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FNH 477 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Compare osteoporotic bone to healthy bone.

A
  • Thinner
  • More porous
  • Weaker
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2
Q

What is osteoporosis?

A

Skeletal disorder characterized by low bone mass and deterioration of bone tissue leading to increased bone fragility and risk of fracture.

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3
Q

How is osteoporosis diagnosed?

A
  • Bone density is obtained through DXA (dual energy x-ray absorptiometry)
  • ‘T-score’ is calculated by comparing the result to the distribution of bone density in healthy young women.
  • If T-score is between -1 and -2.5 = osteopenia
  • If T-score is less than or equal to -2.5 = osteoporosis
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4
Q

What is the difference between osteopenia and osteoporosis?

A
  • Osteopenia and osteoporosis are conditions that lead to a loss of bone mass and density, which can increase the risk of bones breaking.
  • Osteopenia is a condition where people have a lower bone mass or bone mineral density than is usual for a person’s age. However, the bone mineral density is not low enough for healthcare professionals to diagnose osteoporosis.
  • Osteoporosis, on the other hand, is a bone disease where the bones become weak and are more likely to fracture.
  • Osteopenia is less severe than osteoporosis.
  • It is the stage before osteoporosis, and without treatment, it can progress to osteoporosis.
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5
Q

Describe the distribution of bone mineral density in young healthy women aged 30-40 years.

A

Notice 15% has either osteopenia or osteoporosis.

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6
Q

Describe bone mineral density of women aged 80.

A
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7
Q

Describe the prevalence of osteoporosis in Canada.

A
  • 2 million Canadians are affected by osteoporosis (about 80% are women)
  • 14.7% of women and 2.5% of men 50-70 years
  • 31.1% of women and 6.4% of men over 70
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8
Q

Describe the incidence of osteoporosis in Canada in people aged 40 and above.

A
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9
Q

Describe the prevalence of diagnosed osteoporosis in Canadians 40 years and older.

A
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10
Q

What causes over 80% of fractures in people 50+?

A

Osteoporosis

An estimated 1 in 3 women and 1 in 5 men in a group of 50+ will experience an oxteoporotic fracture

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11
Q

What are the common osteoporotic fracture sites?

A
  • Hip
  • Spine
  • Wrist
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12
Q

Why are osteoporotic hip fractures significant?

A

28% of women and 37% of men who suffer a hip fracture will die within the following year.

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13
Q

What are modifiable risk factors for osteoporosis? [10]

A
  • Smoking
  • Low body weight
  • Low calcium intake
  • Low sun exposure
  • Alcohol abuse
  • History amenorrhea (past occurence of amenorrhea can result in low estrogen levels which can lead to a decrease in bone density and increased osteoporosis risk)
  • Estrogen deficiency (females)
  • Testosterone deficiency (males)
  • Repeated falls
  • Sedentary lifestyle
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14
Q

What are non-modifiable risk factors for osteoporosis?

A
  • Older age
  • Caucasian or asian
  • History of fracture
  • Family history of osteoporosis
  • Female
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15
Q

What stages of bone development begin in utero and continue to early adulthood?

A
  • Bone growth (increase in bone size)
  • Bone modelling (determines bone shape)
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16
Q

Bone growth and bone modelling occur in adulthood.
True or False?

A

True.
These stages of bone development occur in utero and continue to early adulthood.

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17
Q

What stage of bone development occurs primarily in adulthood?

A

Bone remodelling
* Maintains bone integrity
* Replaces old bone with new

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18
Q

What is an osteoclast?

A

Type of bone cell that resorbs/dissolves bone using acid & enzymes

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19
Q

What is an osteoblast?

A

Bone building cell

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20
Q

What is bone remodelling?

A

Process by which:
1) Osteoclasts break down bone by resorption (release calcium (& other minerals) into blood; repair damaged bone; strengthen bone)
2) Osteoblasts rebuild bone

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21
Q

Describe bone through the lifespan.

A
  • Childhood/adolescence (bone formation > bone resorption = bone growth)
  • Early to middle adulthood (bone formation = bone resorption)
  • Later adulthood and older age (bone formation < bone resorption = bone loss)
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22
Q
A

Answer: B?

Natural bone loss accelerates at mid-life. This is especially true for menopausal women, ages 55 to 65, as levels of protective estrogen decline.

For men, the loss is more gradual because testosterone declines slowly. By age 65, though, everyone is in the same boat, as the rate of bone loss evens out among the sexes. From there, bone mass gradually declines for the rest of your life.

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23
Q

What is the importance of peak bone density?

A
  • How much bone you accumulated at peak bone mass determines how much you can remove before crossing the threshold for osteoporosis
  • Still, bone health is important across the lifespan
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24
Q

What does osteoporosis prevention depend on? [3]

A
  • Optimizing peak bone mass
  • Minimizing exposure that lead to bone loss
  • Optimizing nutritional exposures for bone maintenance throughout life
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25
Q

Cortical bone has a faster turnover rate than trabecular bone.
True or False?

A

False.
Trabecular bone has a faster turnover rate than cortical bone.

26
Q

Trabecular bone has a faster turnover rate than cortical bone.
True or False?

A

True.

27
Q

There is a higher rate of fracture in regions with greater proportions of trabecular bone (e.g., hip, spine, wrist).
True or False?

A

True.

28
Q

There is a higher rate of fracture in regions with greater proportions of cortical bone (e.g., hip, spine, wrist).
True or False?

A

False.
There is a higher rate of fracture in regions with greater proportions of trabecular bone (e.g., hip, spine, wrist).

29
Q

What is the difference between trabecular bone and cortical bone?

A
  • Trabecular bone is also known as spongy or cancellous bone. It is less dense than cortical bone and is found at the ends of long bones, as well as in the pelvic bones, ribs, skull, and vertebrae. Trabecular bone has a honeycomb-like structure that facilitates space for blood vessels and red bone marrow.
  • Cortical bone is also known as compact bone. It is denser than trabecular bone and forms the outer layer of bones. Cortical bones are rigid and provide structural support to the body while protecting internal organs from physical stress.

So to summarize: The key difference between trabecular and cortical bone is that trabecular bone is more porous inner regional layers of the body while cortical bone is rigid outer regional layers of the body.

30
Q
A

Answer: C

31
Q

Define: cortical bone.

A

Outer part of all skeletal structures; dense and compact with a slow turnover rate; highly resistant to bending and torsion

32
Q

Define: trabecular bone

A

Found inside long bones, vertebrae, pelvis, and other large flat bones; less dense than cortical bone and has a high turnover rate

33
Q

What nutrients are important components of bone? [4]

A
  • Calcium
  • Phosphorus
  • Magnesium
  • Trace minerals
34
Q

What are bone minerals?

A
  • Hydroxyapaptite
35
Q

What nutrients are important for bone health (not components of bone)?

A
  • Nutrients involved in calcium homeostasis (e.g., vitamin D) or regulatory processes of bone formation or resorption.
36
Q

Which nutrients are clearly protective for bone health? [5]

A
  • Calcium
  • Vitamin D
  • Magnesium
  • Vitamin K
  • Potassium
37
Q

Which nutrients are likely/possibly protective for bone health? [13]

A
  • Some trace minerals (silicon, strontium, zinc, copper, manganese, boron)
  • Vitamin C
  • Vitamin E
  • Vitamin B12
  • Vitamin B6
  • Folate
  • Carotenoids
  • Protein
38
Q

What is the major component of hydroxyapatite?

A

Calcium

39
Q

What are calcium recommendations geared towards?

A

Bone health

40
Q

Describe the DRI for calcium across the lifespan.

A
41
Q

Describe the role of vitamin D in regulation of blood calcium.

A
  • Low blood calcium stimulates parathyroid hormone secretion
  • PTH stimulates bone resorption
  • PTH stimulates calcium absorption in the intestines
  • PTH stimulates the kidney to increase activation of vitamin D (conversion to calcitriol); this leads to increased calbindin
  • Calbindin stimulates calcium absorption from the intestine
  • Calbindin stimulates calcium reabsorption by kidneys
42
Q

What are important aspects regarding vitamin D? [4]

A
  • Amount in food
  • Availability
  • Metabolic need
  • Repeated consumption
43
Q

.

A

Answer: A

44
Q

Why is vitamin K important for bone health?

A
  • Vitamin K is needed to form GLA (gamma-carboxyl glutamyl residues) in bone forming proteins: osteocalcin, matrix GLA protein, protein S
45
Q

Why is protein important in bone health?

A
  • Important for bone growth
  • Hypothesis that too much dietary protein may have negative effects on bone density (increased acidity; increased urinary excretion of calcium)
  • Overall, higher protein intakes do not seem to be related to lower bone density, but VERY high protein intakes may be harmful if calcium intake is LOW.

Also note that protein may play a role in pediatric bone development in regard to achieving peak bone mass, but current human evidence is lacking.

46
Q

What were the findings of this study?

A
  • Intakes of dairy protein positively associated with hip bone mineral density
  • Protein intakes <12% TEI (women) and <11% TEI (men) had increased fracture risk compared to those with intakes of 15% TEI
  • Fracture risk did not significantly change as intake increased above 15% TEI, and was not significantly associated with protein source.
47
Q

What were the findings of this paper?

A

A protein intake above the current RDA may reduce hip fracture risk and may play a beneficial role in bone mass density maintenance in older adults.

48
Q

How do sodium and potassium influence bone health?

A
  • Potassium promotes renal calcium retention.
  • Sodium increases renal calcium excretion.
49
Q

Which nutrients may have possible negative effects on bone health (i.e., promote bone loss)? [5]

A
  • High intakes of phosphorus, sodium, iron, fluoride, and vitamin A
50
Q

How does phosphorus influence bone health?

A
  • It is a component of bone, but too much can have negative effects on bone.
  • High phosphorus intake > PTH secretion > increased urinary phosphorus excretion (also increases bone resorption)

Higher cola intakes are associated with lower bone mass (high phosphorus content in colas), but this may also be explained by displacement of milk

51
Q

How does alcohol influence bone health?

A
  • Bone density increases in moderate drinkers (1-2 drinks/day), but decreases with higher intake
52
Q

How does caffeine impact bone health?

A
  • Increased calcium excretion in urine
  • This can be offset with calcium intake
  • Generally only an issue for older adults with high caffeine intake and low calcium intake.
53
Q

What dietary pattern promotes bone health?

A
  • Rich in fruits, vegetables, whole grains, and low-fat dairy products
  • Moderate in alcohol
  • Low in sodium
54
Q

How does weight influence bone health?

A
  • Lower BMI = increased risk for osteoporosis and fractures (however, higher abdominal obesity is harmful)
55
Q

How does physical activity influence bone health?

A
  • Weight bearing exercise increases bone strength
  • Muscle strengthening prevents weight loss associated bone loss and reduces risk of falling
56
Q

What are recommendations for osteoporosis prevention? [4]

A
  • Appropriate intake of calcium, vitamin D, and other nutrients that will promote peak bone mass accretion and bone maintenance throughout life
  • Minimize intake of nutrients that may lead to bone loss (excess phosphorus, sodium, etc.)
  • Maintain weight and avoid central adiposity
  • Increase physical activity
57
Q

How is vitamin B12 related to bone health?
List a few good sources.

A
  • Low levels are associated with increased osteoporosis risk
  • Clams, liver, salmon, dairy
58
Q

How is zinc related to bone health?
List a few good sources.

A
  • Zinc plays a vital role in building strong, healthy bone and preventing osteoporosis by diminishing bone breakdown and stimulating bone formation.
  • Beans, nuts, oysters, beef
59
Q

How is vitamin C related to bone health?

A
  • It plays a role in the formation of collagen, which is the foundation that bone mineralization is built on.
  • Fruits and vegetables
60
Q

How do carotenoids influence bone health?
List a few good sources.

A
  • Carotenoids maintain bone health by stabilizing the balance of synthesis and breakage of bone.
  • They provide protection against osteoporosis by reducing oxidative stress.
  • Some carotenoids have provitamin A activity and therefore may have effects on bone health via this mediator.
  • All carotenoids have antioxidant activity likely to be protective of bone.
  • Members of the carotenoid family have also been shown experimentally to have direct stimulatory effects on osteoblast proliferation and differentiation at physiologically relevant concentrations.

Yams, kale, spinach, watermelon, cantaloupe, bell pepers, tomatoes, carrots, mangoes, and oranges. Note - they are best absorbed with a source of fat (vitamin A is fat-soluble).

FNH 477 (11 decks)

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