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Pathophysiology II > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

Chronic progressive disease characterized by the following:

  1. Low bone mass
  2. Impaired bone quality
  3. Decreased bone strength
  4. Enhanced risk of fractures

Often present w/o any symptoms

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2
Q

True or false: Osteoporosis is the most common PREVENTABLE metabolic bone disease

A

TRUE

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3
Q

Osteoporosis is a major cause of ____ in the elderly, resulting in what 4 factors?

A

FRACTURES

  1. pain
  2. disability
  3. costly rehab
  4. poor QOL and premature death
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4
Q

What are the most common osteoporotic fracture sites? (3)

A

Wrist, hip and vertebrate

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5
Q

What is the incidence of osteoporosis?

A

Affects 55% of Americans > 50+ years

10 million people currently have osteoporosis

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6
Q

What is the prevalence of osteoporosis?

A

1 in 2 women > 50 y/o and 1 in 4 men >70 y/o will have one OP related fx in their lifetime

A woman’s risk of a hip fracture is equal to her combined risk of breast, uterine and ovarian cancer

A man over 50 is more likely to break a bone from osteoporosis than get prostrate cancer

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7
Q

Which sex is more susceptible to developing osteoporosis?

A

FEMALE

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8
Q

What subset of women are more susceptible to osteoporosis?

A

Estrogen deficient women

Postmenopausal women have higher risk

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9
Q

What is the relationship between osteoporosis prevalence and men?

A 
Under diagnosed
Undertreated
Underreported
Higher morbidity and mortality than women(30% vs. 9%)
Major public health problem
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10
Q

What 2 things make up bone?

A

Collagen (mostly): protein that provides soft framework

Calcium phosphate: mineral that adds strength and hardens framework

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11
Q

What are the two types of bone?

A

Compact/Cortical

Cancellous/Spongy Trabecular

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12
Q

What are 3 characteristics of compact cortical bone?

A

Make up outer shell of all bones

Comprises shafts of long bones of arms and legs

Makes up 80% of the skeletal mass

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13
Q

What are 3 characteristics of cancellous/spongy trabecular bone?

A

Makes up inner parts of bone (vertebrate, pelvis and ends of long bones)

Makes up 20% of skeletal mass

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14
Q

How does bone remodeling occur? Does it occur at the same rate in cancellous bone vs compact bone?

A

Occurs through resorption and formation of bone

Occurs at different rates in the two types of bone

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15
Q

Resorption occurs via the interaction of what 3 bone cell types?

A

Osteocytes
Osteoclasts: cells that break down bone (3 week life span)
Osteoblasts: cells that form new bone (3 month lifespan)

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16
Q

What are 4 characteristics of osteocytes?

A
  1. Comprise >95% of bone cells in an adult
  2. Buried in bone
  3. Sense mechanical strain
  4. Respond to mechanical strain (exercise) by sending signals to osteoblasts to increase bone formation or osteoclasts to remove existing bone
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17
Q

What are the 5 steps of normal bone remodeling?

A
  1. Osteoclast activation
  2. Bone breakdown
  3. Transition phase
  4. Bone formation by osteoblasts
  5. New bone matches amount broken down (hardens via mineralization)
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18
Q

What causes osteoporosis?

A

Occurs as a result of a mismatch between osteoclast and osteoblast activity

If osteoclast out performs osteoblast = thinning of bone = decrease in strength = greater risk of fracture

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19
Q

Osteoporosis commonly results from what 3 factors?

A
  1. Aging
  2. Change in normal hormones post menopause
  3. Diets low in calcium and vit D
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20
Q

What is the relationship between age, bone turnover and bone mass?

A

Children/Adolescents: Formation>Resorption and bone mass increases

Adults: Formation = resorption and bone mass unchanged

Older adults/Post menopausal = Formation < Resorption, bone mass decreases

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21
Q

What is peak bone mass? What age does this typically occur?

A

Largest amount of bone tissue that a person has at any point in life

Most people reach their peak bone mass by the age of 30.

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22
Q

What are the differences in peak bone mass among males and females?

A

90-95% PBM attained at age 18 for girls, age 19-20 for boys

Growth spurts occur ages 11-14 for girls, ages 13-17 for boys, 40% of total adult bone mass is accumulated in this period of rapid growth

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23
Q

What are the determinants of peak bone mass (aside from gender)?

A 
Physical Activity
Hormones
Risk Factors 
Genetics (60-80%) 
Nutrition: calcium/vit D
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24
Q

What are the 3 types of osteoporosis?

A

Generalized-involving the whole skeleton (astronauts develop because no stress pulling on bones/muscles in space)

Regional: involving limb or region of skeleton (hip, spine, rib)

Localized: involving only focal areas of bone (caused by prolonged immobilization in cast)

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25
Q

What is primary osteoporosis?

A

Bone loss associated with biological changes that take place throughout the lifespan.

Type l: occurs in post menopausal women in association with a decrease in estrogen.
Type ll: associated with the aging process

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26
Q

What is secondary osteoporosis?

A

Can occur any age, M=W

Bone loss characterized by:

  1. medical conditions
  2. metabolic and nutritional disorders
  3. some medications (i.e. Prednisone)
  4. immobilization with loss of function
27
Q

What are 5 NON-MODIFIABLE risk factors for osteoporosis?

A
  1. Gender
  2. Age (50+)
  3. Body size
  4. Ethnicity (Caucasian/Asian)
  5. Family hx
28
Q

What are 8 MODIFIABLE risk factors for osteoporosis?

A
  1. sex hormones
  2. Anorexia
  3. Calcium/vit D intake
  4. Medication use
  5. Lifestyle (inactivity)
  6. Smoking/alcohol
  7. Excessive protein, sodium, caffeine
  8. Losing weight (decreases stress on bones)
29
Q

What are risk factors for osteoporosis in men?

A
  1. Caucasian ethnicity
  2. Age
  3. Undiagnosed low levels of testosterone
  4. History of prostate cancer with bilateral orchiectomy
  5. Hypogonadism (long-term androgen deprivation therapy or ADT)
30
Q

What osteoporosis risk factors are in the acronym ACCESS?

A 
Alcohol use
Corticosteroid use 
Calcium low
Estrogen low
Smoking 
Sedentary lifestyle
31
Q

What is the FRAX tool?

A

Evaluates fracture risk in Post Menopausal women (PMW) and Men >50

Generates the following results:

  1. 10-year probability of a major osteoporotic event (clinical spine, forearm, hip or shoulder fracture)
  2. 10-year probability of a hip fracture
  3. Body Mass Index
32
Q

What is the FORE calculator?

A

Estimates 10-year fracture risk for postmenopausal women and men age 45 and older who are not receiving treatment for osteoporosis.

33
Q

How is osteoporosis diagnosed?

A

Via a measure of bone density known as the Bone Mineral Density test

34
Q

What is bone mineral density (BMD)? What does is it correlate with? What is it good at predicting?

A

Average concentration of mineral in a defined section of bone

Correlates with bone strength

Considered an excellent predictor of future fracture risk

35
Q

Who should and who shouldn’t be tested for BMD.

A

Should: Women 65+ and Men 70+

Should NOT:

  1. Children or adolescents
  2. Healthy young men
  3. Premenopausal women
36
Q

What is the gold standard test for measuring bone mineral density (BMD)?

A

Dual Energy x-ray absorptiometry (DEXA)

37
Q

DEXA scanning focuses on what 2 main areas?

A

Hip and spine

Although osteoporosis involves the whole body, measurements of BMD at one site can be predictive of fractures at other sites

38
Q

What is the best predictor of hip fractures?

A

Hip bone mass density by DEXA scan

39
Q

What is spine BMD useful in assessing?

A

Preferable to assess changes early in menopause and after bilateral ovariectomy

40
Q

What is a T-score? What T-score indicates a diagnosis of osteoporosis?

A

Pts. BMD is compared with mean of BMD of a young, healthy cohort of females to produce T-score

T-score < -2.5 establishes Dx. of osteoporosis

41
Q

What is a Z-score? What Z-score indicates a diagnosis of osteoporosis?

A

Represents the SD the pts. BMD differs from the mean BMD of a healthy population of the same ethnicity, sex and age as the patient undergoing DEXA.

Z -score is valuable when it indicates a patient’s BMD is significantly below their peer group.

< -2.0 = low BMD for chronological age
> -2.0 = within expected range for age

42
Q

Why is BMD important?

A
  1. Predicts risk of future fracture
  2. Determines use of medication
  3. Presence of osteoporosis may affect orthopedic surgical/casting plan
43
Q

BMD ____ with age

A

DECREASES

44
Q

What are the 2 pros to using x-rays with regards to osteoporosis?

A
  1. X-rays can detect osteoporosis

2. X-rays are widely available

45
Q

What are the 3 cons to using x-rays with regards to osteoporosis?

A
  1. Insensitive to early stages of the disease
  2. 30% bone mass loss required before density changes become detectable on x-ray
  3. Cannot determine BMD from x-ray
46
Q

What is the most common osteoporotic fracture? What is significant about these fractures?

A

Vertebrate fx

OFTEN SILENT

47
Q

What are the clinical symptoms of a vertebral fracture?

A
  1. Back pain
  2. Posture change
  3. Loss of height
  4. Functional impairment
  5. Disability
  6. Decreased QOL
48
Q

Vertebral fx increases risk of subsequent vertebral fx by ____ times

A

5x

49
Q

Who should be tested for vertebral fx?

A
  1. All women >70+, all men 80+
50
Q

What is used to determine the severity of a vertebral fx?

A
  1. Severity of Fx determined by measuring amount of vertebral height reduction
  2. Grades assigned to each vertebra determined by degree of reduced height
51
Q

How are vertebral fractures treated?

A

Hot pack, TENS, Oral analgesics
Bracing and positioning to decrease pain
Calcium and Vit D
Kyphoplasty/Vertebroplasy

52
Q

Why is osteoporosis often overlooked and untreated?

A

It is often clinically SILENT before manifesting in the form of a fracture

53
Q

What are the 4 osteoporotic red flags to look out for in a PT assessment?

A
  1. Height Loss > 1” (6cm or 2.4 inches strongly predictive of vertebral compression fractures)
  2. Previous Fracture
  3. Family History
  4. Presence of Kyphosis (greater than 7cm occiput to wall distance( OWD) is strongly predictive of thoracic compression fracture)
54
Q

What are the top 11 assessment tests for osteoporosis?

A 
Balance
Standing Height
Occiput to Wall Distance
Rib to Pelvis distance
Flexible ruler Kypholordosis
Prone Hip Extension
Supine to Sit
Floor to Stand
Single Leg Standing 
Hip Hinge /spinal alignment

Sit to Stand:
Use of UA assist
Leg alignment

55
Q

Inability to sit to stand from chair independently is linked to a ____ fold increase in hip fx risk

A

2 fold

56
Q

What is the single best predictor of functional decline and disability?

A

Slow gait speed

57
Q

What is the primary goal and # 1 intervention in treating osteoporosis?

A 
Goal: REDUCE FRACTURE RISK 
1. Strengthen areas at risk for fx
2. optimize posture (maintain neutral spine)
3. reduce fall risk (home inspection)
4 Promote overall fitness

Intervention: decrease pain and ease mobility

58
Q

How can PT increase bone density?

A
  1. Joint reaction forces-muscle contraction

2. Ground reaction forces-gravitational forces

59
Q

PT interventions should focus on what 6 components?

A 
Fracture prevention – most important
Leg strength
Balance
Thoracic extension 
Hip Extension
Thoracic mobilization*
60
Q

What movement is contraindicated in patient with osteoporosis? Why?

A

TRUNK FLEXION

Common cause of silent fractures

61
Q

What 3 alignment exercise are used to treat osteoporosis?

A
  1. Perch Posture
  2. Hip hinge
  3. Foot press
62
Q

What are the ideal reps and intensity when strength training pts with osteoporosis?

A

1 repetition max
Ideal intensity of training: 70-80%
8-12 Reps to temporary muscle failure or fatigue

63
Q

What brace is commonly used by patients with osteoporosis?

A

Spinomed Brace

Pathophysiology II (24 decks)

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