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bone densitometry > osteoporosis > Flashcards

osteoporosis Flashcards

1
Q

what is osteporosis

A

when the bone rebuilds slower than it is broken down so bones become weak and brittle

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2
Q

what is peak bone mass

A

usually slows down in 20’s and reaches peak by 30’s
-the later the better bc= more in the bank
-somewhat inherited in ethnic groups

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3
Q

is bone living tissue

A

yes

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4
Q

symptoms of osteo

A

-pain due to collapsed vertebrae/ fx
-slopped posture
-bones that break easier
-loss of height over time

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5
Q

risks

A

lifestyle, general, hormones, dietary, medications, disease

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6
Q

what diseases incr risk

A

IBD, celiac, RA, multiple myeloma, kidney/liver disease, cx, lupus

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7
Q

dietary risks

A

low calcium uptake or GI surgery limiting absorption or eating disorder

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8
Q

medication risks

A

coritcosteroids interfere with bone building and other meds for cx, reflux, transplant rejection, seizure do the same thing

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9
Q

thyroid risk

A

-too much thyroid hormone
-overactive thyroid
-too much medication to treat underactive thyroid

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9
Q

hormonal risks

A

breast and prostate cx treatments reduce sex hormones. decr in estrogen and testosterone

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10
Q

general risks

A

age, gender (women), fam hx, body frame (sm), race

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11
Q

lifestyle risks

A

people who sit alot or live sedentary lives
-balance and good posture incr bone strength
-excessive alc and tobacco use are bad

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12
Q

calcium intake

A

normal for 18 and up=1000 mg/day
women at 50=1200 mg/day
men at 70=1200 mg/day
-low fat dairy, dark leafy greens, canned salmon or sardines with bones, fortified juice/cereals, soy like tofu
-too much ca can cause kdieny stones and heart disease (>2000mg a day)

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13
Q

vitamin D allows for

A

calcium uptake

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14
Q

vitamin d uptake values

A

-51-70 yrs need 600IU
-80 and up need 800IU
-no mor than 4000 IU a day

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15
Q

goal of osteoporosis treatment

A

to restore balance of resorption and formation of bone

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16
Q

2 types of resorption treatment tyoes

A

1-antiresorptive=slows breakdown part of bone modeling
2-anabolic=stimulate bone growth

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17
Q

antiresorptive drugs

A

calcitonin, estrogen, biphosphonates

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18
Q

anabolic drusg

A

teriperatide, parathyroid hormone analog

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19
Q

fosamax

A

-for men and post menopausal women

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20
Q

fosamax treatment dose

A

10 mg daily or 70 mg weekly

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21
Q

fosamax preventin dose

A

5 mg daily or 35 mg weekly

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22
Q

ReClast

A

-for men and post menopausal women

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23
Q

ReClast treatment dose

A

give once a year via infusion

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24
Q

ReClast prevention dose

A

give once a year every two years via IV infusion

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25
Q

Boniva

A

approved for post menopausal women

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26
Q

Boniva preventative dose

A

150 mg once monthly

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27
Q

Boniva treatment dose

A

IV injection 3 mg every 3 month

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28
Q

Prolia

A

men and post menopausal women with high risk of fx

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29
Q

Prolia treatment dose

A

injected every 6 months

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30
Q

denosumab

A

prolia

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31
Q

zolendronic acid

A

ReClast

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32
Q

ibandronate sodium

A

boniva

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33
Q

alendronate sodium

A

fosamax

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34
Q

axial

A

spine, ribs, skull, sternum

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35
Q

appendicular

A

extremities, scapulae, pelvis

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36
Q

cortical bone

A

dense outer surface of bone that forms protective layer aorund inner cavity aka compact bone which makes up nearly 80% of skeleton and imperative for structure as it is bend resistant

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37
Q

trabecular bone

A

aka cancellous or spongy

38
Q

where is cortical bone found

A

temporal neck and forearm

39
Q

where is trabecular bone found

A

ends of long bones and in pelvis bones, ribs, skull, vertebraes, and calcaneus

40
Q

consider what type of bone your observing why

A

becayse some bone shows disease onset better or worse but scan multiple sites

41
Q

what bone should you look at when observing response to therapies

A

trabecular because it has a greater metabolic rate

42
Q

3 phases of bone remodeling

A

1-resorption=osetoclasts break down bone
2-mononuclear cells show on surface of bone
3- formation= osteoblasts lay down new bone until reabsorbed completely replaced

43
Q

after how many years is the skeleton completely replaced

A

7-10 years

44
Q

bone densitometry

A

dual energy xray absorptiometry (DXA/DEXA)

45
Q

what does dexa do

A

quanitative measurement technique used to measure bone mass or densityhat

46
Q

what bones are typically measured

A

lumbar spine, dual femurs and forearm

47
Q

dual photon absorptiometry

A

quantidy degree of attenuation of a photon energy beam after passage through bone and tissue— occurs at two energy peaks

48
Q

how are 2 energy peaks found

A

one energy peak oreferentially attenuated by bone so contributions of soft tissye can be subratced mathematically

49
Q

dual photon isotope

A

gadolinium 153
-2 photoelectric peaks at 44 kev and 100 kev

50
Q

bone preferentially attenuates which photon energy

A

44 kev

51
Q

the photo beams are detected through a ____ _____ _____ and quantified after oassage through ___ ____ _____ set at 44 kev and 100 kev

A

NaI scintiallation detector; pulse height analyzer

52
Q

dual xray absorptiometry

A

x ray tube replaces isotope

53
Q

adv of dual xray

A

no source decay or replacing radioactive sources, better image resolution, faster scan time, precision imporved, smalled focal spots = better beam collimation, less dose overlap between scan lines

54
Q

t/f; xray beams prodcues a beam that spans a wide range of photon energies

A

true

55
Q

maufactures need yo produce tqo distinct photo electric peaks neccesarry to separate bone from soft tissue by

A

k-edge filter and alternating pulses to xray spurce @ 70 and 140 kev

56
Q

the spine beams enter

A

from posterior to anterior

57
Q

L1 has the lowest BMC and BMD of

A

1st 4 lumbar vertebrae

58
Q

when does BMD increase

A

L1-4

59
Q

is it better to individuall report the vertebrae or do 1-4

A

do 1-4 for accuracy and precision

60
Q

scanned image is used for

A

noting artifacts and meausrments from correct area NOT diagnosic

61
Q

goals for spine scan

A

straight lumbar spine, clear verterbral seperation, level iliac crest, visible ribs

62
Q

positioning for spine scan

A

have pt lay flat on center of the table then palapate pt iliac crestand simply look at pt position on table

63
Q

artifacts for spine scan

A

fractures increas BMD falsely and osetophytes, aortic calcification, renal stones, gallstones, contrast agents, ingested calcium tablets, can all incr B<D value

64
Q

labeling vertebrae

A

L5-sideways I
L4-H or X
L3-1-U or Y

65
Q

proximal femur goals

A

properly roated femur internally 20 degrees so parralell with table and size of trochanter hsould sem kinda small. should not scan hardware of previously fx femur

66
Q

proximal femurs rois

A

neck, wards, troch shaft, total

67
Q

forearm scan goal

A

stright unroated forearm including radial and ulnar styloids and 33%ROI. use non dominant arm is pos and ref datat with non dom arm bc dom arm usually high BMD. not previous fx or hardware, scan dominant arm but note that in report

68
Q

forearm positioning

A

lay arm flat on table, bent 90% from upper arm, relaxed first (fingers curled under), include lower 2/3 scaphoid

69
Q

% young adult

A

expression of pt valaue as percent of avg peak value for adults of same sex young

70
Q

%age matched

A

compare pt value for an indicual the same sex and age if less then 80% not normal

71
Q

z score

A

number of standard deviations above or below avg value, age matched

72
Q

t score

A

number of standard deviations above or below avg value, young adult
)currently used dx) (pre men women adn men under age 50 then no t score

73
Q

osetoporsis posotive if

A

2.5 standard deviations away from age value so tscore of -2.5 and belownor

74
Q

normal tscore

A

-1.0 or greater

75
Q

low bone mass (osteopeniea)

A

t score between -1 and -2.5

76
Q

severe osteoporosis

A

t score -2.5 and below PLUS a fragility fracture

77
Q

age regression graph

A

pt B<D plotted above their age which super imposed of line graph of expected change while incr line but should only be used or post meno women

78
Q

vertebral fx assessment (VFA)

A

lateral spine imaging, dx of fx, low rad dose vs norm xray, 30% fx here are not felt

79
Q

frax

A

tool used to rpedict future fx risk up to 10 years in advance made by WHO with or without BMD values but can be built into DEXA, 12 Q’s: age gender weight height and Q 5-11 for clinical risk factors and 12 is optional femoral neck BMD value and not used at FMLH bc concern for pt honesty on questions

80
Q

trabecular bone score TBS

A

relatively new method for assessing bone quality and fx risk of lumbar spine
use dxa spine images, cannot dx osteoporosis but give microarchitecture

81
Q

normal TBS

A

> =1.350

82
Q

partially degreaded TBS score

A

1.200-1.350

83
Q

degraded TBS score

A

<=1.200

84
Q

TBS invalid in cases with

A

signifigant scoliosis

85
Q

TBS value not guarenteed if

A

BMI is higher than 37 kg/m2

86
Q

accuracy is importanat for

A

baseline study precision is importan for

87
Q

precisions important for susequent visists to

A

compares

88
Q

effective dose from natural bkg source

A

0.6-0.7 mrem a day

89
Q

dexa eff dose

A

0.67 mrem per day

90
Q

ap cxr dose

A

5 mrem

91
Q

lateral lumbar sppinse dose

A

70 mrem

92
Q
A

bone densitometry (1 decks)

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