Adult & Elderly Flashcards
1
Q
What maturation milestones are reached in young adulthood?
A
- Sexual maturity (teens)
2. Physiological maturity (around 30)
2
Q
____ maturity is reached before ___ maturity
A
sexual
physiological
3
Q
True/False: When sexual maturity is reached, this indicates that growth has reached a maximum and will stop.
A
false; teens still growing, building bone mass
4
Q
What marks the point of physiological maturity? (2)
A
maximum height reached
maximum bone mass reached
5
Q
Why does growth and bone mass stop increasing? What happens after the maximum is reached?
A
rate of catabolism = anabolism (no more growth)
eventually catabolism > anabolism, will begin to DECREASE muscle and bone mass
6
Q
After the age of 30, humans enter a ____ phase.
A
catabolic
7
Q
When is peak strength reached?
A
5 years after max height reached
8
Q
Young adulthood describes the years:
A
20-35
9
Q
Middle adulthood is the years:
A
50-69
10
Q
As age increases, so does the rate of ____ , increasing the imbalance with _____.
A
catabolism
anabolism
11
Q
How does the metabolic changes in older adults affect body composition? What effects does this have?
A
less muscle mass -> lower BMR
gradually lower energy needs
12
Q
How is the average weight affected in aging people, and why?
A
average is increased
not accounting for lower energy needs, and more sedentary life -> more fat gain
(some will lose weight, but average is still gaining)
13
Q
weight tends to increase until age ____.
A
70
14
Q
What can help prevent muscle/bone loss?
A
resistance exercise & activity
15
Q
Fat gain with age tends to accumulate in the ____ area. What are the health effects?
A
abdominal; accelerates with age
increased risk of diabetes, hypertension, CVD
16
Q
How does decreased LBM contribute to obesity?
A
less LBM -> Higher % fat in body
17
Q
In terms of aging obesity, women have higher ____, but lower ____.
A
risk of obesity,
incidence
18
Q
At what point does morbidity from obesity become a concern? What are the risk for women
A
> 25 (overweight by more than 25lbs)
women: 2-3x greater risk for CHD
19
Q
How does obesity affect blood cholesterol?
A
overproduce LDL
less HDL
imbalance
20
Q
What are the health risks of obesity?
A
increased risk of chronic metabolic disease and morbidity
cancers, diabetes, heart disease, etc
21
Q
The leading causes of death and illness, such as __________, are closely associated with ___ and ___ factors.
A
major chronic disease: heart disease, cancer, stroke
also osteoporosis, dementia, HTN
LIFESTYLE & DIET
22
Q
What are some dietary factors that have increased the occurences of chronic disease?
A
shifting diet: more animal fat, less complex carbs and fibre
23
Q
What is a meta-analysis?
A
an unbiased review of multiple studies
put together data and analyze as 1 big cohort
24
Q
What was analyzed the the meta-analysis by Mozaffarian?
A
likelihood of developing CHD, Stroke, or diabetes from consumption patterns of many types of foods
25
What needs to be considered when analyzing multiple data sets for a meta analysis?
results of each study
uncertainty
population size of each study (determine weight of results)
need to be unbiased, reliable
26
How are results from multiple studies combined?
take the median or mean of results (account for weight % of each study, depending on population size)
27
How do processed meats differ from normal meat?
higher sodium
| nitrites and nitrates, nitrosamines as preservatives
28
What two meat products were shown by the meta-analysis to have negative health effects, and why?
red meat: high in sat fat, high heat produces heterocyclic amines
processed meat: high salt, nitrates (even higher risk)
29
foods found generally to be beneficial are:
fruit/veg, veg oil, fish, nuts, yogurt, beans, whole grains
30
Foods found to be harmful and increase risk of chronic disease are:
refined grain/starch/sugar, high sodium, processed meat, trans fat (worst!)
31
Foods that are somewhat neutral/inconclusive are:
dairy, eggs, poultry, red meat
32
Are low fat diets found to be effective in reducing incidence of CHD?
Slightly; but much more effective was the mediterranean diet (small diet changes: use more EVOO, nuts)
33
What did the PREDIMED study show about the mediterranean diet and fat consumption?
consumption of healthy fats (MUFA, PUFA) even if >35%, can still lead to decreased risk of CHD
so: should not focus diet on fat reduction!
34
What is the key recommendation of the unified dietary guidelines? Why?
adequate fruit veg intake!
- inadequate intake -> increase disease risk
- higher intake -> protective effect against disease
35
How can increased consumption of fruit and veg impact disease risk later in life, and what compounds are associated with this?
can reduce cancer risk (vitamin C, beta carotene, fibre, phytochemicals)
36
What lifestyle/diet factors are found to increase chronic disease risk and accelerate aging? (8)
```
alcohol
smoking
sedentary
high stress
high sat fat
high Na
low fibre
high sugar
```
37
what are the UNIFIED DIETARY GUIDELINES? (6)
1. eat VARIETY of food
2. choose mostly PLANT sources
3. >5 serves fruit/veg per day
4. >6 serves grains/starch per day
5. less high-fat food (especially animal)
6. minimal SIMPLE SUGARS
38
The unified dietary guidelines were developed by:
American: Heart association, cancer society, academy of pediatrics, dietetics association
NIH
39
What is happening to the age of the population in Canada? Why?
population is aging (higher % old people)
| longer lifespan & lower birth rates
40
Why is increasing age of the population problematic in terms of health? In terms of society?
living longer, but faced with chronic disease, loss of independence
less workforce, greater burden on nation to care for the elderly, need more funds for healthcare
41
What is "usual aging," vs "succesful aging?"
usual: normal deteriorative aging effects, accelerated by poor lifestyle/diet
succesful: still some normal aging effects, but NOT amplified because of poor lifestyle/diet
42
What tends to decrease with age (physiological)?
```
muscle mass/function
BMR
organ mass/function
GI cells (less absorption)
```
43
How do people who age "successfully" differ from those with usual aging?
```
exercise regularly
good nutrition
good control BP
no smoking or excess alcohol
not obese
```
44
How is immune function affected by age?
may show decline = IMMUNOSENESCENCE
| but not in everyone! so may be preventable
45
The best characterized feature of immunosenescence:
declining T cell function
46
What vitamin supplement can actually improve immune function, and by what mechanism?
vitamin E
- high PE2 will inhibit T cell proliferation
throws off balance of TH1 vs TH2; not enough TH1
TH1 is interferon gamma, IL2 (cell-med immunity to kill pathogens)
- also reduce IL2 receptor expression
SO: high PE2 -> less immune response
vit E will inhibit prostaglandin E2 (PE2) from macrophages
47
What is the best predictor of # of visits to doctor or hospital for elderly?
malnutrition
48
Why are green vegetables beneficial in improving health of elderly?
high in vit C, E
| improve/prevent cataracts, dementia, improve immunity
49
How is folate related to dementia? (3)
deficiency increases risk (3x)
supplementation improve mental function
weight loss due to dementia may impact folate metabolism
50
Supplementation with ___ and ____ can help prevent/improve symptoms of dementia
fish oil
| folate
51
Change in body composition with age is due to ____ and decrease in _____.
hormonal changes
| decrease in activity
52
How do the amounts of sex hormones change in old age, and how does this impact body composition?
less estrogen & testosterone
less estrogen -> decreased BMD
less testosterone -> can't maintain protein stores -> less muscle
53
What happens first, loss of BMD or loss of LBM?
LBM
54
Why is BMI not a good indicator of obesity in elderly? What are better alternatives?
Does not indicate % fat; low weight but high fat is also dangerous
instead: PERCENT BODY FAT (PBF)
use BIA, MRI, CT, DXA, waist measure, electric impedement, TG levels in blood (can use combo)
55
What is "HTW?"
hypertriglyceridemic waist
56
How can excess fat mass be measured through blood?
measure TG levels
| high visceral fat and fatty liver -> increased TG levels
57
How does excess fat impact hormone action in the body?
high TG -> insulin resistance
high intromyocellular fat -> insulin resistance
changes in production and sensitivity of GROWTH HORMONE, INSULIN-LIKE GROWTH FACTOR 1, sex hormones, corticosteroids, insulin
-> affects muscle metabolism
58
How does decreased PA affect muscle (describe hormone changes)
changes in production and sensitivity of GROWTH HORMONE, INSULIN-LIKE GROWTH FACTOR 1, sex hormones, corticosteroids, insulin
- > affects catabolic/anabolic balance in muscle
- > more intramuscular fat
59
How does long term stress ultimately impact hormonal control?
repeated activation of HYPOTHALMIC PITUITARY ADRENAL ACCESS (HPAA) which is homeostatic response system; coordinate stress response hormones
too much activation -> generate many oxidative species, overwhelm neuron, cannot deal with oxidative stress (possibly less functional)
60
What happens to muscle after age of 30? How does this affect the rest of the body? Can it be slowed/prevented?
decreased muscle mass (lose 3-5% every decade)
decreased function
increase % fat -> inflammation -> further decrease muscle mass/function
can slow/prevent with adequate cal/protein + phys activity
61
More adipose tissue will result in more release of ___, which promote ______ and decrease muscle ____.
cytokines
myofibrillar breakdown
synthesis
62
True/False: aging people should eat as much protein as possible to prevent muscle loss
False: excess protein is converted to fat, more fat will actually slow muscle synth
63
The age related loss of muscle/function is known as: ____. What is a good lifestyle preventative measure?
sarcopenia
| resistance training
64
How are LBM and BMD related?
synergy between the two
better LBM -> better BMD
need muscle for mechanical stress on bone to maintain strength
65
Can body composition and function be improved in old age? How?
yes; can revert changes by acting on muscle mass
physical activity -> less % body fat
phys activity increase muscle STRENGTH and MOBILITY
66
Why are dietary interventions often necessary in elderly? What changes and effects take place?
chronic disease (CVD, cancer, diabetes, HTN, etc)
1. required change in food habits -> less intake (unappetizing)
2. drugs can affect (change metabolism, absorption)
3. restrict access to food (decreased mobility)
67
definition of "frailty"
fit 3+ of these criteria:
1. muscle weakness
2. slow walking
3. exhaustion
4. low activity
5. unintended wt loss
68
The risks associated with frailty:
increased fall risk -> fracture -> convalescence (bed rest), lack of movement, long recovery -> high morbidity (downward spiral)
69
The theories of why we age: (6)
1. Cellular mutations
2. Decreased hormone secretions
3. Cross-linking
4. Free radicals
5. Deteriorating Immunity
6. Pre-programmed (genetic)
70
How does cell mutation contribute to age?
accumulative over the years:
Exposure to UV, radiation, mutagens -> damage DNA repair ability -> cannot fix damage from enviromental stressors -> more "malfunction" cells -> cell death
(too many errors, incorrect proteins -> decrease function)
71
How can DNA be studied to infer someone's age? What else does it reveal?
methylation status (epigenetic modification, methyl on cytosine)
good predictor of how long going to live (higher methylation, higher mortality)
72
How do hormonal changes contribute to aging?
less GH -> more fat, less LBM
less estrogen -> can't maintain protein/bone
less testosterone -> Can't maintain protein
less insulin -> less anabolism
73
What is the theory of cross-linking and aging?
glycation -> linking of protein -> ADVANCED GLYCATION ENDPRODUCTS -> too many, cause APOPTOSIS
74
What is the link between free radicals and aging?
environmental exposure: radiation, oxidation, breathing, etc -> cause macromolecular damage (oxidative damage)
75
Can a reduced diet and therefore decreased oxidation rate in humans extend lifespan?
No; likely to become deficient in nutrients
76
The deterioration of the immune system, called _____, impacts the __ and __ cells. What physiological change causes this? It will leads to what result?
immunosenescence
B & T
due to shrinking thymus -> less mature B and T cells produced
increased susceptibility to chronic inflammatory disease, autoimmune disorders
(dysregulated, lose function, etc)
77
What is the theory of pre-programmed aging?
cells can only divide so many times;
TELOMERES at end of chromosomes w/ protective function, but get shorter with age!
- no more protection from telomeres, need DNA repair machinery
-p53 activated, stop proliferation, so can get fixed
*if not fixed -> cell death
old cells release detrimental chem to surrounding cells
slowing proliferation is bad for areas with high turnover (gut, blood)
78
What are risk factors for malnutrition in elderly? (8)
1. decrease body function
2. chronic disease
3. medication
4. loss of mobility/independence
5. tooth loss/oral pain
6. eating poorly
7. economic hardship
8. less social contact
79
What body functions tend to decrease, how does it impact nutrition in old age?
almost every system decreases
especially GI, liver, renal -> less absorption, detox ability
sensory impairment -> less appetizing food
decrease in oral health
decreased mobility
so: increased malnutrition risk
80
How can medications impact elderly negatively?
interfere with appetite, absorption, excretion, etc
| less detox ability -> easily overdose
81
What factors can lead to loss of mobility and self-care ability in elderly, and possible malnutrition?
disability (eye problems, fractures)
surgery/injury/infection (less intake, but more nutrient needed!; anorexia)
less able to get food -> malnutrition -> even more weak -> more malnourished
82
Oral problems in elderly increases risk of ____ and also ___.
malnutrition; choking
83
Common features of elderly who eat poorly:
eliminate fruit/veg
poorly educated
change in living conditions (institutionalized, or alone)
84
What are changes in organ function with aging? (9)
1. less taste buds
2. less saliva
3. less esophageal function
4. less gastric function/slow emptying
5. less liver/biliary function
6. less pancreatic secretion
7. changed intestine morphology
8. changed renal morphology
9. less bladder control
85
What are the changes that occur in the mouth, with age? What are the effects?
less taste buds -> decrease palatability -> less intake -> malnutrition
less saliva -> dry mouth (xerostomia); less protective enzymes
-> more infection/ulcers
86
What is the importance of saliva, and what can decrease production?
lubricate food -> help swallow
contain IgA, lysozyme -> antibacterial
decreased by drug intake, disease
87
swallowing dysfunction is known as:
What can cause this?
It increases risk of:
dysphagia
diabetic neuropathy, CNS changes, parkinson's
risk of choking, pneumonia (food in lungs)
*need to restrict food types
88
How does the stomach change with age? What negative effects does this cause?
decreased function/emptying
- less acid production -> atrophic gastritis (can't digest)
- weaker lining, less parietal cells -> risk of ulcers, heartburn
- can't maintain healthy flora balance (low acid, other bacteria will colonize) -> overgrowth in small GI -> COMPETE FOR B VITAMINS
89
the importance of gastric acid:
| What 2 conditions arise if it is not enough?
- digestion
- barrier to bacteria
atrophic gastritis
hypochlorydria
90
What does the stomach lining secrete to protect itself from the acid?
thicc mucus with Na bicarbonate
91
What changes occur in the liver and biliary function with age, and what effects does it cause?
less bile -> more intolerant to foods (fat, raw veggies) -> gassy, diarrhea
less drug-metabolizing enzymes -> decreased detox ability -> more drug toxicity
92
A decrease in function of the ____ results in less secretions of _____, leading to impaired nutrient absorption in the ____.
pancreas
digestive enzymes
small intestine
93
How does intestinal morphology change with age?
- slower movement-> constipation, diverticulosis
- less enzymes -> lactose intolerance
(can't drink milk -> def in vit D, A, Ca, B2, protein)
94
How is renal morphology changed by old age?
less function (lose nephrons, renal mass) -> less filtration ability -> can't tolerate high load of protein or electrolyte
95
How can high doses of drugs and vitamins affect kidneys in old age?
lead to GLOMERULONEPHRITIS
Can't excrete; IgG and other complement bind to metabolites -> form depositions -> attract phagocytes (inflammation)
*type III hypersensitivity
96
how can renal function loss lead to nutrient deficiencies? (3)
Can't reabsorb water, glucose, AA -> excreted
impaired thirst mechanism -> dehydration
less able to activate vit D -> vit D deficiency
97
How can drugs affect dietary intake? (2)
reduce/increase appetite
| dry mouth, loss of taste, etc makes eating harder
98
Drugs that impact vitamin status are known as ______. How does this occur? (5)
antivitamin drugs
- inhibit absorption
- bind and decrease bioavailability
- more catabolism
- more excretion
- inhibit activation
99
Multiple intakes of medical drugs (known as: _____), is a good predictor of ___ in elderly.
polypharmacy
| malnutrition
100
Do elderly bodies handle drugs differently than young adults? Why?
liver/renal systems decline; less able to metabolize and excrete drugs -> higher risk of toxicity and side-effects
101
What is the general path of drugs through the body?
absorption
distribution
metabolism
excretion
102
Why might the absorption of oral drugs be problematic?
intake of foods, supplements can interfere with absorption
103
In blood, drugs are usually bound to _____. How do they behave differently from unbound drugs?
plasma proteins
| only unbound drugs can leave bloodstream and affect target organs
104
What does the "distribution" stage of drugs in the body consist of?
drugs leave systemic circulation to diff parts of body
105
How could blood plasma composition affect drug effectiveness?
less serum albumin (carrier protein) -> more unbound drug -> more leaving circulation and into organs (more effective)
106
the metabolism and ____ of drugs occurs primarily in the ____. It is facilitated by the enzyme system ____.
biotransformation
liver
P450
107
What important role of drug metabolism is needed to facilitate excretion?
P450 in liver: convert FAT-SOLUBLE -> WATER SOLUBLE so can excrete out
108
The major route of drug excretion:
The two affecting factors:
What other bodily fluid can it be excreted in?
renal
renal function; pH of urine
bile
109
drugs may be excreted as ___ or ___.
drug metabolites; unchanged
110
What is an example of a food that will affect drug metabolism, even when taken several hours earlier?
grapefruit juice
affect cytochrome p450, enzyme 3A4
(for anti-anxiety meds, Ca channel blockers, HMG CoA reductase inhibitors)
111
____ is an antidepressant that will interact with "pressor agents in food, such as ______. What physiological effects can this have?
Monoamine oxidase inhibitors (MAOI)
tyramine, dopamine, histamine, phenylethylamine.
pressor agents increase BP; normally would be de-aminated (deactivate) by MAO (which is inhibited by drug)
so: if on drug + high intake of pressor agents -> hypertensive crisis
112
How could intake affect the effectiveness of warfarin?
normally prevent conjugation of vit K -> active form; no clotting
but high vit K, vit E, garlic, other foods can overcome this
113
What drugs might impact folate nutrition, and how can this be dealt with? (2)
methrotrexate (cancer or arthritis)
pyreethamine (malaria, toxoplasmosis)
folic acid ANTAGONISTS; folate not activated by DEHYDROFOLATE REDUCTASE
instead: use reduced form (FOLINIC ACID) to prevent deficiency (already active); or extra supplements
114
Alcohol acts as a ____ on the gastric system. If it is combined with ____, it may cause ____.
irritant
other irritants (NSAIDS, hepatotoxic drugs)
gastric bleeding
115
Define "drug-nutrient interactions," and "food-drug interactions"
drug-nutrient: action between the 2, that would not happen with either alone
food-drug: broad term, includes drug-nutrient; effects on NUTRITIONAL STATUS
116
What is cholestyramine drug used for, but what negative effects on nutrition occur?
reduce cholesterol by sequestering bile
BUT: "sticks" to fat soluble vitamins -> less is absorbed by body
if long term use, need vit supplements
117
___ drugs may cause GI damage, by impacting microflora and also: ________.
What are the nutritional implcations?
antibiotic (ex: neomycin)
damage villi, microvilli, destroy mucosa, inhibit enzymes
lower absorption ability
118
The anti-nutrition effects of anti-inflammatory drugs: (2)
inhibit lactase
damage gut -> less fat/micronutrient absorption
119
Function of laxatives, and Antinutrient effects of laxatives:
help retain water in stool, speed up transit time
but: mineral oil dissolve fat + fat soluble vit -> excreted
shorter transit time -> less absorption Ca, K
120
What drugs tend to impair absorption of minerals? Which minerals in particular?
NSAIDs, antiobiotics, chemotherapy
Ca, Fe
(also Mg, Zn)
121
A diet high in ____ can bind and impair absorption of ____ drugs.
fibre
| tricyclic antidepressants
122
____ is taken to prevent ulcers. What is the mode of function, and what nutrition impacts happen?
cimetidine
lower HCl production -> less acidic
but: less B12 released from food! (so lower intrinsic B12 receptor secreted)
less absorption of Ca, Fe, beta-carotene, Folic acid
123
How can use of diuretics impact the heart?
loop diuretics (for BP control) -> more THIAMINE excretion -> cardiac abnormalities
other diuretics -> more K excreted -> cardiac arrhythmia
124
The effects of corticosteroids on renal function: (3)
DECREASE Na excretion
INCREASE K, Ca excretion
water retention
125
What are 2 negative effects of aspirin?
irritant -> can cause gastric bleeding
INCREASE FOLATE EXCRETION (bind to folate site on carrier protein! more folate lost since can't transport)
126
Define diarrhea:
3+ unformed bowel movements in 24 hr
- acute: <2 wks
- chronic: 3-6 wks
127
elderly are (more/less) susceptible to diarrhea. This is due to: ______.
more
immunosenescence; deteriorating GI tract/function; drug therapy (MOST COMMON!) - too high of a DOSE
128
What are risks associated with diarrhea in elderly?
dehydration, illness, electrolyte imbalance, lower quality of life
129
What are some osmotic drugs, and how do osmotic drugs impact GI function?
antacids, laxatives
| cause osmotic diarrhea
130
What is the meaning of "iatrogenic?" What is the most common iatrogenic cause of diarrhea in elderly?
treatment used for one condition will cause another problem
ANTIBIOTICS commonly cause diarrhea (alter microflora, damage mucosa)
131
How can antibiotics cause osmotic diarrhea?
alter gut microflora -> less carb fermentation (carbs will act as osmotic agent)
132
why does damaging gut microflora increase diarrhea risk?
1. microflora needed to protect against diarrhea causing pathogens
2. osmotic diarrhea, since more carbs unfermented
133
What are factors that contribute to the negative effects of drugs?
polypharmacy
non-compliance (wrong dose, wrong time, etc)
self-medication
error with prescribing
134
Anti-cancer drugs are known as _____ drugs. What is the damaging effect on the gut?
antineoplastic drugs
| damage immature epithelial cells -> gut lining (mucosa) damaged -> less absorption ability -> diarrhea, malnutrition
135
The replacement of old bone with new bone is known as ______. How does this occur?
bone remodeling
OSTEOCLASTS break down old bone with acid, PHAGOCYTES remove protein
OSTEOBLASTS synth new matrix
136
Define osteoporosis
```
reduced bone (but normal composition)
<2SD below normal bone in young adults
```
137
Bone loss is accelerated in women during the ______ period, which may lead to _____.
```
early postmenopausal (50-70)
type I osteoporosis
```
138
How do rates of bone resorption and formation change throughout life?
<30 yrs: formation > resorption -> bone mass increases
30: peak bone mass
>30: resorption > formation -> bone mass loss (-1% per yr)
139
How do the rates of bone loss differ for men and women? why?
women: from 50-70 will have MORE rapid loss (3-5% per yr)
due to MENOPAUSE: lower level of estrogens
(less serum estrone & 17b estradione )
*eventually reach new setpoint -> loss will slow to same as men
140
Can high Ca intake during youth prevent the gradual loss of bone with age?
No; but will make ample bone mass stores so that losses will not result in osteoporosis
141
What is the main determinant of peak bone mass, and when does the maximum accretion occur?
Ca intake
| puberty growth spurt
142
Why are women more susceptible to osteoporosis?
smaller skeleton
hormonal changes during menopause
start bone loss earlier
143
What are risk factors for osteoporosis?
```
Female
small/thin
old
genetics (race, family history)
postmenopausal
amenorrhea (low estrogen, no period)
anorexia nervosa (malnutrition, no hormones)
low Ca intake
hypogonadism (low levels of sex hormones)
inactivity
smoking/alcohol/drugs/medication
```
144
Aging results in less secretion of hormone ____, which results in less ____ and ____, resulting in bone loss
GH
| hepatic IGF1/IGF2, GF binding proteins
145
_____ medications have what hormonal effects that affect bone?
steroid (glucocorticoids)
| suppress IGF-1 synth, suppress bone growth
146
____ exercise is recommended to strengthen skeleton
weight-bearing
147
What part of bone contains Ca and responds to daily Ca intake?
```
TRABECULAR BONE (20%)
lacey inner part, contain Ca crystals
```
148
The types of osteoporosis:
type I: postmenopausal - trabecular bone loss
- due to LOW ESTROGEN -> more osteoclast activity
type II: senile - cortical bone loss
- due to accumulation bone marrow fat -> less osteoblast
149
true/false: senile osteoporosis will start in very old age, 70+
false; slow and steady process! begins around 40
150
What is the role of estrogen in preventing bone loss? (3)
1. promote breakdown of osteoclast precursors -> fewer osteoclasts
2. less production of resorption cytokines (IL1, IL6, TNFa, MCSF)
3. reduce Ca-releasing effects of PTH
151
Which tends to begin sooner, Type I or Type II osteoporosis?
Type II
152
A 40 year old man with low bone density would be classified as having ____ osteoporosis
idiopathic (cause unknown; not old enough for senile osteoporosis)
153
What are the mechanisms of senile osteoporosis?
1. more bone marrow adipocytes -> make adipokines, FA -> inhibit OB
2. sarcopenia -> less muscle, less load/resistance on bone
3. stem cells become adipocytes rather than OB
4. estrogen deficiency (men and women!) -> OC Activity increase
5. less Ca/vit D (lower absorption, activation) -> more PTH (hyperparathyroidism) -> more Ca release from bone
154
Can Ca supplementation alone be used to prevent osteoporosis?
NO; But can help prevent; use with other treatments
| high dose in first year menopause can help slow rapid bone loss
155
What are preventative care measures for osteoporosis in different stages of life?
1. acquire max bone mass in youth (adequate Ca, vit D)
2. screen for osteopenia in premenopause
3. slow bone loss in postmenopausal period
4. lifestyle: exercise, avoid smoking/alcohol/drugs
156
What is osteopenia?
bone loss >1SD (not yet osteoporosis)
157
How can bone loss in postmenopausal period be slowed?
1. supplement (Ca, vit D (calcitriol or alfacalcidol)
2. HRT (hormone replacement therapy)
3. lifestyle: exercise, avoid smoking/alcohol/drugs
158
the predominant treatment to slow bone loss is: ____, used for ____ deficiencies in elderly, and other cases such as ______.
What is the optimal treatment period?
hormone replacement therapy
estrogen
anorexia, ovary removal, low-functioning ovaries
unknown optimal timing/duration
159
HRT and similar therapy ____ have fallen out of favor due to increased risk of _______. What is the alternative?
SERMs (selective estrogen receptor modulators)
CVD, breast cancer
BISPHOSPHONATES - Less OC, more OB, less bone marrow fat
160
How does vitamin D contribute to bone?
enhance Ca absorption in gut -> needed for bone mineralization
less bone resorption
161
How is vit D activated, and how is this affected in elderly?
D2 -> D3 in kidney
| as kidney declines -> less active vit D -> poor Ca absorption
162
What are benefits and possible negatives of vit D supplementation?
improve Ca absorption -> better for bones
| but can cause high Ca (hypercalcemia, hypercalciuria)
163
A lifestyle/diet HIGH in _______, and LOW in _______ will increase osteoporosis risk
high in: smoking/alcohol/protein/caffeine/phosphorus
low in: Ca, vit D, exercise
164
exercise will stimulate _____ in bones, and also reduces risk of fracture due to ______
osteogenesis
| reduced bone loss, better coordination/muscle strength
