Osteoporosis Flashcards
How is osteopenia defined?
X ray description of decreased bone density; specifically thinning of the cortex and loss of the trabecule
How is osteoporosis defined?
Rapid loss of bone mass prominently in the trabecular bones of post menopausal females, resulting in increased susceptibility to fracture.
What factors influence osteoporosis/bone loss?
- Age
- Consume and absorb less Ca2+
- Decrease in Vitamin D
- Decrease in physical activity
- Female
- Estrogen
- Family Hx
- excessive protein intake
- caffeine
- Alcoholism
Why are females more prone to bone loss?
- 8 times more common in females than in males
- less bone mass
- decreased estrogen after menopause
What is the function of Estrogen?
- improves Ca+ absorption and decreases Ca+ loss
- increased Vit D levels
- Stimulates Calcitonin production
What is the treatment of osteoporosis?
- physical activity and weight bearing exercise
- Ca+ supplement
- Vitamin D supplement
- Estrogen therapy
- Floride therapy
- Calcitonin therapy
What does estrogen therapy do?
- inhibits activity of osteoclasts (breaks down bone)
- Stimulates osteoblasts (build bone)
- Vitamin D supplement
- Prevents further bone loss- highest bone density achieved when sued from onset of menopause and continued indefinitely
- Reduces fractures 35-60%
What does calcitonin therapy do?
- calcitonin = hormone secreted by the thyroid gland
- decreases plasma calcium concentration
- inhibits osteoclasts activity which slows bone resorption
- may facilitate osteoblasts to produce bone
- decreases rate of bone loss
- prescribed for postmenopausal women who can’t/won’t take estrogen
What are the recommended elemental calcium recommendations?
- Children: 800-1200 mg
- Men and Women (24-64) 1000mg
- Postmenopausal women with HRT: 1000mg
- Postmenopausal women with HRT: 1500mg
- Men and women over 65: 1500mg
How does exercise effect osteoporosis?
- Wolf’s law- skeletal system adapts to forces placed on it
- disuse osteoporosis?
- weight bearing to keep calcium in bones
What types of exercise are appropriate for osteoporosis?
- walking
- swimming
- weight training
What types of exercises risk vertebral fractures?
spinal extension - 16%
spinal flexion - 89%
combined flexion and extension - 53%
no exercise - 67%
What are characteristics of fractures in osteoporosis?
- more common in females than males
2. incidents increase with age
What are common sites of fractures in osteoporosis?
- compression fractures– vertebrae
- Proximal femur and humerus
- Distal radius
- Ribs
What are symptoms of fractures in osteoporosis?
- sudden, sharp pain
2. worse with movement or weight bearing
What are the clinical aspects of fractures in the vertebral column secondary to osteoporosis?
- decreased spinal movements
- paravertebral muscle spasms
- subsequent fractures result in kyphosis and decreased lordosis
What are the rehab principles of osteoporosis fractures during the acute stage???
- bed rest, supine
- analgesics and muscle relaxants
- ice
- heat, massage, electrical stim
What are the rehab principles of osteoporosis fractures during the subacute stage?
patient is able to move side to side without severe discomfort
- back brace
- increases walking and sitting tolerance
- posture and back care training
- extension exercises
What are the rehab principles of osteoporosis fractures during long term rehab?
- goal is to prevent further bone loss
- home exercise program
- resistance training
What medications are used to treat osteoporosis?
- analgesics (pain relievers)
- acetaminophen (tylenol, anacin-3, excedrin)
- Narcotics (Darvocet, Darvon, Percocet, Percodan, Wygesic)
- Muscle relaxants
- Alendronate (fosamax)
- Raloxifene (Evista)
- Risedronate (Actonel)
What are examples of muscle relaxants used to treat osteoporosis?
- Parafon Forte
- Robaxin
- Soma
How does alendronate (fosamax) work?
- binds w/ Calcium phosphate in bone mineral
- when resorbed by osteoclast results in cell death
- net result in increased bone density
How does Raloxifene (Evista) work?
- serum estrogen receptor modulators
- binds to estrogen receptors
- acts as agonist on some estrogen receptors
- acts as antagonist on other receptor sites
How does risedronate (Actonel) work?
- binds with bone to prevent resorption
- poorly absorbed, cannot be taken w/ food
- must remain upright 30 min after taking to reduce chance of severe esophageal ulceration
- incidence of esophageal erosion lower w/ risedronate than Fosamax
What is the prognosis of osteoporosis?
- does not alter lifespan itself but may lead to complications which can become life threatening
