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Geriatric > Osteoporosis and Falls > Flashcards

Osteoporosis and Falls Flashcards

1
Q

This is decreased radiographic density of bone.

A

Osteopenia

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2
Q

This is decreased bone “osteoid” tissue

A

Osteoporosis

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3
Q

This is decreased mineralization of bone

A

Osteomalacia

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4
Q

Location of common fractures

A
  1. Vertebrae
  2. Hip
  3. Colle’s
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5
Q

What are the most common locations of vertebral crush fractures?

A
  • Lumbar to mid thoracic
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6
Q

When do women start being prone for vertebral crush fractures?

A

50s

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7
Q

When do you consider a vertebroplasty?

A

When pain doesn’t remit

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8
Q

Clinical Features of Osteoporosis

A
  • 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
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9
Q

T/F: Men have a greater chance of hip fracture than women.

A

False, women are more prone

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10
Q

Hip fractures have a ______ mortality rate.

A

High, many never regain previous level of mobility.

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11
Q

Vertebral crush fractures are (bone composition)

A

30% cortical bone

70% trabecular bone

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12
Q

Hip fractures are (bone composition)

A

75% cortical bone

25% trabecular bone

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13
Q

Highest Risk Factors for Osteoporosis

A
  • Caucasian or Asian
  • Elderly
  • Female
  • Thin or petite
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14
Q

Increased Risk Factors for Osteoporosis

A
  • Positive Family Hx
  • Alcohol Abuse
  • Smoking
  • Sedentary Lifestyle
  • Low dietary calcium intake
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15
Q

After menopause, there is a ______ loss of bone mass with a _________ loss as you get older.

A

Rapid; Continuing

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16
Q

What is bone mass dependent on? When does Bone Mass Peak?

A
  • Age
  • Sex
  • Race
  • Height
  • Weight

Peaks at 35

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17
Q

Women lose ___% of bone mass per year after age 35 (accelerated for 5 years post-menopause)

A

1

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18
Q

Senile Etiology of Osteoporosis

A
  • Dec. Dietary Calcium
  • Dec. 1,25 Vitamin D
  • Dec. Calcium Absorption
  • Inc. PTH
  • Inc. Resorption
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19
Q

Post-Menopausal Etiology of Osteoporosis

A
  • Dec. Estrogen
  • Dec. Calcitonin
  • Inc. Calcium Mobilization
  • Dec PTH
  • Dec 1,25 Vitamin D
  • Dec. Calcium Absorption
20
Q

Endocrine Causes of Osteopenia

A
  • Endogenous Hypercortisolism (Cushing’s Syndrome)
  • Exogenous Hypercortisolism (Steroid Ingestion)
  • Hyperthyroidism
  • Hypogonadism
  • Hyperparathyroidism
21
Q

Neoplastic Causes of Osteopenia

A
  • Multiple Myeloma
  • Leukemia
  • Lymphoma
22
Q

Genetic Causes of Osteopenia

A
  • Homocystinuria
  • Osteogenesis Imperfecta
  • Ehlers-Danlos Syndrome
23
Q

Idiopathic Causes of Osteopenia

A
  • Postmenopausal or senile

- Juvenile

24
Q

Other Causes of Osteopenia

A
  • Intestinal Malabsorption

- Immobilization

25
Q

Causes of Osteomalacia

A
  • Malabsorption
  • Renal Failure
  • Use of Dilantin
  • Inadequate Exposure to Sunlight
  • Renal Tubular Acidosis
  • Hypophosphatemia (hyperparathyroidism, aluminum-containing antacids)
26
Q

Bone Mass Criteria:

More than 1.0 SD but less than 2.5 SD below mean peak value

A

Osteopenia

27
Q

Bone Mass Criteria:

2.5 SD or more below mean peak value

A

Osteoporosis

28
Q

Difficulties in Clinically Studying Treatment of Osteoporosis

A
  • 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
29
Q

Treatment of Osteoporosis

A
  • Exercise
  • Calcium
  • Vitamin D
  • Estrogen
  • Fluoride
  • Calcitonin
  • Other
30
Q

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.

A

Bisphosphonates

31
Q

T/F: Fosamax 10 mg has been shown to have no effect on increasing bone mass.

A

False; has a considerable effect compared to placebo

32
Q

Do we get enough calcium in food?

A

No, you need a supplement

33
Q

Average Daily Requirements of Calcium

A
  • < 16 yo: 1300 mg/day
  • 16-50 yo: 1000 mg/day
  • 50+ yo: 1200 mg/day
34
Q

Average Daily Requirements of Vitamin D

A
  • 600 IU/day up to age 70
  • 1000 IU/day over 70 yo

*May need to check 25-OH vitamin D level

35
Q

T/F: Estrogen Therapy (Progestin) has been shown to prevent bone loss

A

True

36
Q

Effects of Estrogen on the body

A
  • Inc. Calcium Absorption
  • Inc. Serum 1,25 Vitamin D Synthesis
  • Inc. Calcitonin Secretion
37
Q

Current Perspective on Oral ERT (HRT)

A
  • Controls menopausal vasomotor symptoms
  • Relieves atrophic vaginitis
  • Retards osteoporotic bone loss
  • Addition of progestin to regimen reduces risk of endometrial hyperplasia
38
Q

This type of drug acts as an estrogen agonist at certain organs (bone) but as antagonist at others (breast and uterus, worsens menopausal symptoms).

A

SERMs (Selective Estrogen Receptor)

*Raloxifene

39
Q

T/F: SERMs have a greater effect on bone than strogen or bisphosphonates.

A

False, lesser effect

40
Q

SERMs reduce the risk of _____. But increases the risk of _______.

A

Breast cancer; thromboembolic events

41
Q

T/F: Males lose bone at approximately 1/2 to 2/3 the rate of females

A

True

42
Q

How do you prevent or treat Osteoporosis in Men?

A
  • 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
43
Q

Predisposing Factors for Falls (Instrinsic)

A
  • 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
44
Q

Predisposing Factors for Falls (Extrinsic)

A
  • Lighting
  • Stairs
  • Bathroom
  • Chairs (too low, without armrests)
  • Footwear (soft sole, high heels)
  • Improper Walking Aids (cane, walker)
  • Loose Rugs
45
Q

Management of Falls

A
  • 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

Geriatric (9 decks)

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