Osteo Flashcards
Recommended calcium intake recommended for adolescents and young adults 11-24
1,200 to 1500 mg
Recommended calcium intake recommended for women 25-50 yrs
1,000 mg
Recommended calcium intake recommended for post menopause not on HRT
1,500mg
What do osteoporosis medications do
- slow down or stop bone loss or rebuild bone/ slows down the remodeling process
- reduce the chances of broken bones
- for medications to work, a person still needs to get enough calcium
3 types of osteoporosis meds
Bisphosphonates
Calcitonin
Estrogen receptor modulator
What does bisphosphonates do
Antiresorptive
Slowing down the remodeling process
Examples of bisphosphonates
Fosamax
Boniva
Actonel
Reclast
After taking bisphosphonates the person must be able to
Sit up for an hour
Side affects of bisphosphonates
Heartburn
Abdominal pain
Irritated esophagus
Risk factors from bisphosphonates
Rare type of femur fractures:
Subtrochanteric fx
Diaphicele fx
Brand of calcitonin
Miacalcin
Estrogen receptor modulator is aka
Raloxifene
Brand of Estrogen receptor modulator
Evista
Advantages of Estrogen receptor modulator
Reduce fats in blood, cholesterol
Side affects of Estrogen receptor modulator
Hot flashes
Leg cramps
Blood clots
What is Juvent
Used to tx osteoporosis by sending electrical impulses up into body to stimulate bone growth
Name bone densitometry tests
- Quantitative measurement of bone density
- Bone Mineral Density Test
- Plain skeletal radiographs
- Quantitative Ultrasound
- Quantitative computed tomography
Quantitative measurement of bone density is the measurement of
Weight bearing bones: hip and spine
Can also measure forearm, wrist, finger, heel
BMD is used for?
- Checks bone mineral content
- Used to confirm diagnosis of osteoporosis
- Can predict a persons chances of breaking a bone in the future
- Determine whether a person’s bone density is increasing decreasing or remaining the same
- Can monitor a person’s response to treatment
FRAX
Fracture risk assessment tool
BMD T-score
- Compares your bone density to a young normal healthy 30 year old with peak bone density
- T score indicates how much your bone density is above or below normal
- T score is used by healthcare providers to diagnose osteoporosis
Normal T score
Between +1 and -1
T score indicating low bone density or osteopenia
Between-1 and -2.5
T score that is a diagnosis of osteoporosis
-2.5 and lower
BMD Z score
- Compares your bone density to what is normal in someone your age and body size
- Is not used to diagnose osteoporosis
The bone density unit is called
Dual Energy X-ray Absorptiometry
DXA
DEXA
How does DXA work?
- Works on the principle of x-ray attenuation effect, separation of soft tissue and bone
- Two different photon energies are used to differentiate soft tissue and bone
2 common types of dexa
- Pencil beam (circular pinhole); narrow stream of X-ray that goes across body and back and forth
- Array Beam ( fan-beam)
Has a narrow slit
Beam moves up towards head
C-arm array beam
Less common
Multiple detectors
Can scan at more than one plane
When does plain skeletal radiographs show visual bone demineralization
When bones have demineralized 40%
How does quantitative ultrasound measure bone density
It is used to determine how sound waves travel through the bone
How does quantitative computed tomography measure bone density
This test uses CT scanner with special software designed to perform bone density studies
Place that you position for a hip dexa
Ward’s Triangle
Reason why we would do a forearm scan
If the patient had bilateral hip prosthetics
Type of bone that is dense, outer shell
Cortical/ compact
Type of bone that is delicate lattice work
Trabecular / cancellous
What type of bone supports weight and accounts for 80% of bone mass
Cortical / compact
Type of bone that gets destroyed from osteoporosis
Trabecular / cancellous
2 stages of remodeling process
Resorption
Formation
Resorption
Osteoclasts breakdown bone and remove old bone leaving pits
Formation
Osteoblasts fill in Pitts with new bone
How long does the resorption process take
One week
How long does the formation process take
One month
Five symptoms of osteoporosis
Back pain Loss in height Stooped posture Curved back / humpback/ Dowager's hump Fracture of hip vertebrae and wrist are most common
Risk factors for osteoporosis
Family history Being female Menopause Caucasian or Asian descent Thin or small build Life style risk factors include smoking, excessive drinking, not enough exercise, diet low in calcium
What medication types increase risk factors for osteoporosis
Hyperthyroidism – have problem absorbing calcium
Asthma – COPD steroids long term
Patients taking steroids for other reasons