osteoporosis Flashcards
Osteoporosis
A skeletal disease characterized by low bone mass, disruption of skeletal microarchitecture, and increased skeletal fragility resulting in fractures occurring with a fall from standing height or less or with no trauma
risk factors non-modifiable
age (>65), female, asian/caucasian, FH, atrumatic fx hx, estrogen def from postmenopause
risk factors modifiable
low wt, ca/vit D def, inadquate physical acitivty, cig. smoke, etoh >2 drinks, meds
high risk meds cause osteoporosis
steroids anticoagulants aromatase inhibitors chemtherapy drugs- immunosuppressants PPI (nexium, prilosec, prevacid) decrease CA absorption gnRH (lupron, zoladex) thiazolidinedione heparin excessive thyroid hormone replacement, medroxyprogesterone acetate, chronic opiates, lasix (loose CA in urine), DepoProvera (stop estrogen stop CA)
patho
osteoclasts- cutting
osteoblasts- build
PMH
rheum diseases, ca, seizures, neuro diseases, DM ,GI, depression (ssri affect bone ), endocrine
workup includes
1)risk using FRAX
2) medical hx
3) psychosocial ass
4) med hx
5) osteoporosis hx - fx, FH, therapy
^6)DXA
7) lab
8)PE
labs
serum: vit D 25, CMP(ca, phos,alb, protein,liver,crt, bun,elytes), TSH, CBC, 24 hour urine for CA, ESP, tissue transglutaminase antibodies (ro celiac), urinary cortisol
FRAX
40-90YO
country
ethincity
age/sex/wt/ht/previous fx/ FH/smoker/rheum arthritis
gold standard
DEXA scan >-1.0 normal, -.1- -2.5 osteopenia, >-2.5 osteoporosis
prevention of osteo
- Exercise (weight-bearing, aerobic, and strength training) increases bone mineral density (BMD), although unclear if it prevents fractures – 30min 4x/wk or balance/strengthening
- Calcium (1,200 mg) and vitamin D (800 IU) daily (max 5000/day)
- Avoid smoking.
- Limit alcohol use (<2 drinks/d).
- Screen all women ≥65 years of age and women ≥60 years of age who are at high risk for fracture (2)[B].
- Consider screening elderly men at high risk for fracture
- Correct treatable medical conditions and other risk factors
CA rich foods
milk 8 oz yogurt 6 oz cheese fortified foods/juices supplelments- citrate- more acidic, better aborbed for elderly or GI s&S carbonate- constipation SE 4-5 cups/day (1200mg-1500mg/day)
PE
ht/wt/bmi bp HEENT- teeth? spine- kyposis, scolosis extremities- strength> neuro mobility balance- 12 sec on 1 leg gait
alendronate (fosamax)
biphosphonates
risedronate (actonel, atelvia)
biphosphonates
ibandronate (boniva)
biphosphonates
zolendronate(reclast)
IV biphosophantes monthly
denosumab(prolia)
monoclonal antibody
6month injection
NOT for renal patients
Raloxifene(evista)
SERM- acts like estrogen- stablizes bone turnover
NOT for elderly due to increase PE risk, dvt, cva
teriparatide( forteo)
stimulate bone formation
anabolic med
daily inj for 2 yrs to stimulate osteoblasts
frax -2.9 use
biphosphonates education
empty stomach 30 mins, sit upright 30 mins
contraindications- DO of esophagus, barrets esophagus, hypocalcemia, untreated vit D deficency and renal disease( ct clearance <35)
normal levels in osteo of ca, cit D and PTH
CA- 8.4-10.2
vit D 25- 35-105 (<32 insufficiency)
PTH- 10-65 pg/ml
levels per day ca, vit d,
ca-1200 mg/day >70…1000mg/day
vit d 800 IU daily for >70…600 IU /day or 50,000IU vit D MWF/week x4 weeks
referral
fx managemaent, pain control
Endocrinology for secondary…decreased hypogonadism like muscle waste, fatigue, hair loss
differential dx
- Primary- bone loss from menopause/aging , secondary- acquired or inherited disease affects bone remodeling or turnover
- Multiple myeloma or other neoplasms
- Osteomalacia
- Type I collagen mutations
- Osteogenesis imperfect
- DM
- Paget’s Disease- normal BMD but fx
- Osteopetrosis – normal BMD but fx
goal
prevention then DX- stabilize/improve bone strength/ prevent fx, fx – prevent future falls, fx, reduce pain/deformity, improve QOL
tx when
Treat patients with a T-score ≤-2.5 with no risk factors, patients with a T-score ≤-2.0 and 1 or more risk factors, and patients with a prior history of osteoporotic fracture at the spine or hip.
