osteoporosis

Question 1

remodeling

Answer 1

old bone reabosrbed by osteoclast and replaced by osteoblasto

Question 2

osteoporosis- and what type of disease?

Answer 2

oversupply of osteoclasts or undersupply of osteoblasts. metabolic disease.

Question 3

osteoporosis - most common places (3 of them)

Answer 3

Affects the whole skeleton. Vertebral column, hip, and wrist are most often affected.

Question 4

osteoporosis - causes - hereditary?

Answer 4

Normal aging, Menopause and ↓ gonadal function
Osteoclastic activity > osteoblastic activity
Typically in lean built Caucasian and Asian women with sedentary life style
Heredity (responsible for 70% of peak bone mass)
Poor life time nutrition and calcium intake
Poor life time ↓ wt bearing activities
Pregnancies and breast feeding once thought to deplete Ca++, however new studies show breastfeeding moms rebound and replace their Ca supply

Question 5

osteoporosis - normal?

Answer 5

yes, part of normal aging

Question 6

bmd- when does it peak?

Answer 6

bone marrow density - peaks at age 20

Question 7

Secondary Osteoporosis (5%) - causes (CCATD second)

Answer 7

Chronic disease
Alcoholism
Cigarette smoking
Thyroid disease
Diabetes

Question 8

OSTEOPOROSIS: PATHOPHYSIOLOGY

Answer 8

Combination of factors:
Decreased gonadal function (menopause)
Causes increase in osteoclastic activity
Inadequate Calcium intake
Inactivity
Comorbidity (Disease and medications)

Question 9

osteoporosis - what happens (3 things)

Answer 9

gonad decrease (menopause), osteoclasts increase, then bone loss

Question 10

Typically presents with fracture - and what age

Answer 10

Pt usually has risk factors for primary osteoporosis
Age > than 60
Post menopausal woman, Caucasian or Asian with petite, lean build
Low lifetime calcium intake
Sedentary lifestyle, or prolonged immobility
May be a smoker and hx of high alcohol intake

Question 11

OSTEOPOROSIS: ASSESSMENT
OBJECTIVE DATA - spine? and height? (Down, osteo)

Answer 11

Classic “dowager’s hump” (Kyphosis of dorsal spine)

Shortened height (2 to 3 inches)

Question 12

OSTEOPOROSIS - fast or slow?

Answer 12

occurs faster w/ more fractures

Question 13

types of vertebral fractures (concave the wedge w/ compression)

Answer 13

biconcave, wedge, compression

Question 14

OSTEOPOROSIS: DIAGNOSTICS AND TESTS - x-ray

Answer 14

X-ray: not too sensitive: changes only evident after 25 – 40% bone mineral loss

Question 15

low bone mass - what number (and what is it called)

Answer 15

= osteopenia.1- 2.5 on standard deviation.

Question 16

severe bone loss (osteoporosis) - what number? And what?

Answer 16

more than 2.5 on standard deviation and one or more fragility fractures

Question 17

INDICATION FOR DEXA - x-ray

Answer 17

X-ray evidence of low bone mass

Question 18

PREVENTION OF OSTEOPOROSIS - and how much ca a day?

Answer 18

Prevention should begin as a child
Well balanced diet rich in calcium, and vitamin D
Daily sun exposure (15 minutes/day without sunscreen) (Vitamin D)
Physical activity (wt bearing – walking, running)
Calcium intake
Normal intake in an American diet is 450 – 550 mg/ day

Question 19

Recommended amount of elemental Ca++ (Ca until you’re 15)

Answer 19

Young adults (11 –24) 1200 – 1500 mg/d
Adults (25 – 64) 1200 mg /day
Older adults > 65 1500 mg / day
Postmenopausal > 50 y/o 1500 - 2000 mg / day

Question 20

Vitamin D intake (facilitates Ca++ absorption) (you know this)

Answer 20

Recommended for ages 19 – 59 is 1000 IU/d
> 50 years old 1200 IU / day
Sun exposure 10 – 15 min 3x’s/ wk, milk, egg yolks, fortified foods.

Question 21

Calcium Supplements

Answer 21

Ca Gluconate 9% 650=58mg
Ca Lactate 13% 650=85mg
Ca Citrate 21% 650=137mg
Tribasic Ca Phos 39% 650=253mg
Ca Carbonate 40% 650=260mg
(Tums)
(% of elemental Calcium)

Question 22

EXERCISE - how long?

Answer 22

Exercise early in life contributes to higher peak bone mass
Weight bearing exercise
for at least 30 minutes
3X’s / wk ↑’s bone mass.

Walking, stair climbing,
dancing, hiking, tennis,
running, Tai Chi

Question 23

EXERCISE IN THE ELDERLY

Answer 23

↓’s falls by as much as 25%
Improves muscle strength
↑ Coordination
↑ Balance – Tai Chi
Fall prevention: especially in the elderly: FX
Good Body Mechanics
Walking program 3-5 times per wk
Balance exercises (Tai Chi)
Safe home environment
Ambulatory aids
Hip pads

Question 24

OSTEOPOROSIS:PHARMACOTHERAPY - targets what 3 areas?

Answer 24

Calcium and Vitamin D supplementation
Inhibiting osteoclast activity ( bone resorption)
Promoting osteoblast activity

Question 25

PHARMACOTHERAPY: BIPHOSPHONATES do what? (bi but inhibited)

Answer 25

Inhibit bone resorption

Question 26

FOSAMAX (fos is no fun) - precautions

Answer 26

To prevent esophageal irritation, instruct pt :
No food or drink 30 minutes prior

Take with 8 ounces of water

Do not lie down for at least 30 minutes after taking med (Can burn hole in stomach)
Cash Price: $142

Question 27

CALCITONIN - what does it do?

Answer 27

Thyroid hormone
Inhibits osteoclastic resorption.
Can be given intranasal, SQ, or IM
-Cash Price: Roughly $60

Question 28

EVISTA (Raloxifene) (evista at last)

Answer 28

Selective estrogen receptor modulators
Mimics the effect of estrogen on bone without stimulating the tissues of the breast or uterus
Reduces bone resorption
Cash price: $215

Question 29

FORTEO (Teriparatide) - what does it do? (blast the forte)

Answer 29

PTH Human parathyroid hormone
Increases osteoblastic activity
Sub Q every day
Cash Price-3,586

Question 30

meds that cause secondary osteoporosis (osteo is an HST)

Answer 30

Thyroid Hormone, Steroids, Heparin (long term***)

Question 31

osteoporosis - objective data - fractures where? (Poor hips spine and radius)

Answer 31

Fractures (hip, spine, radius)

BMD: Osteopenia. Low T Scores

Question 32

osteoporosis - diagnostic - Tests to determine BMD - what is DEXA?

Answer 32

Tests to determine BMD: DEXA
DEXA: Dual Energy X-ray Absorptiometry. It is a painless test. Dx’s of Osteoporosis based on T scores. T scores based on 30 year old women

Question 33

blood test to determine osteoporosis (blood test in the alps)

Answer 33

Serum Calcium, phosphorous, ALP, Vitamin D ( usually normal) (bc blood will pull from bone and be fine)

Question 34

indications for DEXA - ages

Answer 34

Fractures after age 50 or menopause
All women after age 65
Younger post menopausal women

Question 35

indications for DEXA - weight and hx?

Answer 35

Wt less than 127#
Family hx hip or spine fractures
Any medical condition that causes bone loss.

Question 36

Fosamax (max is a bio)

Answer 36

biophosphonates

Question 37

pharmacology - Inhibiting osteoclast activity (estrogen and thyroid w/ class)

Answer 37

( bone resorption):
Selective estrogen receptor modulator
Thyroid hormone

Question 38

pharmacology - Promoting osteoblast activity (blast the forte)

Answer 38

PTH: Forteo

Question 39

inhibit osteoclasts - Selective estrogen receptor modulator ex. (estrogen needs a bi rolex)

Answer 39

Raloxifene
Biphosphonates

Question 40

thyroid hormone ex.

Answer 40

Calcitonin

Question 41

Didronel (did the bio)

Answer 41

biophosphonate

Question 42

Aredia (are you a bio?)

Answer 42

biophosphonate

Question 43

Actonel (act on the bio)

Answer 43

biophosphonate

Question 44

Skelid (ske the bio)

Answer 44

biophosphonate

Question 45

fosamax - what does it do? (blast the fos)

Answer 45

PROMOTE OSTEOBLAST ACTIVITY

Question 46

HEBERDEN’S BOUCHARD’S NODES (herb has arthritis)

Answer 46

osteoarthritis