Osteoporosis Flashcards
Men or women are more likely to have osteoporosis?
Women
______ deficiency & age are responsible for most postmenopausal osteoporosis
Estrogen deficiency
Bone tissue is lost progressively.
Lifetime osteoporotic fracture risk for a women who reaches age 50 is? What about for a man?
50% for women - 20% for men
What are three causes of secondary osteoporosis?
Meds (ie steroids, antiepileptics)
Vit D deficiency
Alcohol
High or low body weight is related to risk factors for developing osteoporosis?
Low body weight
What are all the risk factors for osteoporosis?
Women > 65, Men >70
White or Asian
Low body weight (<127 lbs or BMI <20)
FH of osteoporosis/ fragility fracture
Personal history of fragility fracture
Long-term glucocorticoid use
>2-3 drinks alcohol/day
Estrogen deficiency <45 years
Testosterone deficiency
Low calcium intake
Vit D deficiency
Sedentary lifestyle
Current tobacco use
What is the Frax algorithm?
Fracture risk assessment tool -
This calculates a patients 10 year probability for a fracture.
Its used for postmenopausal women and men age 40-90. Only validated for untreated patients.
What the gold standard test for bone density?
DXA scan - bone densitometry.
Who should be DXA scanned?
Women 65 years older or men 70 years older.
Younger but at risk for osteoporosis or osteomalacia.
People with pathological fractures
Radiographic evidence for diminished bone density.
Someone with a T score of -1.0 to -1.5 should get scanned every?
Every 5 years.
Someone with a T score of -1.5 to -2.0 should get scanned every how many years?
every 3-5 years.
What is a Z score
This is comparing bone density in premenopausal women, younger men and kids. Expresses bone density as a standard deviation from age-matched race matched, and sex matched means Same=same
What are the normal ranges for T score?
BMD is within 1 standard deviation of a younger adult. T score is greater than -1
What is the T score for osteopenia (low bone density)
BMD is between -1 and -2.5 Score is between 1 and 2.5 standard deviations below a younger normal adult
What is the T score for osteoporosis?
BMD is 2.5 SD or more below a younger normal adult T score is less than -2.5
What is the T score for severe or established osteoporosis?
BMD is 2.5 SD or more below a younger adult. T score is -2.5 or lower but you already have 1 or more fragility fractures.
Is osteoporosis obvious? IE are people symptomatic?
No, typically asymptomatic/silent until a fracture
In terms of osteoporosis, people with vertebral fractures usually present how?
Height loss or kyphosis Acute episodes may be associated with pain Often no preceding trauma or minor trauma (speed bump) Acute back pain with sudden lifting, coughing, bending.
Where is back pain with someone with vertebral fractures localized to?
Usually localized to the midline spine, variable quality May refer into flank, anterior abdomen, posterior superior iliac spine, radiation into the legs is considered rare. May have pain on palpation/percussion of affected vertebrae
What are 3 things you can see on radiograph when someone has osteoporosis?
Radiolucency
Cortical thinning
Occult fractures
Bone loss has to be greater than what % to be detected on radiograph?
Greater than 30%
What lifestyle modifications should someone take with osteoporosis
Smoking cessation Limit alcohol intake Regular weight bearing and muscle strengthening exercise - At least 30 minutes 3x a week Consume at least 1200mg of calcium/day Adequate calorie intake Take measures in the home to avoid falls Wearing a brace - clam shell brace
What are the guidelines for pharmacological intervention in post menopausal women and men over the age of 50 years.
History of a hip or vertebral fracture
T score less than 2.5 on DXA on the femoral neck or spine
T score between -1 and -2.5 at the femoral neck or spine, and a 10 year probability of hip fracture of greater than 3% or a 10 year probability of any major osteoporosis related fracture greater than 20% based on WHO algorithm.
Total calcium and vitamin D intake a day should be?
Calcium = 1200mg
Vitamin D = 800 units
