Osteoporosis Flashcards
Risk factors for osteoporosis
age, gender (F>M), race, low body weight (>127), smoking (control), FH, excessive alcohol consumption, previous factor, chronic steroid use, RA, secondary osteoporosis
ACCESS leads to osteoporosis
alcohol use, corticosteroids,, calcium low, estrogen low, smoking, sedentary lifestyle
causes of Primary Osteoporosis
Hormone deficiency Estrogen Testosterone (in men) Risk factors Sedentary lifestyle Smoking Age Body size
causes of secondary Osteoporosis
Hormone excess Cushing’s Syndrome Thyrotoxicosis Hyperparathyroidism Alcoholism Celiac Disease (malabsorption) Medications Chronic steroid use Anticonvulsants Depo-provera SSRI’s Rosiglitazone PPI’s
pathophysiology
imbalance between bone resorption (exceeds) and bone formation
osteoclast activity exceeds osteoblast activity
Signs and Sxs
Asymptomatic until fracture occurs Loss of height -1.5 inches or more since young adult -.5 inches in one year Kyphosis - Dowager’s hump
Diagnostic Studies (general)
Serum Vitamin D 25 (OH)
31-100 ng/ml (normal)
< 31 ng/ml = Vit D insufficiency
< 20 ng/ml= Vit D deficiency
TSH
CMP
CBC (anemia)
what levels of vit D increases peoples risk of fracture
Levels < 31 ng/ml - risk of fracture
normal vit D levels
40-60
people w/ vit D def are at an increase risk in developing what?
Autoimmune diseases
MS
Type I diabetes
Also associated w/ HTN and Cardiovascular disease
factors contributing to vit D def
Advancing age Inadequate sun exposure Insufficient dietary intake of vit D Dark skin complexion Malabsorption disorders, liver diseases and kidney disease
gold standard for diagnosing osteopenia and osteoporosis
Dual-energy x-ray absorptiometry(DXA scan) aka Bone Density Test
Repeat every 2-3 years
non-invasive
T- score
Bone density of pt compared to bone density of young normal mean (depends on age) expressed as SD
Usually use for Older pts
compare score to normal mean
USUALLY GO BY T
Z- score
Bone density in premenopausal women, children and younger men
used in younger pts
compare to age and sex
normal T score
> -1
T score for osteopenia (low bone mass)
between -1 and -2.5
T score for osteoporosis
< -2.5
when to first order a DXA scan?
first at age 65… unless risk factors:
risk factors where you would order a DXA scan sooner than 65?
- Late menarche and/or early menopause
- Low BMI < 21 or wt <127 lbs
- Smoker
- Hx of low trauma fracture of hip, wrist, spine, possibly ankle
- Hx of hip fx in parent
- FH of osteopenia/osteoporosis
- Pts on chronic steroids or other meds known to contribute to bone loss
what is the most common site for osteoporosis related-fractures?
vertebrae, hip, distal radius
key for management of osteoporosis
prevention and early detection
preventative management
*1. Meeting daily calcium and vitamin D requirements throughout entire lifetime (500-600 mg BID if 51 years old for calcium, oral vit D3 800-2,000)
*2. Weight-bearing activities
(walking, upper body dumbbells and lower body leg weights, senior programs aerobics/water aerobics)
3. Smoking cessation
4. Limit alcohol intake
5. Limit excessive caffeine intake
6. fall prevention
medications for tx
- Bisphosphonates - Inhibits osteoclast
Fosamax (alendronate), Actonel or Atelvia (risedronate), Boniva (ibandronate)
Reclast (zoledronic acid) IV - Teriparatide (Forteo)
Daily SQ injection for 2 years,
PTH analog - stimulates production new bone matrix - Raloxifene (Evista) - SERM
60mg po QDaily
Dual purpose: prevent bone loss and prevent risk of invasive breast cancer - Denosumab (Prolia)-
Monoclonal ab that inhibits osteoclast activity
Bisphosphonates
- Must be taken with full glass of water (tap, no mineral or well) first thing in the morning.
- *No eating, drinking, or taking other medications for 30 minutes
- Must remain upright for 30 minutes to decrease risk of GI side effects and help w/ absorption
- *Do not take calcium along with bisphosphonate
- Non-compliance can be an issue
