q

When does the average annual rate of bone loss begin in postmenopausal women?

A

1 to 3 years before menopause.

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44
Q

What happens to bone density after the initial rapid loss phase?

A

Bone density decreases about 0.5% per year.

45
Q

By age 80, how much of their peak bone mass have women typically lost?

A

Approximately 30%.

46
Q

What is osteopenia?

A

A condition that does not give a full picture of bone density and does not necessarily indicate that bone loss has occurred.

47
Q

What are the two types of osteoporosis?

A

Primary (occurs after menopause) and secondary (due to glucocorticosteroids).

48
Q

What are major risk factors for low bone mineral density (BMD) in postmenopausal women?

A
  • Menopause status
  • Advanced age
  • Genetics
  • Thinness
  • Weight less than 127 lb (57.7 kg) older than 65 years
  • Diseases or drugs.
49
Q

What is the Osteoporosis Self-Assessment Tool formula?

A

T-score = 0.2 x (weight in kg - age in years).

50
Q

What is a significant risk factor for fracture related to BMD?

A

The strongest correlation of BMD and fracture risk is with hip bone density.

51
Q

What is the most important risk factor for having another fracture?

A

Having or having had a fracture since menopause.

52
Q

What increases the likelihood that a vertebral fracture is present?

A

Height loss of 1.5 in (3.8 cm) or more.

53
Q

What is the recommended daily intake of calcium for postmenopausal women?

A

1,000 mg to 1,200 mg, with an upper limit of 2,000 mg.

54
Q

What is the recommended daily intake of Vitamin D for women older than 70 years?

A

800 IU.

55
Q

What is the effect of high protein intake in fall-prone older adults?

A

Higher protein intake was associated with reduced fall frequency.

56
Q

What precaution should be taken in those who have vertebral fractures during exercise?

A

Avoid activities involving lifting or pulling with foward spine flexion or rotation

57
Q

What role do probiotics play in bone health?

A

Gut microbiota can influence several aspects of bone health including calcium absorption.

58
Q

What is the impact of exercise on skeletal mass?

A

Skeletal mass is strongly influenced by mechanical loading.

59
Q

What type of exercise programs are most effective for preventing falls?

A

Programs such as tai chi that target balance, gait, and muscle strength.

60
Q

What is the role of estrogen in preventing osteoporosis?

A

Estrogen alone or combined with progestogen is appropriate for prevention in women with low BMD experiencing rapid bone loss.

For younger healthy post menopausal woman

61
Q

Which class of drugs can be chosen if estrogen is contraindicated?

A

A bisphosphonate.

62
Q

What is the recommendation for the routine use of biochemical markers of bone turnover?

A

Not recommended in clinical practice.

63
Q

What is the primary demographic affected by fibromyalgia?

A

Women are more affected than men.

64
Q

What is the main issue in the pathogenesis of fibromyalgia?

A

A pain-processing problem in the brain.

65
Q

What psychological problems can be associated with fibromyalgia?

A

Constant hypervigilance to pain.

66
Q

Name neurotransmitter imbalances involved in fibromyalgia.

A

Elevated glutamate and substance P; decreased serotonin and norepinephrine.

67
Q

What is dopamine dysregulation in the context of fibromyalgia?

A

An imbalance of dopamine that may contribute to symptoms.

68
Q

What factors contribute to the pathophysiology of fibromyalgia?

A
  • Neuroendocrine factors
  • Genetic predisposition
  • Oxidative stress
  • Environmental changes
  • Psychosocial changes
69
Q

Define central sensitization in fibromyalgia.

A

A neuron signal amplification mechanism in the CNS that leads to a greater perception of pain.

70
Q

What does allodynia refer to?

A

Pain due to a stimulus that does not normally provoke pain.

71
Q

What does hyperalgesia refer to?

A

Increased sensitivity to painful stimuli.

72
Q

What types of medications are effective for fibromyalgia?

A
  • Antidepressants
  • GABA analogs
73
Q

What are fMRI findings related to fibromyalgia?

A

Increased connectivity in the insula and decreased connectivity in anti-nociceptive areas in brainstem

74
Q

What role do NMDA glutamate receptors play in fibromyalgia?

A

They are central to the induction and maintenance of widespread hyperalgesia.This contributes to the central mechanism deficits seen in FM.

75
Q

What are the changes in peripheral nerves observed in fibromyalgia patients?

A
  • Reduced number of epidermal nerve fibers
  • Altered heat and cold thresholds
  • Increased C-fiber sensitivity
76
Q

What is the relationship between type I muscle fibers and fatigue in fibromyalgia?

A

Higher percentage of type I fibers correlates with better recovery of strength.Early onset of fatigue is noted in FM, early fatigue is not CNS function. Changes in nociceptors in muscle and Sub P thought to contribute.

77
Q

How does fibromyalgia affect the immune system?

A

Involves anti-nuclear antibody positivity related to ESR values and inflammation.Confirmation that information is involved in FM.

78
Q

What is the significance of genetic polymorphisms in fibromyalgia?

A

They affect pain sensitivity and analgesia.Several receptors and processes are encoded by genes expressed differently in FM

79
Q

What endocrine changes are associated with fibromyalgia?

A

Alterations in the hypothalamic–pituitary–adrenal axis and cortisol secretion.

80
Q

True or False: Depression is correlated with a worse prognosis in fibromyalgia.

A

True.

Stress is another predictive and negative prognostic factor

81
Q

What effect does sleep deprivation have on fibromyalgia?

A

Leads to hyperalgesia and mood alterations.

82
Q

What are the two types of fibers transmitting peripheral impulses in fibromyalgia?

A
  • Myelinated Aδ fibers
  • Unmyelinated C fibers
83
Q

What is peripheral sensitization due to A delta and C fibers ?

A

A fibers generally respond to stimuli of antidromic propagation. This causes C fibers to release pro inflammatory cytokines and chemo kinds and neuropeptides.

84
Q

What metabolic disturbances are associated with fibromyalgia?

A

Gut brain access is impaired by stress related disorder such as FM. Metabolic markers of disturbances are present in the gut

85
Q

What role do antioxidants play in managing fibromyalgia?

A

They may reduce oxidative stress and improve symptoms.

86
Q

List some antioxidants and vitamins used in fibromyalgia treatment.

A
  • Vitamins D and E
  • Melatonin
  • CoQ10
  • Palmitoylethanolamide (PEA)
87
Q

What outcomes are used for FM ?

A

HRQOL Health-Related Quality of Life
VAS

HRQOL is a measure of how well a person’s health impacts their quality of life.

88
Q

What types of exercise seem to be most effective in decreasing pain and severity of FMS?

A

Muscle strengthening and aerobic exercise

These exercises have shown significant benefits in managing fibromyalgia symptoms.

89
Q

Which type of exercise produces a greater improvement in the physical component of HRQOL?

A

Stretching exercise

Stretching is more effective than other types of exercise for physical health improvements.

90
Q

What combination of exercises is most effective in reducing symptoms of depression in fibromyalgia patients?

A

Aerobic exercise, muscle strengthening, and stretching exercises

Aerobic and combine exercise seem to be better at improving mental quality of life

91
Q

True or False: Combined exercise is the most effective way of reducing symptoms of depression.

A

True

Combining different types of exercises can lead to better mental health outcomes.

92
Q

Fill in the blank: Stretching and aerobic exercise produce the biggest improvements in _______.

A

HRQOL

Muscle strengthening and aerobic exercise are the most effective in reducing pain and severity

93
Q

What was the main objective of the LIFTMOR Randomized Controlled Trial?

A

To improve bone mineral density and physical function in postmenopausal women with osteopenia and osteoporosis

94
Q

What interventions were included in the first month of the LIFTMOR RCT

A
  • body weight and low-load exercise variants
  • focus on progressively learning the movement patterns of the HiRIT exercises.
  • All participants were able to perform the 4 fundamental exercises of the intervention within 2 months.
95
Q

What were the four fundamental exercises learned during the first two months of the intervention?

A

Deadlift, overhead press, back squat, jumping chin-ups

96
Q

What intensity level and repsx sets was maintained during the resistance exercises after the learning phase?

A

> 80% to 85% 1 RM
5x5

Dead lift, overhead press, and back squat

97
Q

What did the control exercise group (CON) primarily consist of?

A

Walking, low-load resistance training, and stretches. Low load resistance training included lunges calf raises standing forward raise and shrugs

98
Q

What intensity progression was used for the control group’s resistance exercises?

A

From body weight to a maximum of 3 kg hand weights

99
Q

What are TUG, FTSTS, and functional reach scores related to?

A

Balance and incident falls

100
Q

How may HiRIT reduce the risk of fractures in postmenopausal women?

A

By enhancing parameters of bone strength and preventing falls

101
Q

What characteristics did HiRIT improve that reduce the risk of falling?

A

Muscle strength and functional and neuromuscular performance

102
Q

What evidence supports the compliance and safety of HiRIT?

A

Preliminary evidence shows feasibility and safety with no serious or chronic injuries reported

103
Q

What is the significance of improvements in BES back extensor strength and kyphosis?

A

They are associated with a decreased incidence of vertebral fracture

104
Q

True or False: HiRIT poses a significant risk for postmenopausal women with low bone mass when supervised.

A

False

105
Q

What warm-up percentage of 1 RM was used for deadlifts in the HiRIT?

A

50% to 70% of 1 RM

106
Q

What was a consideration regarding the compliance of participants in the HiRIT program?

A

Time to commit to the intervention

107
Q

What is the result of combining antiresorptive agent and exercise on lumbar spine BMD

A

additive effects on LB BMD

108
Q

What was the effect of combine exercise and HRT and lumbar spine and femoral neck

A

Beneficial effects and lumbar spine and femoral neck than exercise only

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