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Geriatrics > Common Geriatric Problems- pt 2 > Flashcards

Common Geriatric Problems- pt 2 Flashcards

1
Q

what are the 3 MC fracture sites associated with osteoporosis?

A

hip
vertebral
wrist

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2
Q

what is primary osteoporosis?

A

term used to describe osteopenia that is dt advanced age and/or menopause

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3
Q

what is secondary osteoporosis?

A

implies that the decreased bone mass is dt other conditions, medications, malabsorption or prolonged immobilization

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4
Q

RFs for osteoporosis?

A 
increasing age
early menopause (before 50 yo)
caucasian
low body wt
EtOH- more than 3 a day
inadequate physical activity
tobacco use
family Hx
poor health/frailty
recurrent falls
poor nutritional status
dementia
anti-seizure medications 
prolonged immobilization
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5
Q

conditions that can cause increased risk for osteoporosis?

A 
hyperthyroidism
excess supplemental thyroid
Cushing's dz
glucocorticoids use
hyperparathyroidism
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6
Q

at what point can you finally see osteoporosis on xray?

A

only once 30-40% of bone has been lost

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7
Q

what can you measure in the blood, that give limited use, to dx osteoporosis?

A

serum calcium, phosphorous or alkaline phosphatase

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8
Q

what is the best way to dx osteoporosis?

A

DEXA scan

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9
Q

what is a T score? what is a normal T score? osteopenia? osteoporosis? at what levels is prophylactic tx for osteoporosis begun?

A

of standard deviations above or below a healthy 30 yo of the same sex, ethnicity
normal: greater than -1
osteopenia: between -1 and -2.5
osteoporosis: below -2.5
begin prophylactic tx at T score less than -2
begin prophylactic tx at T score less than 1.5 w/known RFs for osteoporosis

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10
Q

what is a Z score?

A

of standard deviations above or below the mean for the pts current age, sex and ethnicity

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11
Q

what is NTx?

A

a small, cross-linked portion of collagen’s amino terminus that is a stable and specific breakdown product of bony collagen
can help predict osteoporosis and response to tx

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12
Q

what does an elevated NTx level indicate? how can you measure?

A

diminishing bone over time

can be measured either in urine or serum

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13
Q

what is FRAX?

A

diagnostic tool used to evaluate 10 yr probability of bone fracture risk
integrates clinical risk factors w/bone mineral density at femoral neck to calc 10 year probability of hip, spine, shoulder or extremity fracture

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14
Q

RFs used in FRAX calculator?

A

pts age, sex, prior fx hx, EtOH use, tobacco use, use of glucocorticoid drugs, hx of RA, hx of dzs known to contribute to osteoporosis, T-score results of pts last DEXA

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15
Q

out of 4, how many post-menopausal women are estimated to have osteoporosis?

A

1 in 4

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16
Q

how do men respond to osteoporosis medications?

A

generally not as good b/c men usu do not begin tx until osteoporosis is more advanced

17
Q

tx options for osteoporosis?

A

regular wt bearing exercise
discont tobacco use
moderate EtOH intake
calcium: 1 g/d if pre-menopausal, 2 g/d if post-menopausal
predominantly plant based diet (after 60 yo rate of bone loss in non-vegetarians has been found to be greater than that of vegetarians)

18
Q

lifestyle recommendations to prevent osteoporosis?

A 
wt bearing exercise
quit smoking
eliminate or moderate EtOH use
eliminate soft drinks
reduce or eliminate coffee
decrease or eliminate red meat intake
19
Q

what 3 forms of calcium could be more readily absorbed in pts w/diminished stomach acid?

A

calcium citrate, calcium lactate, calcium gluconate

20
Q

is milk a good source of calcium for osteoporosis prevention?

A

possibly not- nurses study showed those who drank 2 glasses of milk/d actually had higher rates of fractures than those who drank less

21
Q

aside from supplementing with calcium, what other supplements could one use?

A 
vit D
magnesium
boron
strontium
multi-vit and/or B complex to ensure adequate levels of B6, B12 and folic acid
22
Q

why is vit D good to supplement with?

A

necessary for calcium absorption from the GI

in order to protect against osteoporosis need to combine with calcium

23
Q

why might strontium be esp good to supplement with?

A

has been shown to not only diminish bone loss but to also increase bone density in areas of bone loss

24
Q

what dz has a correlation with HRT?

A

has been shown that women who have been on HRT have statistically significant higher rates of heart dz

25
Q

what do bisphosphonates do? when do you prescribe it?

A

inhibit osteoclast activity, increase bone mass
primary drug used to tx osteoporosis in postmenopausal women and in ppl taking corticosteroids or hormonal agents that suppress estrogen

26
Q

benefits of bisphosphonates?

A

have been shown to reduce risk of spinal and hip fractures including women who have had prior bone fxs

27
Q

ADRs of bisphosphonates?

A

esophagitis, stomach ache, heartburn, nausea, osteonecrosis of the jaw, myalgias

28
Q

medication that has been approved for both prevention and tx of osteoporosis?

A

raloxifene

29
Q

drug that has been approved to treat osteoporosis?

A

calcitonin

30
Q

synthetic PTH analogue approved for the tx of osteoporosis in postmenopausal women and men who are at higher risk for fx?

A

teriparatide

31
Q

what tx has been shown to have same benefits of estrogen in regards to bone density but doesn’t increase the risk of development of hormone-related CAs?

A

selective estrogen-receptor modulators

32
Q

what two drugs can be used to prevent and treat osteoporosis?

A

raloxifene, alendronate

33
Q

what 2 drugs can only be used to treat osteoporosis?

A

calcitonin, calcimar

34
Q

what 6 drugs can be used to prevent osteoporosis?

A 
E conjugated premarin
esterified estratab
menest
estradiol estrace
estropipate ortho-est
ogen
35
Q

ADRs of raloxiphene?

A

hot flashes, arthralgias, myalgias, edema, pruritis, small risk for DVT or PE

36
Q

drug indicated for postmenopausal women w/osteoporosis at high risk for fracture? what must be achieved before starting on it?

A

denosumab
pt must have sufficient calcium and vit D levels before starting therapy
c/i in pts w/hypocalcemia

37
Q

MOA of calcitonin?

A

acts to significantly inhibit osteoclastic activity

38
Q

T/F: calcitonin is used for the prevention and tx of osteoporosis?

A

NO- just for treatment of osteoporosis

39
Q

MOA of synthetic parathyroid hormone?

A

inhibits osteoclast activity and stimulates new bone formation in both spine and hip

Geriatrics (5 decks)

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