Chapter 09 Osteoporosis Flashcards
Osteoporosis, OP is a systemic skeletal disease characterized by _________ bone mass, caused by an imbalance between bone resorption and bone formation, and _________ deterioration of bone tissue, with a consequent increase in bone fragility.
Osteoporosis, OP is a systemic skeletal disease characterized by low bone mass, caused by an imbalance between bone resorption and bone formation, and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility.
Osteoporosis: The WHO definition of OP is a t-score (measured using DXA scan) of ≥_________ SDs below the mean BMD value for young, healthy, white women (or t-score of ≤ –_________). Patients who have already experienced ≥1 fracture are considered to have severe or “established” OP. Osteopenia is defined as a t-score between –_________ and –_________. The WHO diagnostic classification should not be applied to premenopausal women, men younger than 50 years, or children. Instead of a t-score, the ISCD recommends using ethnic or race-adjusted z-scores, with z-scores of ≤ –_________ defined as either “low bone mineral density for chronological age” or “below the expected range for age” and those ≥ –_________ being “within the expected range for age.”
Osteoporosis: The WHO definition of OP is a t-score (measured using DXA scan) of ≥2.5 SDs below the mean BMD value for young, healthy, white women (or t-score of ≤–2.5). Patients who have already experienced ≥1 fracture are considered to have severe or “established” OP. Osteopenia is defined as a t-score between –1 and –2.5. The WHO diagnostic classification should not be applied to premenopausal women, men younger than 50 years, or children. Instead of a t-score, the ISCD recommends using ethnic or race-adjusted z-scores, with z-scores of ≤–2.0 defined as either “low bone mineral density for chronological age” or “below the expected range for age” and those ≥–2.0 being “within the expected range for age.”
Osteoporosis: Risk factors for OP include advanced age (>50 years); _________ gender; _________ race; positive _________ history; _________; immobilization; _________ deficiency; history of prior _________; decreased _________, _________ (127 lbs), or BMI; _________ use; and _________. Secondary causes of OP include disuse, _________, _________, and _________. _________ pull is more important than weight bearing in disuse OP prevention.
Osteoporosis: Risk factors for OP include advanced age (>50 years); female gender; Caucasian race; positive family history; smoking; immobilization; calcium deficiency; history of prior fractures; decreased estrogen, weight (127 lbs), or BMI; alcohol use; and smoking. Secondary causes of OP include disuse, hyperthyroidism, steroids, and heparin. Muscle pull is more important than weight bearing in disuse OP prevention.
SUPPLEMENTS AND PHARMACOTHERAPY
Osteoporosis: The NOF guidelines recommend a calcium intake of ≥ _________ mg/day for all patients (including supplements if necessary) and _________ to _________ IU/day of vitamin D. The NOF recommends pharmacotherapy in postmenopausal women and men over 50 years with the following: (1) t-score ≤–2.5 at the femoral neck or spine; (2) a hip/vertebral fracture; (3) t-score between –1.0 and –2.5 at the femoral neck or spine, a 10-year probability of a hip fracture ≥3%, or a 10-year probability of a major OP-related fracture ≥20% based on the US-adapted WHO algorithm.
SUPPLEMENTS AND PHARMACOTHERAPY
Osteoporosis: The NOF guidelines recommend a calcium intake of ≥1,200 mg/day for all patients (including supplements if necessary) and 400 to 800 IU/day of vitamin D. The NOF recommends pharmacotherapy in postmenopausal women and men over 50 years with the following: (1) t-score ≤–2.5 at the femoral neck or spine; (2) a hip/vertebral fracture; (3) t-score between –1.0 and –2.5 at the femoral neck or spine, a 10-year probability of a hip fracture ≥3%, or a 10-year probability of a major OP-related fracture ≥20% based on the US-adapted WHO algorithm.
Osteoporosis
Estrogen is effective in studies with BMD and vertebral fractures as the primary outcome.1 Hip and vertebral fracture risk is reduced with estrogen use in observational studies. A _________ (ones that are FDA approved include alendronate, ibandronate, risedronate, and zoledronic acid) is recommended if HRT fails or is contraindicated/refused: there is a dose-dependent increase in spine and hip BMD; vertebral fracture risk is reduced by 30% to 50%. The goal of _________ _________ _________ _________ (raloxifene) is to maximize the beneficial effect of estrogen on bone while minimizing the deleterious effects on breast and endometrium. Raloxifene has reduced vertebral fracture risk by 36% in large clinical trials. Salmon calcitonin (100 IU IM/SQ qd) improves BMD and reduces vertebral fracture risk at the lumbar spine, but not at the hip.5Nasal calcitonin (200 IU qd) has similar benefits, but is not as effective in treating bone pain as the injectable.
Osteoporosis
Estrogen is effective in studies with BMD and vertebral fractures as the primary outcome. Hip and vertebral fracture risk is reduced with estrogen use in observational studies. A bisphosphonate (ones that are FDA approved include alendronate, ibandronate, risedronate, and zoledronic acid) is recommended if HRT fails or is contraindicated/refused: there is a dose-dependent increase in spine and hip BMD; vertebral fracture risk is reduced by 30% to 50%. The goal of selective estrogen receptor modulators (raloxifene) is to maximize the beneficial effect of estrogen on bone while minimizing the deleterious effects on breast and endometrium. Raloxifene has reduced vertebral fracture risk by 36% in large clinical trials.Salmon calcitonin (100 IU IM/SQ qd) improves BMD and reduces vertebral fracture risk at the lumbar spine, but not at the hip.5Nasal calcitonin (200 IU qd) has similar benefits, but is not as effective in treating bone pain as the injectable.
EXERCISE AND REHABILITATION
The NOF recommends an exercise prevention program, emphasizing weight bearing, of 45 to 60 minutes per day, four times per week. Interventions to reduce the risk and/or impact of falls (e.g., appropriate assistive mobility devices, exercise programs, hip padding, and avoidance of medications affecting the CNS) may reduce hip fracture incidence. Poor back _________ strength correlates with a higher incidence of vertebral fractures.
EXERCISE AND REHABILITATION
The NOF recommends an exercise prevention program, emphasizing weight bearing, of 45 to 60 minutes per day, four times per week.2 Interventions to reduce the risk and/or impact of falls (e.g., appropriate assistive mobility devices, exercise programs, hip padding, and avoidance of medications affecting the CNS) may reduce hip fracture incidence. Poor back extensor strength correlates with a higher incidence of vertebral fractures.
Acute vertebral fractures can be painful and are often managed with bed rest, orthotic immobilization, and analgesics (e.g., narcotics). _________ should be used with caution. Spine surgery is reserved for rare cases involving neurologic deficits or an unstable spine. Vertebral injection of polymethyl methacrylate (i.e., _________) anecdotally improves acute pain; it is unknown, however, if this rigid vertebral reinforcement increases the long-term risk of fracture of adjacent vertebrae. Postural training, back extensor exercises, pectoral stretching, walking, or other weight-bearing exercises are key to rehabilitation. Rigid orthoses to limit spinal flexion (e.g., cruciform anterior spinal hyperextension [CASH] and _________) may reduce the risk of additional vertebral body fractures.
Acute vertebral fractures can be painful and are often managed with bed rest, orthotic immobilization, and analgesics (e.g., narcotics). NSAIDs should be used with caution. Spine surgery is reserved for rare cases involving neurologic deficits or an unstable spine. Vertebral injection of polymethyl methacrylate (i.e., vertebroplasty) anecdotally improves acute pain; it is unknown, however, if this rigid vertebral reinforcement increases the long-term risk of fracture of adjacent vertebrae.Postural training, back extensor exercises, pectoral stretching, walking, or other weight-bearing exercises are key to rehabilitation. Rigid orthoses to limit spinal flexion (e.g., cruciform anterior spinal hyperextension [CASH] and Jewett) may reduce the risk of additional vertebral body fractures.
