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Brad 4th Ed Part 2 > Ch.41 Osteoporosis > Flashcards

Ch.41 Osteoporosis Flashcards

1
Q

What is the osteoporosis according to WHO?

A

BMD of 2.5 standard deviations below peak bone mass of young healthy adults

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2
Q

What is a T score?

A

Amount of bone density compared to a 35 yo adult of same gender with peak bone mass

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3
Q

What is a Z score?

A

Comparison of bone mass made with same age, sex, race, height and wt

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4
Q

What is a normal BMD T score?

A

T score of -1 or >

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5
Q

What is an osteopenic T score?

A

T score b/w -1 to -2.5

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6
Q

What is an osteoporotic T score?

A

T score of

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7
Q

What is severe osteoporosis?

A

T score of

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8
Q

How much bone is replaced annually?

A

20%

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9
Q

What are osteoclasts?

A

Bone cells that resorb calcified matrix

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10
Q

What are osteoblasts?

A

Bone cells that synthesize new bone matrix

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11
Q

Describe the activation phase of bone remodeling

A

Osteoclastic activity recruited

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12
Q

Describe the resorption phase of bone remodeling

A

Osteoclasts erode bone and form a cavity

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13
Q

Describe the Reversal phase of bone remodeling

A

Osteoblasts are recruited

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14
Q

Describe the formation phase of bone remodeling

A

Osteoblasts replace cavity with new bone

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15
Q

Describe the quiescence phase of bone remodeling

A

Bone tissue remains dormant until the next cycle starts

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16
Q

What endocrine disorders can increase rate of bone remodeling?

A

Thyrotoxicosis

Hyperparathyroidism

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17
Q

What is primary osteoporosis?

A

Rare idopathic juvenile d/o b/w 8-14 yo w/ inc osteoclastic activity for 2-4 years

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18
Q

Which hormones inc bone remodeling?

A

PTH
Thyroxine
GH
Vitamin D

19
Q

Which hormones dec bone remodeling?

A

Calcitonin
Estrogen
Glucocorticoids

20
Q

What does PTH do in the presence of Vit D?

A

Stim bone resporption and release of Ca and P

21
Q

What does Calcitrol do?

A

Produced by kidneys and inc intestinal absorption of Ca and P

22
Q

What does Calcitonin do?

A

Prohibits Ca and P resorption by inhibiting osteoclastic activity

23
Q

What does active Vit D do?

A

Inc intestinal absorption of Ca and P

24
Q

How is Vit D synthesized?

A

Sun exposure and conversion in the liver

25
Q

How does age affect bone remodeling?

A

Osteoblast activity dec
Active form of Vit D-1,25(OH)2 dec ~50%
GH dec which stim renal prod of vit D

26
Q

What are the MC locations for osteoporotic fx?

A

Midthoracic and upper-lumbar spine
Proximal femur
Distal forearm (Colles fx)

27
Q

What is the risk of death with osteoporotic hip fx?

A

15% to 20%

28
Q

How does the risk of osteoporotic fx change with every SD of dec in BMD?

A
  1. 5-2.0 fold inc in spine fx

2. 6 fold inc in hip fx

29
Q

How is a typical limb with hip fx positioned?

A

Externally rotated and shortened

30
Q

Who is at inc risk of osteoporosis?

A 
Estrogen def women
Women >65 yo
Type I DM
Liver dz
Kidney dz
Thyroid dz
FHx of osteoporosis
Early menopause
Cigarette smokers
Alcohol abuse
31
Q

What can use of the spinal proprioceptive extension exercise dynamic (SPEED) program do?

A 
Dec fall risk and falls at obstacles
Dec step width
Improve gait steadiness
Inc velocity
Inc Cadence
Inc Stride length
32
Q

What is the recommendation for walking to dec osteoporosis risk?

A

45 min 3x/wk or 30 min daily

33
Q

What exercises should be avoided in osteoporosis?

A

Spinal flexion

34
Q

What are anti-resoprtive agents?

A

Estrogens
Androgens
Calcitonin
Bisphosphonates

35
Q

What are osteoblast stimulator agents?

A

Fluoride (not approved in US d/t risk of appendicular fx)

PTH

36
Q

What is a contraindication of PTH therapy?

A

Hx of cancer

37
Q

What are the SE of PTH therapy?

A 
Nausea
Dizziness
Leg cramps
HA
Hypercalcemia
38
Q

What is a SE of bisphosphonates?

A

Osteonecrosis of the jaw

39
Q

What are contraindications of estrogen therapy?

A

Hx of thromboembolism or thrombophlebitis
Suspected breast or endometrial CA
Liver or gallbladder dz
CV dz

40
Q

What does use of progesterone with estrogen dec risk of?

A

Endometrial hpyerplasia and CA

41
Q

How should Alendronate be taken?

A

10 mg/day or 70 mg/wk
W/ full glass of water on awakening
No eating or reclining for 30-45 min after dose d/t esophageal irritation

42
Q

How should Risedronate be taken?

A

5 mg/day or 35 mg/wk

43
Q

What doe thiazide diuretics do?

A

Inhibit urinary excretion of Ca and slow bone loss dec rate of fx

Brad 4th Ed Part 2 (28 decks)

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