Osteoporosis Lecture Powerpoint Flashcards
Osteoporosis definition
Disease characterized by low bone mass and microarchitectural deterioration of bone tissue that is associated with increased fragility and a consequent increased risk of fractures
Bone density over the aging process
Active growth of bone mass peaking at 30 and then loss begeins gradually until 50 (menopause for women) followed by rapid continuing loss
Osteoporosis morbidity and mortality
- hip fracture sreduce survival by 12-20% related to coexisting chronic medical conditions
- after hip fracture only half of patients are able to return to ambulation independently
- 60k nursing home admissions yearly attributed to hip fracture
- same lifetime risk of dying as breast cancer
Who should be tested for osteoporosis? (7)
- All women over age 65
- all individuals taking long term corticosteroids
- all individuals over 50 that suffer an osteoporotic fracture
- postmenopausal women with major risk factors
- men with hypogonadal conditions
- men over 70
- patients with diseases associated with bone loss and fracture
Bone mineral density testing
Bone density measurements predict fracture risk better than cholesterol measurements and predict the risk of heart disease better than blood pressure does for stroke, most often done via a DXA scan
Distribution of fracture rates in women
-Based on T score, lower the T score greater risk however because more women exist in the middle than at the extremes we actually see more fractures there, therefore we treat earlier rather than later
When should secondary causes be considered in testing for osteoporosois (3)
- vit D deficiency
- low Z score (age matched control T score)
What is tested for when assessing osteoporosis (6)
- 25 OH vit D level
- PTH
- serum calcium, phosphorus, creatinine
- CBC
- TSH
- serum testosterone in men
Universal recommendtiaons for osteoperosis treatment (3)
- adequate ca2+ and vit D intake
- exercise
- behavioral strategies
Pharmacologic treatments for osteoporosis (3)
- bisphosphonates
- Raloxifene (selective estrogen reuptake modulator)
- PTH derivatives
Biphosphonates concerns (2)
- osteonecrosis of the jaw (very rare, benefits always outweigh concerns about it)
- subtrochanteric fracture of femur (midshaft of femur in area where hypertrophy occurs - happens with very long duration of therapy)
Duration of osteoporosis treatment
- begin therapy until treatment considered a success
- take drug holiday for several years
Monitoring treatment of osteoporosis (3)
- repeat DXA scan every 2 years
- when bone density is stable or improved, it is felt that treatment is successful in decreasing risk in fracture
- if still decreases, then may be due to other underlying condition or or noncompliance
