B6.055 Clinical Implications of Osteoporosis Flashcards
most common metabolic bone disease in the elderly
osteoporosis
difference between male and female bone mass
men have 30% more bone mass
difference between AA and Caucasian bone mass
AA get 10% higher peak bone mass
risk of hip fracture in white and black women in the US
risk by age 90
- 3% in white women
- 3% in black women
prevalence of osteoporosis worldwide
8.9 million fractures annually
fracture every 3 seconds
200 million women worldwide
75% in patients 65 or over
epidemiology of osteoporosis in the US
52 million women and men 50 or older have osteoporosis OR osteopenia (14 million osteoporosis)
50% of women over age 50 will sustain a fracture in their lifetime
what areas are measure in a DXA scan
radius
lumbar spine
greater trochanter
how much is fracture risk increased with a drop of 1 SD in BMD
2.6%
how much is fracture risk increased with a drop of 2.5 SDs in BMD
10%
not linear
most common fractures
- distal forearm
- hip
- spine
fracture risk factors
- fall risk
- BMD
- architecture and geometry of bones
screening of BMD
start @ 65
every 2 years get a DXA
every year if on osteoporosis therapy
can start earlier with justification
risk factors for osteoporosis in men
hypogonadism
alcoholism
glucocorticoid use
what is the minimum amt of steroid that can begin bone loss
7.5 mg qd for a month
mortality post hip fracture in men vs women
men 2x higher mortality
residual lifetime risk of osteoporotic fracture in men vs prostate cancer
27% osteoporotic fracture
11.3% prostate cancer
progression of bone mass
peaks at age 30
loss worsens after menopause
estrogen protects against osteoclastic activity
lab work to do when screening for osteoporosis
CMP CNC UA TSH vit D PTH if high Ca free testosterone if male SPEP/UPEP if suspect MM
IADLs
shopping housekeeping accounting food prep telephoning transportation
BADLs
dressing eating ambulating toileting hygiene
SH when evaluating for osteoporosis
active?
function?
history of fractures
cognitive history
exercise rec on osteoporosis prevention
30-60 min 3-4x/wk weight bearing
strength training 2x/wk
750 cal/week reduced hip fractures by 36%
Ca recommendations
adolescents, non pregnant women, menopausal women: 1200 mg/d
women and men over 65: 1500 mg/day
how are individuals >65 given Ca
usually given as CaCo3 600 twice daily with dietary intake
OR
500 3x per day without dietary intake
when to use Ca supplements
osteopenia, osteoporosis, poor Ca intake patients take 500-600 mg at a time CaCo3 with meals -can be constipating Ca citrate with or without meals
Vit D recommendations
600-1200 IU/d
milk, cereals, egg yolk, seaweed, liver
vit D compliance
over 70% of women 51-70 don’t meet guidelines
90% of women over 70 don’t meet guidelines
NIH vit D guidelines
< 70 : 600 IU
> 70: 800 IU
how to take bisphosphonates
poor absorption take in AM 30 min before PO stand up or sit up 8 ox of plain water
use of calcitonin
nasal spray 200 IU/day
1 spray per day
used for analgesia for acute fracture, not effective as monotherapy for future fracture reduction
how does ONJ present?
nonhealing tooth extraction or exposed bone in jaw progressing to bone inection
risk of ONJ with bisphosphonates
<1/10,000 pts
associated primarily with IV bisphosphonate use in cancer patients undergoing dental procedures
only 1 case without cancer history
