Osteoporosis Flashcards
what are the 2 main features of bone strength
- bone density
2. bone quality
4 factors involved in peak bone quantity4
- genetics (60%)
- bone modelling
- mech factors
- nutrition (Ph and Ca)
4 things age related bone loss
- bone remodelling
- genetics(vit D receptor)
- diet/lifestyle
- disease and drugs
what is esp. important in women
estorogen
5 diseases
- hyperparathyroidism
- hyperthyroidism
- hypogoinadism (anorexia, ovarian failure or early menopause)
- malabsorbtion/malnutirion
- rheumatoid arthritis
5 important drugs
- glucocorticoids
- anti-Est
- anti-andro
- SSRIs
- PPIs
4 things bone quality depends on
- architecture (size and shape)
- bone turnover (remodeling rate)
- accumulated damge - microfractures
- quality of mineralization
2 main types of fractures over 65
vert, hip wrist
def. fragility fracture
- from minimal trauma (standing hieght)
- wrist, vert, hip, humerous, pelvis
NOT skull, metas, or ankle
Hx risk factors (5)
- age >65
- gender
- lifestyle - tobac, alc, caf
- disease and drugs
- fam Hx - esp first female
Important physical exams
- vision
- gait
- quad strenght
- balance
- height loss
- kyphosis
- percussion tenderness
- illiac to rib
4 poss. lab studies
- CBC wth MCV
- creat/liver
- Ca, Ph, albumin
- vit D
2 other tests
- spine x-rays
2. DXA (dual xray absobometry)
what does DXA tell us (2)
- T score for pop
2. z score for ref. group
what defines osteo with DXA
under 50 -
- what is 10 year fracture risk made up of (3)
- gender
- age
- bone density
2 modifiers to 10 year and how to deal with
- prednisone
- previous fracture
(move up a category)
what is intervention based on risk cat
low risk - CA, vit D, lifestyle
med risk - not sure
high risk - pharma, diet life style
5 lifestyle things to avoid
- weight restriction (BMI
Ca and Vit D reccomendation
Ca - 1200 mg/day
Vit D - 800-1000IU
2 pharma treatments
- antiresorbative - target clasts
2. anabolic - target blasts
SEs of pharma
early - esophageal irritation, bone pain
late - osteonecrosis of jaw, femoral fractures
4 contraindications
- hypocalcemia**
- low vit D **
- active upper GI disease
- renal dysfucntion
what is RANKL inihib
denosumab
- stops clast activation
what are SERMS
raloxifene
- bone agonist
- breat and uterus antag
2 pops not to use raloxofen
- pre-meno
2. men
what is effect of meds
50% drop in VCF
0-50% drop in non-vert fractures
