osteoporosis, hip fx and pharm Flashcards
bone mass by age and sex
women have lower peak bone mass
women more effected
osteopenia
thinning of trabecular matrix of the bone before osteoporosis
T-score between -1 and -2.5
what is osteoporosis
bone mineral density 2.5 standard deviations below peak bone mass
measured with dexa
results reported with t score
characteristics of osteoporosis
low bone mass
micro-architectural deterioration
increased bone fragility
susceptible to fracture
major risk factors of osteoprosis
age women white and Asians hip fx as adult famiyl hx LOW body weight smoking alcohol corticoid steroid and immune suppressive drugs
other risk factors of osteoporosis
thin and small frame lack or weight bearing activities lack of calcium and Vit D eating disorders, gastric bypass surgery lack of estrogen/ testosterone excess caffine
FRAX
prediction tool for assessing individual risk of fx
used for tx guidelines
calculates a 10yr risk for hip fx and osteoporotic fx
pathogenesis of osteoporosis
bone resorption (osteoclasts) bone formation (osteoblasts) problem occurs with failure to make new bone or increased resorption
clinical manifestations of osteoporosis
early: none
late: fx, pain, loss of height, stooped posture
three common fx caused by osteoporosis
hip: upper end of femur
wrist
vertebrae: compression fx
hip fx complications
death after fall
osteoporotic hip fx are specifically linked to an increased risk of mortality
women are more common for hip fx
risk of hip fx
age greater than 65
female
osteoporosis
frequent falls
clinical presentation of hip fx
sudden onset of hip pain before or after fall inability to walk severe groin pain tenderness affected leg externally rotated affected extremity is shortened
complications of hip fx
infection
venous thromboembolism
osteoporosis pharmacology
goal is to reduce fx
primary prevention: calcium/ vit D
treatment: promote bone formation
DECREASE bone reabsorption
osteoporosis prevention
calcium 1200-2000mg daily
vitamin D 800-1000 IU daily
exercise at least 30min 3x’s week
osteoporosis treatment
bisphosphonates- alendronate
raloxifene
calcitonin
alendronate
bisphosphates
FDA approved for the prevention and treatment of osteoporosis
reduces FX by 50%
MOA of alendronate
binds permanently to surfaces of bones
inhibits osteoclasts
SE of bisphosphates
GI upset, nausea, discomfort
Raloxifene
SERMs
prevention and treatment of osteoporosis
reduces the risk of spinal fx by 50%
MOA of raloxifene
mimics estrogen
inhibits bone resorption
side effects of raloxifene
hot flashes, leg cramps
SERMs patient teaching
take adequate calcium and vitamin c
discontinue at least 72 hours before immobilization
no tobacco or alcohol
NO pregnant
Black box warning for SERMs
stroke
calcitonin-salmon
bone resorption inhibitor reduces spinal fx by 30% have to take for 5 years to see benefit slows down bone loss increases spinal density
MOA of calcitonin-Salmon
inhibits bone removal by osteoclasts
side effects of calcitonin-salmon
can cause nasal irritation
strong safety profile
