Osteoporosis & Osteoarthritis

Question 1

Osteroporsis - Risk Factors

Answer 1

• Older age in both genders & all races
• Parental hx of osteoporosis, esp mother
• Hx of low-trauma fracture after 50yrs
• Low body weight
• Chronic low calcium and/or vit D intake
• estrogen or androgen deficiency
• current smoking
• high alcohol intake
• lack of physical exercise or prolonged immobility

Question 1

Osteoporosis Etiology

Answer 1

• Chronic metabolic disease in which bone loss causes dcrd density & possible fracture
  > dcrd bone mass
• Spine, hip, & wrist are most often at risk

Question 2

Osteoporosis - Assessment

physical
lab
imaging

Answer 2

• Physical
  > kyphosis
  > reports of “getting older”
  > pain
  > assess for fracture (pain, swelling, misalignment)
• Lab
  > no definitive lab test confirms diagnosis of primary osteoporosis
  > serum calcium & vit D3 lvls annually for all women & men older than 50 who are at high risk for disease
• Imaging
  > dua x-ray absorptiometry (DXA or DEXA): measures bone mineral density, best tool available for a definitive diagnosis

Question 3

Osteoporosis - Interventions

nutrition
exercise
lifestyle

Answer 3

• Nutrition Therapy
  > fruits & veggies
  > low-fat diary & protein sources
  > incrd fiber
  > moderation of alcohol & caffeine
  > dcr carbonation
• Exercise
  > walking 30mins 3-5/wk is most effective
• Lifestyle Changes
  > avoid tobacco
  > hazard-free envr’t to dcr risk for falls

Question 4

Osteoporosis - Drug Therapy Intervention

Answer 4

• Calcium & Vit D supplements
• Bisphosphonates
  > slows bone resorp by binding w/ crystal elements in bone
  > EX: Alendronate (Fosamax), Risedronate (Actonel), Ibandronate (Boniva)
  > take early in AM, 8oz water, sit upright for 30-60mins
• Estrogen agonist/antagonists
  > EX: Reloxifene (Evista)
  > inhibits bone resorp (breakdown of bones)
  > stimulates osteoblast activity & inhibits PTH (parathyroif hormone)
• Calcitonin
  > inhibits bone resorp (breakdown of bones)

Question 5

Osteoarthritis Causes

Answer 5

• Combination of many factors: aging, genetic, obesity, joint injury, occupation
• More females affected 2:1

Question 6

Osteoarthritis - Assessment

pattern
phx assess

Answer 6

Hx
- Disease Pattern:
> unilateral, single joint
> affects weight-bearing joints & hands, spine
> non-systemic
- Physical Assessment/Key Features:
> chronic joint pain & stiffness
> Herbeden’s Nodes

Question 7

Osteoarthritis - Assessment

psychosocial
imaging
lab

Answer 7

• Psychosocial Assessment
  > constant, chronic pain
  > inability to care for oneself
  > depression & anxiety
  > altered body image
  > dcrd self-esteem
• Imaging
  > x-ray
  > MRI
  > CT
• Lab Findings
  > normal or slightly elevated ESR
  > slightly elevated C-reactive protein (CRP)

Question 8

Osteoarthritis - Drug Therapy

Answer 8

• Tylenol (drug of choice):
  > not a primary inflamm disorder
• Topical Drug: Lidocaine 5% patch (Lidoderm)
  > may apple for 12hrs/day
• NSAIDs
  > CBC, kidney, liver func tests are obtained for baseline
  > EX: celecoxib (Celebrex), ibuprofen
• Cortisone Injections
• Muscle Relaxants

Question 9

Osteoarthritis - Treatment/Interventions

nonpharm
surgery
contras

Answer 9

• Nonpharmacologic
  > restm balanced w/ exercise
  > joint positioning
  > heat or cold applications
  > weight control (to dcr stress on joints)
• Surgery
  > most common procedure is Total Joint Arthroplasty
  > hip & knee joints are most commonly replaced
• Contraindications to Surgery
  > active infection
  > advanced osteoarthritis
  > rapidly progressive inflamm