ch 26 - common musculoskeletal concerns Flashcards
age related musculoskeletal changes
- thinner vertebral discs
- bone calcium loss
- atrophic cartilage and muscle
- decreased skeletal muscle
- painful joints due to less fluid and movement
what group is at highest risk for developing osteoporosis
postmenopausal white women
major RF osteoporosis
- white and asian
- low body weight
- estrogen deficiency
- inadequate calcium and vit d intake
- lack of weight bearing exercises
- excess alcohol use
- smoking
- eating disorders
how is Dx of osteoporosis made
- following fragility fracture
- DEXA scan
S+S osteoporosis
- loss of height of 3+ cm
- unexplained back pain
assessment tool for ten year probability of fracture with osteoporosis
FRAX tool
med instructions for bisphosphonates
- empty stomach with full glass of water first thing in morning
- remain upright for 30 mins after, don’t eat/drink
- take 2 hours before PPI
recommendations for older adults to prevent/slow down osteoporosis
- calcium and vit d supplements
- weight bearing and resistance exercises
- meds (bisphosphonates, SERMs, RANKL)
most commonly affected joints by osteoarthritis (4)
- knees
- hips
- hands
- spine
inflammatory process affecting joints; thinning of cartilage and deterioration of joints
osteoarthritis (OA)
modifiable RF for OA
- obesity
- joint injury
- knee pain
- job requiring excessive mechanical stress
- muscle weakness
nonmodifiable RF for OA
- female
- age 50-75
- race
- family h/o
S+S OA
- stiffness with inactivity
- morning stiffness
- osteophytes (heberdens and bouchards nodes)
S+S RA
- stiffness more than 20-30 mins after rest
- affects proximal joints
Tx RA
DMARDs
Tx OA
- heat
- exercise
- NSAIDs
S+S gout
- sudden acute pain
- inflammation especially in big toe
Tx gout
NSAIDs
short Tx steroids or colchicine
systemic inflammatory disorder affecting joints; pain, swelling, loss of function, fatigue
rheumatoid arthritis (RA)
RF for RA
- older age
- female
- smoking
- obesity
inflammatory arthritis with uric acid crystal deposits in tissues and fluid; typically affects big toe
gout
RF for gout
- h/o organ transplant
- male
- overweight
- alcohol abuse
- excessive purine consumption
- lead toxicity
- renal insufficiency
- HTN
- hypothyroidism
- meds (diuretics, salicylates, niacin, cyclosporin, levodopa)
what meds increase the risk for gout
- diuretics
- salicylates
- niacin
- cyclosporin
- levodopa
complication of gout
renal failure
S+S gout
- intense pain in joint
- bright red and hot to touch
foods that are high in purine
- meat, poultry, certain fish
- organ meats
- alcohol
- peas
- anchovies
- liver
- high fructose corn syrup
what race and gender is most likely to develop gout
black men
loss of muscle bulk and strength of skeletal muscles
sarcopenia
excessive loss of bone density can lead to (2)
osteopenia
osteoporosis
how many T score deviations does a pt have to have to have osteoporosis? osteopenia?
osteopenia: 1.4
osteoporosis: 2.5
