9 - Osteoporosis Flashcards
Can osteoporosis occur in young adults?
Yes
The use of which medications can lead to osteoporosis?
All the medications that are used to decrease inflammation
Definition of osteoporosis
Metabolic disease of the bones
Osteo = ? Porosis = ?
= bone
= porous (cavities in the bone)
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
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
BMD
Bone mineral density
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
Level of radiation for QCT
10 times higher than DEXA
QCT is the only method capable of distinguishing BMD level between ___ and ___
the exterior cortical bone
the interior trabecular bone
Trabecular bone =
where the bone loss begins
BMD measurement is give as a ___ and a ____
T-score
Z-score
T-score
the deviation from the mean bone density of healthy young adults of the same gender and ethnicity
Z-score
the deviation from the mean bone density of adults of the same age. gender and ethnicity
WHO score for osteoporosis
A T-score of -2,5 S.D and below
WHO score for osteopenia
A T-score between -1 S.D and -2,5 S.D
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
What is established osteoporosis?
Preferred term for those with osteoporosis and having one or more fragility fractures
What is a fragility fracture?
Any fall from a standing height or less, resulting in a fracture
Most common areas of fragility (3)
Wrist, hips, spine
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
Z-score is used to determine what?
Whether the loss of bone density is secondary to another disease or condition
If the Z-score is ___ than expected for age, them there must be something accelerating this loss beyond the normal process of aging
Lower
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
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
- 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)
- 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)
- Postmenopausal Osteoporosis (type 1)
- Senile Osteoporosis (type 2)
- Secondary osteoporosis
- 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
- Senile osteoporosis
Over 80 years
30% are men
Forearm, pelvic and hip fractures
- 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