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CLINDX Unit 2 UFCOM > G. Osteoporosis/Osteoarthritis/RA > Flashcards

G. Osteoporosis/Osteoarthritis/RA Flashcards

1
Q

What is Osteoporosis?

A

Low bone mass & microarchitecture deterioration –> fragile bones

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2
Q

What is the prevelence of osteoporosis in post-menopausal women?

A

30%

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3
Q

What are the outcomes for hip fracture?

A

20% die
20% return to normal
20% instituitionalized
20% need a lot of assistance

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4
Q

What % of bone mass & bone remodeling does trabecular & cortical bone account for?

A

Trabecular = 20% mass & 80% turnover

Cortical is the opposite

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5
Q

What age has peak bone density?

A

28

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6
Q

Patients with severe osteoporosis tend to present with what posture?

A

Keyphosis
Rib cage dropped down to pelvis
Stomach pushed out
Overall height decreased

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7
Q

How is the trend of bone density different in men & women?

A

Both peak at 28, but peak is higher in men

Both decrease after 28, but men decrease linearly & women have a big decrease around menopause

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8
Q

Risk factors for Osteoporosis?

A 
Female
White
Low body weight
Low calcium intake
Sedentary lifestyle 
Steroid deficiency 
Alcohol & smoking
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9
Q

Lab tests for osteoporosis work up?

A 
Ca
P
Alkaline phosphatase 
24 hour urinary Ca
Testosterone if makle
Creatine
Albumin
CBC
TSH
Estradiol, prolactin, FSH & LH
Serum protein electrophloresis 
PTH
Vit D 
24 hour urinary Free cortisol
Carotene
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10
Q

How are bone densities reported?

A

T = difference between patient & idealized 28 yo

Z = difference between patient & idealized age matched patient

-1 to -2.5 standard deviations from idealized 28 yo = Osteopenia
> -2.5 = osteoporosis
> -2.5 + fractures = severe osteoporosis

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11
Q

How do the lifetime risk of fractures in males & females compare?

A

Women about 40% & men about 10%

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12
Q

How is osteoporosis prevented?

A

Primary Prevention =

  • Good nutrition (Ca)
  • Stop smoking
  • Exercise
  • Hormone Replacement Therapy

Secondary Prevention = preventing fractures by preventing falls

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13
Q

What drug interferes with Ca absorption?

A

H2 blockers

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14
Q

What causes osteoporosis pain?

A

Acute fractures & muscle spasms associated with spinal deformity

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15
Q

Osteoporosis drug therapy?

A 
Ca
Vit D
Estrogen
Calcitonin
Anabolic steroids
Bisphosphonates
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16
Q

Why do elderly need more Ca?

A

Ca absorption is decreased?

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17
Q

Why do elderly need more Vit D?

A

They create less via sun exposure

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18
Q

What frequently coexists with osteoporosis?

A

Osteomalacia (Vit D)

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19
Q

What is the standard of care treatment for osteoporosis? When to use? Efficacy?

A

Estrogen
10% increased bone mass & 50% fewer fractures
Debate over increased risk of malignancy

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20
Q

Decreased Ca absorption can be overcome with supplementation of what?

A

Vit D in high doses

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21
Q

What forms of Vit D are available for supplementation?

A

Vit D
1,25 dihydroxy Vit D3 (If dont think kidney & liver can convert precursor)

Need pharmacologic doses

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22
Q

What form of Ca has the highest levels of elemental Ca? Which type is better for people with achlorhydria (H2 blocker or PPI)?

A

Ca Carbonate

Ca Citrate

23
Q

What supplement reduces bone resorption? Outcome?

A

Bisphosphonates

Increase bone mass 10% & reduce fractures 50%

24
Q

When to take bisphosphonate supplement?

A

30 minutes before eat when first wake up

25
Q

How to Glucocorticoids lead to osteoporosis?

A 
Increase Ca excretion by kidneys
Decrease Ca absorption by intestine
Increase bone breakdown
Decrease bone synthesis
Decrease LH
26
Q

How are Glucocorticoids used correctly?

A 
Give minimal necessary dose
Encourage weight bearing exercise
Eliminate smoking & alcohol
Supplement Ca & Vit D
Measure 24 hour urinary Ca
27
Q

What are the different definitions for osteoarthritis listed in order of prevalence?

A

Cartilage changes at autopsy (almost 100% at 50)
Osteoarthritis at autopsy
Osteoarthritis by X ray (50% by 50)
Symptomatic Osteoarthritis
Chronic disabling Osteoarthritis (10% by 70)

28
Q

Clinical definition for osteoarthritis?

A 
Enlarged tender joints
No joint warmth
Crepitus (grating sound with movement)
Morning stiffness
Age >50
29
Q

Radiographic findings for Osteoarthritis?

A

Osteophytes
Joint space narrowing
Subchondral cysts & sclerosis
Malalignment

30
Q

What are the 2 major classifications for Osteoarthritis?

A

Idiopathic = localized, general or Ca crystal associated

Secondary = Trauma, congenital/developmental or other diseases

31
Q

Swelling of the DIP & PIP due to osteoarthritis are called what?

A 
DIP = Haverdens Node
PIP = Bouchard's Node
32
Q

Osteoarthritis of what finger(s) tend to be painful?

A

most fingers aren’t painful, but osteoarthritis of the thumb can be very painful

33
Q

What is the pathosphysiology of osteoarthritis?

A

Aging or immobilization –> chondrocyte malnutrition –> chondrocyte injury –> matrix degeneration

34
Q

How is weight bering physical activity related to chondrocyte nutrition?

A

The chondrocytes are avascular, they only get nutrients when they are compressed –> forces fluid out –> “sucks” in new nutrient rich fluid

35
Q

Intrinsic risk factors for osteoarthritis?

A 
Age
Sex
Bone density
Joint Mechanics 
Heredity
Metabolic
36
Q

How is weight correlated with Osteoarthritis?

A

Only men with weight in the highest quintile have increased risk

Risk is more dispersed gradually over the quantiles for women

Women will benefit from small weight reduction. Men only benefit if they are obese & lose a lot of weight

37
Q

Which joints are disproportionately represented in each sex?

A 
Men = hip
Female = knee
38
Q

What are the 3 most important determining factors for osteoarthritis?

A

Age
Weight
Genetics

39
Q

In 2 words, what is the basis of osteoarthritis?

A

Chondrocyte dysfunction

40
Q

What is the prevalence of RA? Effect on lifespan?

A

1%

Shortens lifespan by 3-18 years

41
Q

What age groups & sex get RA most often?

A

Young (30-50)

Women

42
Q

What HLA Gene Complexes are associated with RA?

A

DRB1

DR3

43
Q

Clinical criteria for RA?

A

Morning stiffness
3 or more joints
Symmetric
Hands involved

44
Q

What cytokines are related to the pathophysiology of RA?

A

TNF alpha
IL-1

Imbalance of these cytokines & anti-inflammatory cytokines (Soluble TNF receptor, IL1 receptor agonist & IL-10)

45
Q

What is the predominant microscopic appearance of the synovium in RA?

A

Inflammatory infiltrate

46
Q

What joints are usually effected in RA?

A

Spine & DIP not effected

Other than those small distal joints are traditionally effected more than proximal (hand & feet more so than knees & elbow)

47
Q

What finger positions are associated with RA? Cause?

A

Swan Neck = flexed DIP
Boutenneires = Flexed PIP

Tendon destruction

48
Q

What are the 2 main organs outside of the joints that can effected by RA?

A

Eyes

Lungs

49
Q

What is Rhuematoid Factor?

A

Autoantibody directed against Fc portion of IgG

50
Q

How accurate is the RF test for RA?

A

Not very

Only 80% of RA patietns test + (low specificity)
Can get false + from infection (TB, hep, endocarditis, viral & parasitic), neoplasms, healthy elderly & a lot of other stuff

51
Q

What two tests should be performed if RA is suspected? What is the combined specificity? When do these markers present as +?

A

RF & anti-CCP
99.5%
CCP is early & RF is later (once symptomatic)

52
Q

Ways to differentiate RA from OA?

A

RA is younger patients
RA pain gets better through day
RA affects small joints
RA has elevated ESR, RF/CCP, anemia, luekocytosis

53
Q

How accurate is anti-CCP test for RA?

A

Very specific

CLINDX Unit 2 UFCOM (8 decks)

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