Osteoporosis Flashcards
Bone strength reflects integration of
- bone density (mineral packed within the bone)
- bone quality (structure, mineralization)
DQ
Diminished bone mass can result from
- failure to reach an optimal peak bone mass by early adulthood
- once you’ve gotten there, you have either increased bone resorption or decreased bone formation
Non-modifiable risk factors for osteoporosis
- female gender
- advanced age
- Caucasian/Asian race
- FH of osteoporosis
- personal history of fracture
- previous hyperthyroidism
- early menopause (before 45)
- Maybe something like RA
The FACt is I’m Fucking Pissed at HER
Three main factors contributing to osteoporosis:
- Gender (women with lower peak bone mass, hit menopause, or pregnancy and lactation with transient bone loss)
- Ethnicity: men and non-white women with higher peak bone mass than whites
- Genetics
GEG
Some modifiable risk factors?
- tobacco
- sedentary
- caffeine use (excessive)
- low Ca and vit D intake
- Too much alcohol
- Hormone deficiency like testosterone or estrogen
- Low BMI (anorexia nervosa)
- Glucocorticoids
Aging bone loss is ____ than menopausal
slower
Some drugs that lead to osteoporosis; mechanisms of how many of these drugs work:
- glucocorticoids
- chemo
- anticonvulsants (inhibit vit D metabolism)
- SSRI’s
- medroxyprogesterone
- Proton pump inhibitors
- excess thyroid hormone;
estrogen antagonism or work at Ca absorption and vit D level
SEMPre CAGney
On history and physical, look for; Consider further lab tests only if
risk factors and signs of occult vertebral fractures; signs of a secondary cause of osteoporosis
For someone with vertebral fractures, what would be in the history?
- back pain: acute or chronic
- loss of height (>1.5 inches)
- Restrictive lung disease symptoms (exertional dyspnea, decreased exercise tolerance)
- Early satiety (reduced abdo cavity)
- Depression, anxiety, fear
On physical consider:
- height and body weight
- spinal tenderness/deformities (Dowager’s hump)
- protuberant abdo
- secondary osteoporosis signs
- fall risk
Risk factors for fractures:
- history of falling
- poor physical condition
- neuro disorders
- impaired vision and hearing
- sedatives and anti-hypertensives
- environmental hazards
Screening criteria:
- women over 65; men over 70
- those with fracture over 50
- 50-69 with clinical risk factors
- RA or glucocorticoids
Gold standard for screening for osteoporosis is
DEXA (dual-energy X-ray absorptiometry)
Three sites for DEXA:
spine, hip (total and femoral neck) and forearm (non-dominant included)
T-score for normal, osteopenia, osteoporosis:
Over -1.0, b/w -2.5 and 1.0, less than -2.5
T-score related to ____ and ____; it compares
bone strength, fracture risk; pt’s BMD with young-normal mean BMD and expresses difference as SD score (T-score!!!)
Fracture risk doubles with
every SD decrease in BMD
X-ray of bone
cannot reliably measure bone density, but CAN ID spinal fractures (explain back pain, height loss, or kyphosis)
Morbidity after vertebral fractures:
- back pain
- height loss
- deformity (kyphosis, protuberant abdomen)
- reduced pulmonary function
- diminished quality of life (lose self-esteem, depression, distorted body image, loss of INDEPENDENCE)
Prevention of osteoporosis:
- adequate intake of Ca, vit D
- weight-bearing and muscle-strengthening exercise (especially walking)
- avoid falls
- avoid tobacco/excess EtOH use
First line of treatment of osteoporosis is; major one is
bisphosphonates (increased bone density and reduced fracture risk; inhibits action of osteoclasts!!);
alendronate!!!
More common SE’s of bisphosphonates; more rare ones?
- Hypocalcemia
- Hypophosphatemia
- Musculoskeletal pain
- GI (abdo pain, acid reflux, eso ulcer, gastritis);
- osteonecrosis of the jaw
- atypical femoral fractures
- visual disturbances
