9 - Osteoporosis Flashcards by Marilou Gélinas

Can osteoporosis occur in young adults?

Yes

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The use of which medications can lead to osteoporosis?

All the medications that are used to decrease inflammation

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Definition of osteoporosis

Metabolic disease of the bones

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Osteo = ?
Porosis = ?

= bone

= porous (cavities in the bone)

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Osteoporosis diagnosis: BMD measurement - Dual-energy X-ray absorptiometry (DEXA)

Scans the entire body and measures the risk for fracture in the hip, spine, and wrist

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Level of radiation of DEXA + type of image provided

Low and the test takes less than 5 min

Provides 2-D images of successive bone layers

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BMD

Bone mineral density

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Osteoporosis diagnosis: BMD measurement - Quantitative computed tomography (QCT)

Measure BMD in the hip and spine and produces a 3-D image that shows true volume density QCT. Can isolate area for testing

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Level of radiation for QCT

10 times higher than DEXA

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QCT is the only method capable of distinguishing BMD level between ___ and ___

the exterior cortical bone

the interior trabecular bone

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Trabecular bone =

where the bone loss begins

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BMD measurement is give as a ___ and a ____

T-score

Z-score

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T-score

the deviation from the mean bone density of healthy young adults of the same gender and ethnicity

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Z-score

the deviation from the mean bone density of adults of the same age. gender and ethnicity

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WHO score for osteoporosis

A T-score of -2,5 S.D and below

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WHO score for osteopenia

A T-score between -1 S.D and -2,5 S.D

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If BMD of healthy young adults for the hip is 1000 +/- 100 S.D (mg/cm2), what is osteopenia and what is osteoporosis?

Osteopenia = BMD of 900 to 750 mg/cm2
Osteoporosis = BMD of 750 or lower

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What is established osteoporosis?

Preferred term for those with osteoporosis and having one or more fragility fractures

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What is a fragility fracture?

Any fall from a standing height or less, resulting in a fracture

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Most common areas of fragility (3)

Wrist, hips, spine

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Every standard deviation below normal doubles the risk for fracture, so -1 S.D equals 2 times the risk, if -3 S.D ?

equals 8 times the risk of fracture

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Z-score is used to determine what?

Whether the loss of bone density is secondary to another disease or condition

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If the Z-score is ___ than expected for age, them there must be something accelerating this loss beyond the normal process of aging

Lower

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Prevalence of osteoporosis in Canada (women vs men, race/sex difference, cost)

1 out of 4 women over the age of 50 is affected
1 out of 8 men over the age of 50 is affected
More women than men
Costs 4.6 billion per year

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Why are women more affected than men?

Lack of hormones after menopause, women have smaller bones to start with which puts them at risk

Hip fractures and falls: Is the fall due to the femoral neck fracture or is the fracture the result of the fall?

The fracture is the result of the fall (80%)

Most common fractures (3)

Vertebra, hip, wrist

Over 60 years old, ___% fracture of vertebra

18%

Over 50 years old, ___% hip fracture

15%

Women aged 65-69 who break a hip are ___ times more likely to die within ___ than women of the same age who don't break a hip

3 times | a year

Slide 16, trend of the graph

Increase in osteopenia until reach age 80 because they they fall into the osteoporosis category (lowering of their BMD)

To be considered in the established osteoporosis category, what 2 things to you need?

Fragility fracture + osteoporosis

Bone remodeling happens every?

3 to 4 months

Osteoclast

Bone eroding cells - dissolve the mineral and cause small cavities

Bone resorption

Decalcification

Osteoblast

Bone reforming cells - fill in the cavities until it is restored

Bone formation

Calcification

End product

New mineralized bones

name the 2 aging effects

1. unbalance in bone remodeling process | 2. calcium is less efficiently absorbed

Loss of __% of total bone mass each after year after the age of __ ( = peak)

1% | 20 years old

Loss of __ to __% of total bone mass each year in women after ___ (first 5 years)

2 to 3% | Menopause

How can we positively change/influence the BMD slope? (3)

Better nutrition Physical activity Hormones in post-menopausal for women

Bone remodeling process is under the control of: (2)

1. Hormones | 2. Mechanical loading (exercise)

Role of hormones (bone remodeling process)

To maintain appropriate level of calcium in the bone

Lack of hormones =

bone atrophy

Role of mechanical loading (bone remodeling process)

Required to maintain adequate bone density | Loading = activation of bone cells = BMD (increase or maintain)

Absence of loading =

bone atrophy

Spongy bone

Where the degeneration occurs first

Why is it that there is no spinal cord damage with most fracture on the spine?

Damages are limited to the front of the vertebral column

The bony trabeculae are thinned out and the mechanical strength of the vertebra is reduced. This leads to (2)?

Compression fractures and flattening of the vertebra

Factors beyond your control - Direct effect on bone remodeling process (4)

Menopausal Prolonged hormonal imbalances (thyroid gland) Removal of ovaries or premature menopause (before age 45) Prolonged use or heavy doses of certain medications

Factors you can control (5)

``` Lack of physical exercise Diet poor in calcium and vitamin D Smoking Caffeine Excessive consumption of alcohol ```

Classification (3)

1. Postmenopausal Osteoporosis (type 1) 2. Senile Osteoporosis (type 2) 3. Secondary osteoporosis

1. Postmenopausal osteoporosis (type 1)

Decrease estrogen = decrease 10-15% BMD in the first 5 years Only women Vertebral and hip fractures

Most common classification

Postmenopausal osteoporosis

2. Senile osteoporosis

Over 80 years 30% are men Forearm, pelvic and hip fractures

3. Secondary osteoporosis

Associated with calcitonin imbalance, malabsorption conditions, alcoholism, smoking and the use of certain medications

Prevention technique

Hormone replacement therapy (estrogen)

Pros of hormone replacement therapy

Inhibit or slow bone bone resorption | Decrease effects of menopause

Cons of hormone replacement therapy

Increase risk of blood clots, stroke and coronary heart disease Necessary or not?

Best kind of physical activity for prevention (2)

- Weight-bearing activities | - Resistance exercise

Special consideration for exercise for intensity

High intensities and few repetitions to increase bone pressure

Effects of exercise on the bones

Increase pressure on the bone = increase bone mass

Special considerations to exercise for people with osteopenia/osteoporosis

- Avoid forward flexion of the spine - Adapt equipment for decrease risk of falling - Aerobic dance exercise = low impact - Resistance training = decrease load and increase repetitions