orthopedics Flashcards
What is osteoporosis?
decreased cortical thickness, decrease in the number and size of trabeculae (but normal chemical composition), resulting in increased fracture
what is the most prevalent degenerative disease in the US
osteoporosis
True or false: 70% of fx in pts >45 are d/t osteoporosis
TRUE
Most common fractures in osteoporosis
vertebral bodies, distal radius, proximal femur
true or false: 1 in 5 pts is no longer living 1 year after sustaining hip injury
TRUE
compare osteoblasts and osteoclasts
osteoblasts lay down bone, osteoclasts resorb bone - work together to make adult skeletons in equilibrium
when does bone resorption begin to exceed formation?
3rd decade of life
What determines good bone future?
bone deposition in youth, exercise, diet, estrogen
RF of osteoporosis
gender, age, race, early menopause, low calcium intake, sedentary lifestyle
Describe type 1 osteoporosis
Women, d/t estrogen deficiency, greater than 50, trabecular bone loss, fx of vertebrae and radius
describe type 2 osteoporosis
anyone, d/t aging, greater than 70, trabecular and cortical bone loss, fx of vertebrae and hips
Treatment of early post menopause osteo.
estrogen replacement, caution with raloxifene (increases menopause)
treatment of pts >75 y/o osteo.
bisphosphonate, caution with estrogen
treatment of existing fx with osteo.
estrogen, bisphosphate
Name the calcium supplements
calcium carbonate, acetate, chloride, glubionate, gluconate, lactate
what should be checked before giving calcium
serum calcium
how are calcium supplements different?
elemental calcium present, side effects (GI), the need for calcium
Which calcium supplement needs an acidic medium?
calcium carbonate - take with meals 3 times a day
how much elemental calcium do I need per day?
1000mg per day
how much elemental calcium do teenagers need?
1200mg/day
how much elemental calcium do elderly need?
1500mg/day
what should be given along with calcium supplements?
vitamin D
how much vitamin D is needed per day?
600 international units per day
what is included in the combo of Ca and vit D
500mg Ca, 200mg Vit d
ADR of calcium
GI (pain, constipation, diarrhea, flatulence), too much
what are the estrogen supplements?
estradiol, estrogens conjugated A synthetic, estrogens conjugated B synthetic, estrogens conjugated/equine, estrogens esterified
what is premarin
derived from urine of female horses (equine estrogens) - could cause cancer
natural forms of estrogens
soy, yams, black cohash
what do “conjugated estrogens” contain?
multiple forms of estrogens - multiple components in these supplements
do estrogens work?
yes, not the best
when should estrogens be given?
refractory cases, after menopause for <5 years
how can cancer risk be reduced in women?
give with progestin to even out, safe in women without uterus
ADR of estrogens
cancer, thromboembolic risk
MOA of estrogens
bisphosphonate, calcitonin and estrogens inhibit osteoclasts
name the selective estrogen receptor modulators
raloxifene
MOA of SERMs
looks like estrogens, taken up only in bone, inhibits osteoclasts
when should SERMs be given?
soon after menopause (if used in premenopause bone density will drop)
is there a risk of CA with SERMs?
yes but lower than estrogens
ADR of SERMs
increases hot flash rate, thromboembolic risk
what is calcitonin salmon
calcitonin from salmon that is 30-50x stronger than human calcitonin