Osteoporosis and Falls Flashcards
This is decreased radiographic density of bone.
Osteopenia
This is decreased bone “osteoid” tissue
Osteoporosis
This is decreased mineralization of bone
Osteomalacia
Location of common fractures
- Vertebrae
- Hip
- Colle’s
What are the most common locations of vertebral crush fractures?
- Lumbar to mid thoracic
When do women start being prone for vertebral crush fractures?
50s
When do you consider a vertebroplasty?
When pain doesn’t remit
Clinical Features of Osteoporosis
- No early warnings; fracture is often first sign
- Gradual height loss
- Dorsal kyphosis with “dowager’s hump”
- Protuberant lower abdomen
- Chronic Back Pain
- Pulmonary dysfunction
- Low skeletal mass and/or atraumatic fractures
T/F: Men have a greater chance of hip fracture than women.
False, women are more prone
Hip fractures have a ______ mortality rate.
High, many never regain previous level of mobility.
Vertebral crush fractures are (bone composition)
30% cortical bone
70% trabecular bone
Hip fractures are (bone composition)
75% cortical bone
25% trabecular bone
Highest Risk Factors for Osteoporosis
- Caucasian or Asian
- Elderly
- Female
- Thin or petite
Increased Risk Factors for Osteoporosis
- Positive Family Hx
- Alcohol Abuse
- Smoking
- Sedentary Lifestyle
- Low dietary calcium intake
After menopause, there is a ______ loss of bone mass with a _________ loss as you get older.
Rapid; Continuing
What is bone mass dependent on? When does Bone Mass Peak?
- Age
- Sex
- Race
- Height
- Weight
Peaks at 35
Women lose ___% of bone mass per year after age 35 (accelerated for 5 years post-menopause)
1
Senile Etiology of Osteoporosis
- Dec. Dietary Calcium
- Dec. 1,25 Vitamin D
- Dec. Calcium Absorption
- Inc. PTH
- Inc. Resorption
Post-Menopausal Etiology of Osteoporosis
- Dec. Estrogen
- Dec. Calcitonin
- Inc. Calcium Mobilization
- Dec PTH
- Dec 1,25 Vitamin D
- Dec. Calcium Absorption
Endocrine Causes of Osteopenia
- Endogenous Hypercortisolism (Cushing’s Syndrome)
- Exogenous Hypercortisolism (Steroid Ingestion)
- Hyperthyroidism
- Hypogonadism
- Hyperparathyroidism
Neoplastic Causes of Osteopenia
- Multiple Myeloma
- Leukemia
- Lymphoma
Genetic Causes of Osteopenia
- Homocystinuria
- Osteogenesis Imperfecta
- Ehlers-Danlos Syndrome
Idiopathic Causes of Osteopenia
- Postmenopausal or senile
- Juvenile
Other Causes of Osteopenia
- Intestinal Malabsorption
- Immobilization
Causes of Osteomalacia
- Malabsorption
- Renal Failure
- Use of Dilantin
- Inadequate Exposure to Sunlight
- Renal Tubular Acidosis
- Hypophosphatemia (hyperparathyroidism, aluminum-containing antacids)
Bone Mass Criteria:
More than 1.0 SD but less than 2.5 SD below mean peak value
Osteopenia
Bone Mass Criteria:
2.5 SD or more below mean peak value
Osteoporosis
Difficulties in Clinically Studying Treatment of Osteoporosis
- Low fracture incidence
- Uncertainty as to significance of change in bone mineral content
- Alterations in bone dynamics often don’t persist
- Mixture of Type I and II patients in a treatment group
Treatment of Osteoporosis
- Exercise
- Calcium
- Vitamin D
- Estrogen
- Fluoride
- Calcitonin
- Other
This type of drug binds to hydroxyapatite and is a potent inhibitor of bone resorption. It have low oral bioavilability, and adversely causes GI disturbances most frequently.
Bisphosphonates
T/F: Fosamax 10 mg has been shown to have no effect on increasing bone mass.
False; has a considerable effect compared to placebo
Do we get enough calcium in food?
No, you need a supplement
Average Daily Requirements of Calcium
- < 16 yo: 1300 mg/day
- 16-50 yo: 1000 mg/day
- 50+ yo: 1200 mg/day
Average Daily Requirements of Vitamin D
- 600 IU/day up to age 70
- 1000 IU/day over 70 yo
*May need to check 25-OH vitamin D level
T/F: Estrogen Therapy (Progestin) has been shown to prevent bone loss
True
Effects of Estrogen on the body
- Inc. Calcium Absorption
- Inc. Serum 1,25 Vitamin D Synthesis
- Inc. Calcitonin Secretion
Current Perspective on Oral ERT (HRT)
- Controls menopausal vasomotor symptoms
- Relieves atrophic vaginitis
- Retards osteoporotic bone loss
- Addition of progestin to regimen reduces risk of endometrial hyperplasia
This type of drug acts as an estrogen agonist at certain organs (bone) but as antagonist at others (breast and uterus, worsens menopausal symptoms).
SERMs (Selective Estrogen Receptor)
*Raloxifene
T/F: SERMs have a greater effect on bone than strogen or bisphosphonates.
False, lesser effect
SERMs reduce the risk of _____. But increases the risk of _______.
Breast cancer; thromboembolic events
T/F: Males lose bone at approximately 1/2 to 2/3 the rate of females
True
How do you prevent or treat Osteoporosis in Men?
- Maintain Muscle Mass
- Keep Calcium Intake 800+ mg/day
- Treat hypogonadism
- Keep alcohol intake < 3 oz/day
- Don’t smoke
- Avoid hypercortisolism
- Check for fat malabsorption
Predisposing Factors for Falls (Instrinsic)
- Muscle weakeness (ankle dorsiflexion), balance problems
- Impaired vision (night > day)
- Postural Dizziness, Postural Hypotension (few non-syncopal falls are related to arrhythmias)
- Neuropathology (stroke, Parkinson’s, peripheral neuropathy)
- Medication (sedatives), polypharmacies
- Foot problems
Predisposing Factors for Falls (Extrinsic)
- Lighting
- Stairs
- Bathroom
- Chairs (too low, without armrests)
- Footwear (soft sole, high heels)
- Improper Walking Aids (cane, walker)
- Loose Rugs
Management of Falls
- Detect of faller before injury – ask?!
- Observe gait and balance (get up and go, nudge test)
- Assess fall circumstances; premonitory symptoms, location
- Manage intrinsic and extrinsic risk factors
