osteoporosis

Question 1

gender and bone mass

Answer 1

women have > bone loss in early postmenopausal years -> continues at gradual rate
F also have decreased bone density
F reach fracture threshold earlier than M
M lose 1/3 less bone mass compared to F over lifetime
~30yo: bone reabs by osteoclasts > bone formed by blasts

Question 2

osteoporosis

Answer 2

bone mineral density 2.5 SD below peak bone mass
measure w/ DEXA scan -> T score
common and serious
decreased bone density and structural deterioration: trabecular bones = hips vertebrae, wrists
actual breaks in trabecular membrane have occurred

Question 3

T scores

Answer 3

-1+: normal bone density
-1 - -2.5: osteopenia, low bone mass (poor bone)
<-2.5 = osteoporosis, porous bone
<-2.5 = osteoporosis with hx of fragility fracture = severe osteoporosis

Question 4

osteopenia

Answer 4

thinning of trabecular matrix of bone before osteoporosis

Question 5

osteoporosis: cm

Answer 5

decreased bone mass, micro architectural deterioration, increased bone fragility, increased susceptibility to fracture
early = none
late = fractures, pain, decreased height, stooped posture (kyphosis)

Question 6

osteoporosis: rf - major

Answer 6

age, F, white/asian, hx of fracture as adult, fam hx and genetics, <127lbs, smoke, OH, long term corticosteroids (inhibit osteoblast function) and immunosuppressive drugs

Question 7

osteoporosis: rf - minor

Answer 7

thin, small frame, no weight bearing exercises, decreased Ca/vitD, eating disorders, gastric bypass, decreased estrogen/testosterone, excessive caffeine consumption

Question 8

osteoporosis: patho

Answer 8

increased resorption (increased osteoclast activity), decreased bone formation (blasts)
fail to make new bone, too much resorption, or both

Question 9

osteoporosis: complications - hip fracture

Answer 9

increased r/o mortality d/t complications after and immobility
more common in those >65, F
proximal 3rd of femur
complications: VTE, sepsis, skin breakdown, pna, lose idep living

Question 10

hip fracture: cm

Answer 10

cm: sudden onset of hip pain before or after fall -> fragility or not, there may not be obvious hx of trauma, may complain of vague knee/butt/groin/thigh pain
bone may be so damaged they cannot bear weight
inability to walk (some can walk at beginning), severe groin pain bc hip displaced and externally rotated + shortened), tender, usually little bruising bc fracture encapsulated

Question 11

osteoporosis: tm

Answer 11

decrease fractures
primary prevention: increasing density does nothing if we dont decrease fractures
encourage Ca (diet and supplement - elemental): 1200 - 2000 mg/daily, some just take more tums
encourage vit D (diet and supplement): 800 - 1000 IU daily
supplements especially important in post menopausal F
promote bone formation or decrease bone reabs (more common)