B8.027 Prework 5: Disease Risk with Aging Flashcards
health risks associated with estrogen loss over time
hot flashes mood, sleep, and/or acute cognitive changes urogenital symptoms cardiovascular disease osteoporosis cognitive decline
benefits of estrogen on atherosclerosis
decreased LDL oxidation
decreased LDL binding/ accumulation
decreased monocyte adhesion to endothelium
decreased macrophage accumulation
decreased smooth muscle cell proliferation
increased endothelial function
increased vasodilation
adverse effects of estrogen on established plaques
increased inflammation > increased plaque instability
increased MMP expression > increased plaque instability/rupture
increased neovascularization > increased plaque hemorrhage
increased thrombosis > increased clot formation > increased risk of MI
symptoms in CVD in women
often different than in men
angina can be mistaken for indigestion or heartburn
women can have milder symptoms such as sudden onset of weakness, SOB, nausea/vomiting, body aches, unusual or mild pain in back
what is osteoporosis
low bone mass and microarchitectural deterioration of bone tissue
leads to enhanced bone fragility and increased risk of fracture
epidemiology of osteoporosis
most common bone disorder
risk of hip fracture doubles for every 5 to 6 year increase in age from 65-85
80% of americans w osteoporosis are women
changes that occur in bones with estrogen deficiency
- increase in frequency with which new remodeling sites are activated
- increase in bone resorption without an increase in bone formation resulting in a net loss of bone
estrogen receptors in bone
have been demonstrated in osteoblasts
possible role for estrogen in bone formation
management of osteoporosis
- identify women at risk for fracture using FRAX
- institute measures that reduce modifiable factors through dietary and lifestyle changes
- prescribe pharm therapy if indicated
risk factors for fracture used in FRAX
age sex weight and height (BMI) prior fragility fracture parental history of hip fracture secondary causes of osteoporosis low femoral neck BMD
testing recommendations for BMD
women 65 and older
postmenopausal women younger than 65 is FRAX score for 10 year risk of major fracture is >9.3%
postmenopausal women with medical causes of bone loss
postmenopausal women with history of fragility fracture
who should BMD testing be considered for
postmenopausal women 50 and older with:
- previous fracture after menopause
- thinness
- history of hip fracture in a parent
- current smoking
- RA
- excessive alcohol intake
when is drug therapy needed for osteoporosis
history of vertebral, hip, fragility, or low trauma fracture
BMD T score <2.5
10 year FRAC risk of major osteoporotic fracture of at least 20% or hip fracture of at least 3%
anti-resorptive agents for osteoporosis
bisphosphonates
estrogen agonist/antagonist : raloxifene
calcitonin
denosumab
cancer risk in midlife women
menopause NOT associated with increased cancer risk
cancer rates increase with age: regular screening for breast, colorectal, endometrial, ovarian, and cervical cancer is recommended
