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HUNT243 Exam > Lecture 26: Bone Health, Falls and Fractures > Flashcards

Lecture 26: Bone Health, Falls and Fractures Flashcards

1
Q

The human skeleton is initially…

A

Cartilage and fibrous membranes

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2
Q

By what age is the skeleton completely hardened?

A

25

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3
Q

How many bones make up the adult skeleton?

A

206 (20% of body mass)

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4
Q

What are osteoclasts?

A

Break down bone

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5
Q

What are osteoblasts?

A

Build bone

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6
Q

Osteoclasts tear down and osteoblasts build bone throughout the lifespan with the processes of….

A

Resorption and deposition

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7
Q

What percent of bone calcium is exchanged annually?

A

Average 3% to 5%

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8
Q

What is bone resorption?

A

Action of osteoclasts and parathyroid hormone

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9
Q

What is bone deposition?

A

The action of osteoblasts and calcitonin

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10
Q

What is homeostasis of bone tissue regulated by?

A

Thyroid and parathyroid glands

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11
Q

When blood calcium levels increase…

A
  • Receptors in thyroid gland sense increase
  • Thyroid gland releases calcitonin
  • Osteoblasts deposit calcium in bones
  • Blood calcium is returned toward normal
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12
Q

When blood calcium levels decrease…

A
  • Receptors in parathyroid gland sense decrease
  • Parathyroid gland releases parathyroid hormone
  • Osteoclasts break down bone releasing calcium
  • Blood calcium is returned toward normal
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13
Q

What are the most important factors affecting bone development, growth and repair?

A
  • Calcium deficiency
  • Vitamin D deficiency
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14
Q

What does calcium deficiency result in?

A

Fragile bones

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15
Q

What does vitamin D deficiency result in?

A

Rickets, osteomalacia

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16
Q

When are rates of bone growth the highest?

A

Infancy and pubertal growth spurt

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17
Q

Why is adolescence a critical period in peak bone mass?

A
  • Velocity of bone growth doubles
  • 40% of the peak bone mass is laid down
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18
Q

What happens at the end of puberty?

A

The epiphyses fuse and linear growth stops

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19
Q

Bone mass continues to increase from age 20 to…

A

25 to 30 - 90-95% of peak bone mass attained

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20
Q

After your mid-30s…

A

You slowly lose bone mass

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21
Q

What are determinants of bone strength?

A
  • Bone mineral density
  • Bone Geometry
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22
Q

What is the most important effect of stress on bone?

A

Strain

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23
Q

What is strain?

A

Measurement of deformation of bone to external load

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24
Q

What is strain magnitude?

A

External load

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25
Q

What is strain rate?

A

Speed of loading

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26
Q

Is remodelling reversible?

A

Yes

27
Q

Peripheral skeleton bone strength is positively correlated with…

A

Total and dairy protein intakes in healthy postmenopausal women

28
Q

What three alterations of protein use in older persons cause loss of functionality?

A
  • inadequate intake of protein
  • reduced ability to use available protein
  • greater need for protein
29
Q

What are overarching stratagies to maximise and protect bone mass?

A
  • Achieve peak bone mass in childhood and adolescence
  • Maintain bone mass during adulthood
  • Slow bone loss and reduce falls and fractures in older adults
30
Q

What is osteoporosis?

A

weakened bones and decreased bone density

31
Q

How many NZ’ers are currently aged over 50 years?

A

More than 1.6M

32
Q

Osteoporosis NZ estimates how many older Kiwis have broken a bone since their 50th birthday?

A

Over 180,000

33
Q

How many people annually sustain a hip fracture?

A

3,700

34
Q

How many people annually are admitted to hospital with other fractures?

A

13,800

35
Q

What are the different types of osteoporosis?

A
  • Age associated/post menopausal
  • Idiopathic
  • Secondary
36
Q

What are the risk factors of osteoporosis?

A
  • Age
  • Sex
  • Genetics
  • PA
  • Hormones
  • Diet (Ca, Vit D)
  • Smoking
  • Alcohol (3+ units/day)
37
Q

What is secondary osteoporosis?

A

osteoporosis caused by specific disease, genetics, medical conditions, medications, or lifestyle factors that interfere with bone density and strength, rather than age or menopause

38
Q

What are the risk factors of secondary osteoporosis?

A
  • Disease/genetics
  • Surgery
  • Bedrest
39
Q

The development of osteoporosis is inversely related with…

A

Maximum bone accumulated during growth

40
Q

The development of osteoporosis is positively related with…

A

the rate and duration of bone loss with ageing

41
Q

What percent of hip fractures are due to falls?

A

> 95%

42
Q

What is the 5th leading cause of death and traumatic brain injury in older adults?

A

Falls

43
Q

What percent of older people who fall can’t get up “long lie”?

A

50%

43
Q

What percent of those over 80 and those in a care facility will fall each year?

A

50%

44
Q

What percent of older adults with hip fractures will not return to pre-functional status?

A

25-75%

45
Q

What are risk factors for falls?

A
  • Muscle weakness
  • Poor balance
  • Low PA
  • Poor eyesight
  • Benzodiazepine use
  • Poor overall health
  • Unsafe enviornment
46
Q

What are risks for a fracture in a fall?

A
  • Failure to break a fall
  • Falling to the side
  • Age
  • Low bone mass
  • Unfavourable bone geometry
  • High bone turnover
47
Q

A prior fracture at any skeletal site….

A

Doubles future fracture risk

48
Q

What are the two pathways to fracture?

A

Mechanical overload and incompetence

48
Q

When does a second fracture often happen?

A

Within 6-8 months

49
Q

What is mechanical overload caused by?

A

Sarcopenia

50
Q

What is mechanical incompetence caused by?

A

Osteoporosis

51
Q

Vitamin D has an important role together with calcium in…

A

Mineral metabolism and bone growth maintenance

52
Q

Most cells in the body have been found to have…

A

receptors for vitamin D, and is therefore now seen as an important nutrient in preventing many chronic diseases

53
Q

Major trials in community-dwelling individuals have not demonstrated fracture prevention with either…

A

Calcium, vitamin D or their combination

54
Q

Trials show vitamin D supplements increase…

A

Bone density

55
Q

Clinical trials have not demonstrated benefits of vitamin D on…

A

non-skeletal endpoints (e.g. muscle mass or function)

56
Q

Calcium supplements in healthy individuals are…

A

not needed

57
Q

Overall, current evidence does not support the use of…

A

Vitamin D or Ca+ supplements in healthy adults although it may be warranted in frail older adults in nursing homes with low Vit D

58
Q

In VITAL, supplementation with 2000IU/d of vitamin D…

A

Did not reduce the risk of hip fractures

59
Q

In what populations might findings that supplementation did not have health benefits be different?

A

Individuals with:
- very low 25(OH)D (Vit D) levels
- GI disorders causing malabsorption
- those with osteoporosis

60
Q

Osteoporosis and sarcopenia are linked to…

A

Nutritional deficits and reduced function in geriatric inpatients

61
Q

What is osteosarcopenia?

A

the coexistence of osteoporosis (reduced bone density) and sarcopenia (loss of muscle mass and strength) in older adults

62
Q

What is osteosarcopenia associated with?

A

A higher degree of malnutrition than osteoporosis or sarcopenia alone

HUNT243 Exam (18 decks)

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