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NUR 202 Week 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q
  • Porous bone (fragile bone disease), is a chronic, progressive metabolic bone disease characterized by low bone mass & structural deterioration of bone tissue, leading to increased bone fragility, increasing a pt’s risk for fx’s
A

1 in 2 women & 1 in 5 men >50 y.o. will sustain an osteoporotic fx & 50% of all postmenopausal women will sustain an osteoporotic fx

Osteoporotic hip fx’s cause mortality inc of 10-20% per year

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2
Q

Pathophysiology - Important factors that occur w/aging

  • ↓ calcitonin
  • ↓ estrogen
  • ↑ PTH
A

Most freq noted areas of bone loss are assoc w/vertebral changes of L/S & hip fx’s & Colles fx of wrist

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3
Q

Clinical manifestations

  • “silent disease”
  • fragility fx’s occur in spine, hip, & distal radius
A

Why more common in women?

  • Lower calcium intake
  • Less bone mass (b/c generally smaller frame)
  • Bone resorption begins earlier & accelerates >menopause
  • Pregnancy & breastfeeding
  • Longevity (inc likelihood)
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4
Q

Risk Factors

  • Advancing age (>50 y.o.)
  • Female gender
  • Low body weight
  • White or Asian ethnicity
  • Current cigarette smoking
  • Non-traumatic fx
  • Sedentary lifestyle
A
  • Postmenopausal (estrogen deficiency)
  • Fhx
  • Diet low in calcium or vitamin D deficiency
  • Excessive use of alcohol (>2-3 drinks/day)
  • Low testosterone level in men
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5
Q

Risk Factors cont’d

  • Spec dz’s assoc w/ like IBD, intestinal malabsorption, kidney dz, RA, hyperthyroidism, chronic alcoholism, cirrhosis of the liver, hypogonadism, & DM
A

Many rx’s can interfere w/bone metabolism like
- corticosteroids
- anti-seizure (divalproex sodium [Depakote], phenytoin [Dilantin])
- aluminum-containing antacids
- heparin
- certain cancer treatments
- excessive thyroid hormones

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6
Q

Long-term corticosteroid use is a major contributor to osteoporosis

A

Preventive Factors

  • Regular weight-bearing exercise
  • Fluoride
  • Calcium
  • Vitamin D
  • 15 mins of sunshine/day
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7
Q

Etiology & Pathophysiology

  • Peak bone mass (by age 20) determined by heredity, nutrition, exercise, & hormone function
  • Bone loss >35-40 y.o. inevitable; rate of loss variable
  • Rapid bone loss for women @ menopause
A
  • Remodeling
    > Osteoblasts - deposit bone
    > Osteoclasts - resorb bone

! In osteoporosis, bone resorption exceeds bone deposition

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8
Q

Clinical Manifestations

  • Occurs most commonly in spine, hips, & waist
  • Back pain
  • Spontaneous fx’s
  • Gradual loss of height
  • Dowager’s hump (kyphosis)
A
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9
Q

Screening Guidelines

  • Initial bone scan in women <65
  • Repeat in 5-10 yrs if normal
  • Is not suggested to have them more freq than once q2yr
  • Earlier & more frequent if high risk
  • Men screened <70
    > By age 50 if high risk (e.g., low body wt, hypogonadism)
A
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10
Q

Diagnostic Studies

  • BMD measurements obtained through a dual-energy x-ray absorptiometry (DEXA) scan
  • Fx risk assessment tool, or FRAX
  • Prevention & early screening is the treatment focus
A
  • Often goes unnoticed b/c it cannot be detected by conventional xray until 25-40% of calcium in bone is lost
    > Serum calcium, phosphorous, & alk phos levels are normal, although alk phos may be elevated >a fx
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11
Q
  • Bone mineral density (BMD) is determined by peak bone mass & amount of bone loss
  • Types of BMD measurement incl quantitative ultrasound (QUS) & dual-energy xray absorptiometry (DEXA)
    > a DEXA scan gives precise measurements @ clinically relevant skeletal points within the body, which highlight areas for future fx risks
A
  • 1 of the most common BMD studies is DXA, which measures bone density in the spine, hips, & forearm (the most common sites of fx’s resulting from osteoporosis)
  • also useful to evaluate changes in bone density over time & to assess the effectiveness of treatment
  • QUS measures bone density w/sound waves in the heel, kneecap, or shin
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12
Q

The most widely used tool is the ____, which was developed by the WHO’s Collaborating Centre for Metabolic Bone Disease

A

Fracture Risk Assessment Tool (FRAX)

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13
Q

A T-score of ____ indicates normal bone density

A

≥ -1

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14
Q

Osteoporosis is defined as a BMD of ____ below the mean BMD of young adults

A

≤ -2.5

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15
Q

Osteopenia is defined as bone loss that is more than normal (a T-score between ___ and ___), but not yet at the level for a dx of osteoporosis

A

-1 & -2.5

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16
Q

Sometimes the HCP will ask for a Z-score instead of a T-score

In this case, a person is compared to someone her own age &/or ethnic group instead of an individual in the best health @ 30 y.o.

A low Z-score that is less than ___ is an indication of a bone density problem

A

-2.0

17
Q

Collaborative Care - Focus on

  • Proper nutrition
  • Calcium supplements
  • Exercise
  • Prevention of fractures
  • Medication therapy
A

Treat if

  • T-score less than -2.5
  • T-score between -1 and -2.5 w/addl risk factors
  • Prior h/o hip or vertebral fx

Risk assessment - FRAX (takes into acct BMD & addl clinical factors when assessing fx risk)

18
Q

Calcium is best absorbed over the course of a whole day & not more than 500mg @ a time

A
19
Q

Adequate Calcium Intake

____ mg/day premenopausal & postmenopausal taking estrogen

____ mg/day postmenopausal w/o estrogen

Supplemental calcium must be taken in divided doses w/food to enhance absorption

A

1000

1500

20
Q

Good sources of calcium

  • Milk (whole/skim)
  • Yogurt
  • Turnip greens
  • Cottage cheese
  • Ice cream
  • Sardines
  • Spinach
A
  • Vitamin D necessary for calcium absorption/function; bone formation
  • Sunlight for 20 minutes adequate
  • Supplemental (800-1000 IU/day)
    > Postmenopausal
    > Older adults
    > Homebound
    > Minimal sun exposure
21
Q
  • Weight-bearing exercise
    > Build up & maintain bone mass
    > Increase strength, coordination, balance
    > Walking, hiking, weight training, stair climbing, tennis, dancing
  • Quit smoking
  • Decrease alcohol intake
A
  • Treatment of existing disease
    > Prevent further loss w/supplements & meds
    > Keep ambulatory
    > Gait aid to prevent falls/fx’s
    > Brace for vertebral fx
    > Vertebroplasty & kyphoplasty to treat osteoporotic vertebral fx
22
Q

In ____, an air bladder is inserted into the collapsed vertebra & inflated to regain vertebral body height & then bone cement is injected

A

kyphoplasty

23
Q

In ___, bone cement is injected into the collapsed vertebra to stabilize it, but it does not correct the deformity

A

vertebroplasty

24
Q

Bisphosphonates

  • Inhibit bone resorption
  • S/e: anorexia, weight loss, gastritis
  • Proper admin
    > take w/full glass of water
    > take 30 min before food or other meds
    > remain upright for @ least 30 min
A
  • Precautions have been shown to dec GI s/e (esp esophageal irritation) & inc absorption
  • Rare & serious s/e of bisphosphonates is jaw osteonecrosis (bone death)
25
Q
  • Alendronate (Fosamax) - once/wk oral tablet
  • Ibandronate (Boniva) & risedronate (Actonel) - once/month oral tablet
A
  • Zoledronic acid (Reclast) - appvd for once/yearly IV infusion & can prevent osteoporosis for 2 yrs >a single infusion
  • flu-like sx’s for first few days >admin
26
Q

?

  • inhibits bone resorption
  • give IM,SC form at night to minimize s/e (nausea, facial flushing)
  • alternate nostrils when using nasal form (no nausea)
  • must use calcium supplementation (to prevent 2° hyperparathyroidism)
A

Calcitonin

27
Q

Denosumab (Prolia, Xgeva)

  • Monoclonal ab for postmeno women
  • SC inj q6mos
    > binds to protein RANKL
A

Management of pts receiving corticosteroids
> prescribe lowest effective dose
> ensure adequate intake of calcium & vitamin D, incl supplementation when osteoporosis rx’s prescribed
* if osteopenia evident on bone densitometry in ppl taking corticosteroids, treatment w/bisphosphonates may be considered

28
Q

Estrogen agonists/antagonists - raloxifene (Evista)

  • Only rx in its class appvd for prevention & treatment of osteoporosis
    ! Not for women w/ h/o thromboembolism; is hepatotoxic
A

NUR 202 Week 1 (6 decks)

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