Osteoporosis Flashcards
What is osteoporosis?
A chronic skeletal disorder of compromised bone strength associated with low bone density (quantity) and deterioration of bone microarchitecture (quality) which often results in fragility fractures
What does bone strength depend on?
Bone mass and bone microacrchitecture
What do osteoclasts and osteoblasts do?
Osteoclasts excavate areas of damaged or weakened bone.
Osteoblasts then fill in the areas to form bone
What causes bone reabsorption to become greater than formation?
Menopause (accelerates bone loss), aging (begins after mid 30s), disease and drugs
Why is osteoporosis known as the silent thief?
Because it slowly steals bone density over many years without signs or symptoms until a bone breaks or fractures
Extreme curvature can form over time (kyphosis)
What is a compression fracture?
A loss of >25% of vertebral height with end plate disruption
Can cause 6-9 inches loss in height.
How do fragility fractures occur?
Spontaneously or from minor traumas like falling from sitting or standing height, at walking speed or climbing 3 stairs or coughing, hugging, sneezing.
What are some common sites for a fragility fracture?
Hip, spine and wrist
Not feet, ankle, hands, craniofacial
How is bone mineral density (BMD) assessed?
Using a Dual X-ray Absorptiometry (DXA) at the hip and spine
OP classification is a T-score less than -2.5
What else is used to determine risk of fragility fractures?
BMD, age, height, weight, risk factors
Who is eligible for BMD testing?
Fragility fracture, prolonged glucocorticoid use, >65 years use of high risk medications
Those >50 with RA, current smoking, high alcohol intake or low body weight
Those
What are some disorders strongly associated with osteoporosis?
Primary hyperparathyroidism, diabetes, hypogadism, chronic liver disease, Cushing disease, COPD, chronic inflammatory conditions
What will automatically increase a patient to the next fracture risk assessment category?
Fragility fracture after age 40, prolonged corticosteroid therapy (7.5 mg prednisone daily in previous year is equivalent to 3 months of it)
What confers high risk in the 10-year fracture risk assessment tool?
Hip/vertebral fracture, >1 non-vertebral non-hip fragility fracture
Who is a candidate for osteoporosis therapy?
Based on 10-year fracture risk calculation and fracture history
High risk should receive treatment, moderate may, low does not need
What are some high risk fracture history scenarios?
Fragility fracture of the hip or spine, 2 or more non-hip, non-spine fragility fractures or 1 non-spine, non-hip fragility fracture after age 40 and prolonged glucocorticoid use in the previous year
How should all patients maintain basic bone health?
Strength training twice a week, balance training or tai chi daily, 30 minutes aerobic physical activity daily, home safety and med assessment, calcium, vitamin D, smoking cessation, limit alcohol (2 per day), good nutrition (adequate protein, low sodium)
All very important adjunct to OP meds
Which medications put patients at risk for falls?
Medications taken for sleep, mood, anxiety, depression, hypertension, allergies, pain and muscle spasms. They may impair balance, coordination, vision, dizziness, drowsiness, confusion