Exam 3 - Osteoporosis

Question 1

Bone Mass Through the Life Cycle

Answer 1

Active growth until age 20
Peak bone mass 13 to 30
Bone less age after age 35

–
Bone loss fasters in females, lose in early 30s

Bone is constantly remodeling, skeleton is replaced every 10 years

Remodeling - osteoclasts dissolve bone, osteoblasts lay down protein and minerals, new bone

Question 2

Osteoporosis - Definition

Answer 2

• Bone loss with age
– Loss of estrogen
– Inadequate intake of Calcium
• Bones become porous
– Fractures

–
Seen more in 4x more common in women than inmen.
Women - 30s - ?
Men 50 - 60s

Decrease osteoblasts, increase osteoclasts
Fractures as a result of falling, Getting old affectsbalance and muscle mass

Exercise is important for maintaining bone density and muscle mass

Question 3

Risk Factors - Non Modifiable

Answer 3

Risk Factors - Non Modifiable
• Older age
• Female
• Early Menopause
• Race
• Genetics
• Family History

–
Seen more in white women

1300 mg calcium for growing years

Question 4

Risk Factors - Modifiable

Answer 4

Risk Factors - Modifiable
• Nutritional status
– Body weight
– Physical activity
– Nutrient intake

Smoking
High caffeine intake
Alcohol abuse
Some medications

–
Body weight is good, stresses bone which lays
down more bone. Excessive fat sequesters vitamin D and keeps it
from being active. Less than 127 lbs is increased risk for
osteoporosis.

Loss physical activity
Smoking / nicotine can damage the osteoblasts
Smoking usually have low body weight
High caffeine intake associated with low bone
density
Alcohol abuse - alcohol can increase excretion of calcium and
magnesium
Hyperthyroid medication - associated with decreased bone density
Cortisone/sal - anti-inflammatory, decreased bone density, more
susceptable to osteoporosis.

Osteoblasts migrate into bone and become osteocytes

Question 5

Prevalence Osteoporosis White Women

Answer 5

50-59 age - 4%
60-69 - 20%
70-79 - 34%
80+ - 52%

Eat a variety of minerals and incorporate more Vitamin D
White women - older you get the more common it is

Higher incidence than Heart attack, breast cancer, stroke
combined

Question 6

Bone Densitometry

Answer 6

Dual energy X-ray absorptiometry (DEXA)

–
DEXA scan - low radiation - determines bone
density and body-fat / lean muscle percentage

Bone density is measured as a T-score
T-score compares an individual to a population of women at 30
years of age (peak bone mass) - compares to same gender

Question 7

Trabecular Bone Cortical Bone Osteoporotic Bone

Answer 7

Trabecular - spongey inside
Cortical - hard outside
Trabecular susceptible to breaking if you fall

Question 8

Osteoporosis T-score

Answer 8

Measured in standard deviation T-score

Normal 0 to -1

Below -1 to -2.5 is osteopenia - loss of bone mass but not enough to be osteoporosis

Below -2.5 is osteoporosis

Question 9

Warning Sign for Osteoporosis

Answer 9

Warning Sign for Osteoporosis:
Any fracture after 50
Loss of height
Back pain
Dowager’s back (kyphosis)
Bone density test T-score below - 2.5

–
Dowager’s back - hump, rounding of back - could also be due to vertebrae disks shrinking

Question 10

One Year Mortality After Hip Fracture

Answer 10

Age and mortality:
90: 50%

–
Older, higher mortality

90 years of age, 50% chance you will die within a year - hip fracture

Question 11

Meds that Decrease Risk Fracture

Answer 11

Meds that Decrease Risk Fracture

Biphosphonates
-Fosamax, Boniva, Actonel, Reclast

Hormonal

• Estradiol
• Selective Estrogen Receptor Modulators
• -Evista
• Calcitonin
• Parathyroid Hormone

–
Most drugs DECREASE OSTEOCLAST ACTIVTY:

Bisphosphonates - most popular - decrease boneloss and fracture risk - incorporate into bone and stay there for a long time - half-life is ten years -side affect - gastric reflux esphogeal inflammation
- long term therapy - jaw osteonecrosis (OP of thejaw) - more than 5 years on the drug rare atypical fracture but a possibility

Denosumab (prolia) - decrease bone loss. Used for gastric reflux sufferers. side affect- hypocalcium low blood calcium, eczema

Estradiol - Increased risk of heart attack and breask cancer

SERM - acts as estrogen does on the bone but not in the breast -
not as effective as bisphosphonates but still effective

Calcitionin - Nasal spray - Nasal irritation

Parathyroid Hormone - increases osteoplast activity, synthetitic form - intermitent frequency - injection - releases calcium into the
blood - blood calcium increases - Vitamin D goes to liver and becomes hydroaxlated, Kidney hydroxylates and activates Vitamin D - increases blood calcium - increase calcium reabsorbtion and retention of calcium -
Forteo - only use for no more than two years - can cause osteosarcoma - leg cramps, dizziness - only drug than increases
bone density

Question 12

Lifestyle and Bone Health

Answer 12

Lifestyle and Bone Health
• Weight Bearing Exercise
• Diet
- Minerals
- Protein
- Vitamins
- Alkaline diet
- Soy ??
• Sun exposure

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Minerals
1200mg for calcium for above 50 years age
women.
Magnesium, potassium, zinc
low levels of sodium associated with calcium
excretion
BALANCE OF MINERALS

Protein - 1g per kg of weight during 60s and 70s. Bones are partly protein (collegen)

–
Vitamin D involved in bone health - fatty fish, liver
Vitamin C - collagen production - bone healthy
Vitamin K - Produced osteocalcin - binds minerals
Vitamin A - increase risk of hip fracture with too much Vitamin A,
don’t go overboard

Alkaline diet - diet higher in fruits and vegetables, except in meats and grains (protein, amino acids, sulfur) form acids in our blood.
Problem for older people with weak kidneys. Blood becomes more acidic. Calcium from the bone is taken to neutralize the blood acids
Decrease grains to decrease acid loads on calcium. Increase fruits and vegetables. Good for blood pressure.

Soy - high soy diet gained a little bit of bone density, not much evidence

Question 13

Calcium Supplements

Answer 13

Calcium Supplements
high % of calcium
easily absorbable calcium
supplement between meals
low dose supplements

–
Kale, sardines, green leafy vegetables

Calcium carbonate - most common - 40% calcium - requires acid for absorption - elderly people have gastritis

Calcium citrate (23%) - contains less calcium but requires less acid - good for elderly people - in fortified orange juice

Calcium gluconate (9%) - not worth it
Oyster shell calcium - don't get it, might have
heavy ...? some mineral

Low doses many times, eat between meals
(increases absorption)