Osteoporosis Flashcards
What’s osteoporosis?
- Osteo = bone
- Porosis = porous
- Metabolic disease of the bones
What’s does BMD means?
Bone Mineral Density
Osteoporosis Diagnosis BMD Measurement - Dual-energy x-ray absorptiometry (DEXA)
- scans entire body
- measures the risk for fracture in hip, spine, wrist
- Low level of radiation
- Less than 5 min
- 2D images
Osteoporosis Diagnosis BMD Measurement - Quantitative computed tomography (QCT)
- Measures BMD in hip and spine
- Isolate area
- Radiation level 10 times higher than DEXA
- 3D image
Where does osteoporosis starts ?
Starts on the inside of a bone
BMD measurement - scores (2 types)
- T-score
- Z-score
BMD measurement - T-score
Deviation from the mean bone density of healthy young adult
BMD measurement - Z-score
Deviation from the mean bone density of adults of the same age
What is the T-score used by World Health Organization for osteoporosis?
-2.5 S.D.
What is the T-score used by World Health Organization for osteopenia ?
-1 S.D. to -2,5 S.D.
Calcul of osteopenia for 1000 ± 100 mg/cm2 ?
1000 - (100 x 2.5) = 750
1000 - (100 x 1) = 900
BMD of 900 to 750 mg/cm2
What’s a fragility fracture?
Any fall from a standing height or less resulting in a fracture
Most common areas of fragility fracture
- hip
- spine
- wrist
What’s established osteoporosis?
preferred term for people with osteoporosis and one or more fragility fracture
Standard deviation (3 types)
- 1 standard deviation (osteopenia) = 2 times risk of fracture
- 2 standard deviation = 4 times risk of fracture
- 3 standard deviation (osteoporosis) = 8 times risk fracture
Standard deviation - Osteopenia
-1 standard deviation
Standard deviation - Osteoporosis
-3 standard deviation
Z-scores
- use to determine if the bone density loss is secondary to another disease or condition like drug use, alcohol, tobacco, eating disorders, etc
Osteoporosis - Prevalence (incidence)
- 1.4 million in CAN
- 350 000 in QC (4% of population)
- 1 out of 4 women over 50 yo
- 1 out of 8 men over 50 yo
Osteoporosis - why more women than men?
because of the decreased of estrogen and smaller bone in women
Osteoporosis - most common fractures
- Vertebra
- Hip
- Wrist
Osteoporosis - fractures over 60 yo
18% fracture of vertebra
Osteoporosis - fractures overs 50 yo
15% hip fracture
Women between 65-69 are how many times more likely to die within a year after breaking a hip than women of same age who don’t break a hip?
3 times more likely
trend of women in WHO categories - age 25
most women are in the normal categorie
trend of women in WHO categories - age 50
number of women with osteopenia increase as the women normal decrease
trend of women in WHO categories - age 65
Same thing as age 50 but with an increase of women with osteoporosis and established osteoporosis
trend of women in WHO categories - age 80
decrease in women with osteopenia bc osteopenia become osteoporosis
Aging effects (2)
- unbalance in bone remodeling process
- Calcium is less efficiently absorbed
Aging effects (2)
- unbalance in bone remodeling process
- Calcium is less efficiently absorbed
Aging effects - unbalance in bone remodeling process
- Loss of 1% of bone mass each year after 20 yo
- Loss of 2 to 3% of bone mass first 5 year after menopause
What positively change the BMD slop?
- Hormones
- PA
- Better nutrition
Hormones - Roles
- maintain the appropriate level of calcium in the bone
- General response of the skeletal system
Role of calcium
Calcium controls the activity of the bone cells
Hormones - processus
CA level - hormones - bone cells - BMD
Hormones - lack
Bone atrophy
Mechanical loading - Roles
- Maintain adequate bone density
- Local response of the skeletal system
Mechanical loading - processus
Loading - activation of bone cells - BMD
Mechanical loading - Absence
Bone atrophy
Osteoporosis - Risk factors that can’t control with direct effect on bone remodeling (4)
- menopausal
- prolonged hormonal imbalances
- removal of ovaries or premature menopause
- prolonged use or heavy doses of certain meds
Osteoporosis - Risk factors that can be control and decreased mechanical loading
- Lack of PA
Osteoporosis - Risk factors that can be control and decreased calcium in the bones (4)
- Diet poor in calcium and vitamin D
- Smoking
- Caffeine
- Excessive consumption of alcohol
Osteoporosis - classification (3 types)
- Postmenopausal Osteoporosis (type I)
- Senile Osteoporosis (type II)
- Secondary Osteoporosis
Postmenopausal Osteoporosis (type I)
- Decrease of estrogen = decrease of 10-15% BMD in first 5 yrs
- Most common
- Only women
- Mid sixties
- Vertebral and hip fractures
Senile Osteoporosis (type II)
- Poor absorption of calcium in bone
- Over 80 yrs
- 30% are men
- Forearm, pelvic, hips fractures
Secondary Osteoporosis (type III)
- Associated with calcitonin imbalance, malabsorption conditions, alcoholism, smoking and use of meds
- Can occur in young people
Osteoporosis - prevention
Hormone remplacement therapy (estrogen)
Pros of Hormone remplacement therapy
- Inhibit/ slow down bone resorption
- Decrease effects of menopause
Cons of Hormone remplacement therapy
- Increase risk of blood clots, stroke, coronary heart disease
- Necessary or not?
Osteoporosis vs exercise - Goal PA for prevention
stress the bone
Osteoporosis vs exercise - Types of PA for prevention
- Weight-bearing activities
- Resistance exercises
Osteoporosis vs exercise - effect of exercises on the bones
Increase pressure on bone = increase bone mass
Osteoporosis vs exercise - Consideration for PA for osteopenia/ osteoporosis
- Avoid forward flexion
- Decrease risk of falling by having adapted equipment
- Low impact = aerobic dance exercise
- Resistance training = decrease load and increase repetitions
