Osteoporosis, and Hip Fractures Flashcards
What are some risks for osteoporosis?
Age >65
Thyroid disease (long time use of levothyroxine, can result in osteoporosis, post menopausal
femaleAdvanced age (> 65)
Low body weight
Cigarette smoking
Nontraumatic fracture
Inactive lifestyle
Family history of osteoporosis
Diet low in calcium or vitamin D deficiency
Excessive use of alcohol (>2drinks a day)
Postmenopausal, including premature or surgical menopause
White and Asian American descent
Low testosterone in men
Which drugs can interfere with bone metabolism?
Corticosteroids (prednisone)
Long-term corticosteroid use is a major contributor to osteoporosis.
When a corticosteroid is taken, loss of bone and inhibition of new bone formation occur.
Increases bone loss and stimulates breakdown
Anti-seizure drugs (e.g., valproate [Depakote], phenytoin [Dilantin])
What other influence do these drugs have?
Aluminum-containing antacids
Certain cancer treatments
Antiseizure drugs (e.g., valproate [Depakote], phenytoin [Dilantin]) What other influence do these drugs have?
Anti seizure drugs depress bone marrow, can have low bone marrow, blood count
Aluminum-containing antacids
Certain cancer treatments
Antacids- leads to poor absorption of other meds
Heparin is also a culprit in osteoporosis. Why?
Antidote for Heparin?
detrimental effect of heparin on bone, with an increase in fracture rate.Heparin—Heparin causes bone loss by decreasing bone formation. The few studies of the mechanism of bone loss have revealed decreased bone formation
Protamine Sulfate
Medications and Osteoporosis
Meds can decrease osteoblast function, increase bone resorption, inhibit GI calcium absorption,
What is the gold standard diagnostic test?
Her physician orders a dual-energy x-ray absorptiometry (DEXA Scan).
What is a DEXA scan?
A dexa scan is a measurement of bone mass of spine, femur, forearm, and total body. Allows assessment of bone density with minimal radiation exposure, used to diagnose bone disease and to measure response to treatment. One beam is high energy while the other is low energy. The amount of X-rays that pass through the bone is measured for each beam. This will vary depending on the thickness of the bone. Based on the difference between the two beams, the bone density can be measured.
At what age should a DEXA scan be conducted for a woman? For a man?
65 or older in women
Man - unless having hx or pain, bc there bone is bigger and denser
Diagnostic Studies Osteoporosis
Osteoporosis is a BMD >-2.5 standard deviations below a young adult BMD.
Osteopenia
is a BMD > -1.0 but less than - 2.5 standard deviations below a young adult BMD
What is osteopenia? “Pre osteoporosis”
Osteopenia is a loss of bone mineral density (BMD) that weakens bones. It’s more common in people older than 50, especially women. Osteopenia has no signs or symptoms, but a painless screening test can measure bone strength. Certain lifestyle changes can help you preserve bone density and prevent osteoporosis
Osteoporosis is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone among the elderly.
is a systemic skeletal disorder characterized by low bone mass, micro-architectural deterioration of bone tissue leading to bone fragility, and consequent increase in fracture risk. It is the most common reason for a broken bone among the elderly.
Osteomalacia causes soft bones due to a lack of
vitamin D.
What other Diagnostic Studies Are Appropriate?
History and physical exam
Hip, vertebra, or wrist fracture Back pain Loss of height Spinal deformities Kyphosis Stooped posture
Quantitative ultrasound
Uses sound waves to evaluate bone mass
May see increased use due to cost effectiveness
x-ray
Osteoporosis often goes unnoticed because it cannot be detected by conventional x-ray until more than 25% to 40% of calcium in the bone is lost.
Serum calcium, phosphorus, and alkaline phosphatase levels usually are normal, although alkaline phosphatase may be elevated after a fracture.
normal, although alkaline phosphatase may be elevated after a fracture.
Blood Tests
Many of the blood tests are used to screen for disease processes that may contribute to osteoporosis
Albumin is affected by alcohol
Albumin can be impacted with liver dx check for elevated ALT and AST! (if 3x’s the normal)
Liver fx study to look for decreased platelets
Look for thyroid problems
Thyroid stimulating hormone
High TSH = hypo
High T3, T4 maybe they are taking too much levothyroxine?
Other tests that might be helpful
CBC
Serum Chem levels
Vitamin D Levels check for
insufficiency, can predispose a patient to osteoporosis
= low mood, low immune, low calcium absorption
Calcium Homeostasis The calcium level in blood is balanced by:
Parathyroid hormone (PTH)
secreted by the parathyroid gland
If calcium level is low – PTH raises calcium level by stimulating osteoclasts to break down bone
Increases calcium resorption from kidneys
Calcitonin hormone
secreted by the thyroid gland
if calcium level is too high – calcitonin moves calcium from the blood and deposits it in bones
Decreases calcium resorption in kidneys
When calcitonin is released in response to high calcium levels, calcium is
not reabsorbed in kidneys and neither is phosphorus.
Which two antagonistic hormones play the major role in calcium homeostasis
PTH and calcitonin
Calcium phosphorus relationship
Calcium high, phosphorus and vice versa
