osteoporosis Flashcards
remodeling
old bone reabosrbed by osteoclast and replaced by osteoblasto
osteoporosis- and what type of disease?
oversupply of osteoclasts or undersupply of osteoblasts. metabolic disease.
osteoporosis - most common places (3 of them)
Affects the whole skeleton. Vertebral column, hip, and wrist are most often affected.
osteoporosis - causes - hereditary?
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
osteoporosis - normal?
yes, part of normal aging
bmd- when does it peak?
bone marrow density - peaks at age 20
Secondary Osteoporosis (5%) - causes (CCATD second)
Chronic disease
Alcoholism
Cigarette smoking
Thyroid disease
Diabetes
OSTEOPOROSIS: PATHOPHYSIOLOGY
Combination of factors:
Decreased gonadal function (menopause)
Causes increase in osteoclastic activity
Inadequate Calcium intake
Inactivity
Comorbidity (Disease and medications)
osteoporosis - what happens (3 things)
gonad decrease (menopause), osteoclasts increase, then bone loss
Typically presents with fracture - and what age
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
OSTEOPOROSIS: ASSESSMENT OBJECTIVE DATA - spine? and height? (Down, osteo)
Classic “dowager’s hump” (Kyphosis of dorsal spine)
Shortened height (2 to 3 inches)
OSTEOPOROSIS - fast or slow?
occurs faster w/ more fractures
types of vertebral fractures (concave the wedge w/ compression)
biconcave, wedge, compression
OSTEOPOROSIS: DIAGNOSTICS AND TESTS - x-ray
X-ray: not too sensitive: changes only evident after 25 – 40% bone mineral loss
low bone mass - what number (and what is it called)
= osteopenia.1- 2.5 on standard deviation.
severe bone loss (osteoporosis) - what number? And what?
more than 2.5 on standard deviation and one or more fragility fractures
INDICATION FOR DEXA - x-ray
X-ray evidence of low bone mass
PREVENTION OF OSTEOPOROSIS - and how much ca a day?
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
Recommended amount of elemental Ca++ (Ca until you’re 15)
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
Vitamin D intake (facilitates Ca++ absorption) (you know this)
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.
Calcium Supplements
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)
EXERCISE - how long?
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
EXERCISE IN THE ELDERLY
↓’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
OSTEOPOROSIS:PHARMACOTHERAPY - targets what 3 areas?
Calcium and Vitamin D supplementation
Inhibiting osteoclast activity ( bone resorption)
Promoting osteoblast activity
PHARMACOTHERAPY: BIPHOSPHONATES do what? (bi but inhibited)
Inhibit bone resorption
FOSAMAX (fos is no fun) - precautions
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
CALCITONIN - what does it do?
Thyroid hormone
Inhibits osteoclastic resorption.
Can be given intranasal, SQ, or IM
-Cash Price: Roughly $60
EVISTA (Raloxifene) (evista at last)
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
FORTEO (Teriparatide) - what does it do? (blast the forte)
PTH Human parathyroid hormone
Increases osteoblastic activity
Sub Q every day
Cash Price-3,586
meds that cause secondary osteoporosis (osteo is an HST)
Thyroid Hormone, Steroids, Heparin (long term***)
osteoporosis - objective data - fractures where? (Poor hips spine and radius)
Fractures (hip, spine, radius)
BMD: Osteopenia. Low T Scores
osteoporosis - diagnostic - Tests to determine BMD - what is DEXA?
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
blood test to determine osteoporosis (blood test in the alps)
Serum Calcium, phosphorous, ALP, Vitamin D ( usually normal) (bc blood will pull from bone and be fine)
indications for DEXA - ages
Fractures after age 50 or menopause
All women after age 65
Younger post menopausal women
indications for DEXA - weight and hx?
Wt less than 127#
Family hx hip or spine fractures
Any medical condition that causes bone loss.
Fosamax (max is a bio)
biophosphonates
pharmacology - Inhibiting osteoclast activity (estrogen and thyroid w/ class)
( bone resorption):
Selective estrogen receptor modulator
Thyroid hormone
pharmacology - Promoting osteoblast activity (blast the forte)
PTH: Forteo
inhibit osteoclasts - Selective estrogen receptor modulator ex. (estrogen needs a bi rolex)
Raloxifene
Biphosphonates
thyroid hormone ex.
Calcitonin
Didronel (did the bio)
biophosphonate
Aredia (are you a bio?)
biophosphonate
Actonel (act on the bio)
biophosphonate
Skelid (ske the bio)
biophosphonate
fosamax - what does it do? (blast the fos)
PROMOTE OSTEOBLAST ACTIVITY
HEBERDEN’S BOUCHARD’S NODES (herb has arthritis)
osteoarthritis
