Chapter 53

Question 0

Osteopenia

Answer 0

Low bone mass

Question 1

Osteoporosis

Answer 1

Chronic metabolic disease in which bone loss causes decreased density and possible fracture
First sign of osteoporosis in most people follows some kind of fracture

Question 2

Diagnosis of osteoporosis and osteopenia (T-score)

Answer 2

Osteopenia: -1 to -2.5
Osteoporosis: -2.5 and more

Question 3

Risk factors

Answer 3

Older age
Parenteral history
Hx of low trauma fracture after age 50 years
Low body weight, thin build
Chronic low calcium and or vitamin d intake
Estrogen or androgen deficiency
Current smoking
High alcohol intake (3 or more a day)
Lack of physical exercise or prolonged immobility

Question 4

Diagnostic tests

Answer 4

• No definitive test
• Bone-specific alkaline phosphatase (BSAP): found in the cell membrane of the osteoblasts and indicates bone formation status
• Osteocalcin: protein substance in bone and increases during bone resorption activity

Question 5

Best tool for assessing BMD

Answer 5

DXA (Dual X-Ray Absorptiometry)

Question 6

Nutritional therapy

Answer 6

Increased vitamin D and calcium intake
Protein, magnesium, vitamin K, and trace minerals
Avoid excessive caffeine and ETOH

Question 7

Drug therapy

Answer 7

Calcium and vitamin D
Biphosphates: Fosamax (can cause esophagitis, take by itself on an empty stomach with full glass of water)
-watch renal function and watch for jaw pain
Estrogen agonist/antagonist

Question 8

Osteomalacia

Answer 8

Loss of no none related to vitamin D deficiency
-softening of bonner resulting from inadequate delis it’s if calcium and phosphorus in the on one matrix
-normal remodeling of the bone is disrupted, and calcification does not occur
Rickets in children

Question 9

Causes of osteomalacia

Answer 9

• Vitamin D disturbance
• Drug therapy: phenytoin, fluoride (increase the need for other nutrients, notably calcium, iodine, selenium, C, E, and possibly D), barbiturates
• Liver disease
• Inadequate absorption
• Kidney disease
• Familial metabolic error

Question 10

Diagnosis of osteomalacia

Answer 10

Muscle weakness and unsteady gait
X-rays: decrease in spongy bone and lack of osteoid sharpness
Labs: low phosphorous levels are associated with risk factors

Question 11

High calcium and vitamin D foods

Answer 11

Spinach, kale, okra, collards, soy beans, white beans, some fish, like sardines, salmon, perch, and rainbow trout

Question 12

Paget’s disease

Answer 12

• Chronic metabolic disorder in which bone is excessively broken down and reformed
• Three phases: 1. Active=rapid increase in osteoclasts! massive bone destruction and deformity. 2. Mixed=osteoblasts react forming new bone (weak and deformed). 3. Inactive=osteoblasts activity is greater than osteoclasts activity (newly formed bones become sclerotic and hard)
• Very strong genetic component: noted in pup to 30% of triple with a positive family history