Week 3 - Arthritis and Musculoskeletal conditions Flashcards
What effect does estrogen have on osteoporosis?
It has a protective effect –> women after menopause are more likely to get it
What are some risk factors for Osteoporosis?
- Coeliac disease - impairs calcium absorption
- Alcohol
- Glucocorticoid therapy for longer than 3 months - affects osteoclasts/blasts
- Thinness
- Smoking
- Genetics
- Fracture history
- Calcium/Vit D intake
- More than 3 cm height loss
- Lifestyle factors
- Inflammatory arthritis
- Premature menopause
- Hyperthyroidism
- Age - over 70
- No exercise
What proportion of Australian’s have OP?
1 in 10 over 50
What is the difference in male and female rates of OP?
5x more women over 50 than men (15.1% women, 3.3% men)
Where do RCTs sit in the Hierarchy of evidence?
Third from the top, beneath systematic reviews/meta-analysis and evidence based synopses
Above Cohort studies/non-randomised trials
WHy is OP called the Silent Epidemic?
Symptomless development
Lack of Public Awareness
How many times more likely are women over 50 to be hospitalised for minimal trauma hip fractures?
2x
What are the 8 recommended elements of clinical assessment after a fragility fracture?
- Prior fragility fractures
- Parental hip fractures
- Glucocorticoid use
- Current smoking
- High alcohol intake (>3 units P/D)
- RA
- Falls in previous 12 months
- Gait/balance
What are some risk factors for falls?
- Reduced lower limb strength/impairments in gait/balance
- Cognitive impairment
- Incontinence
- Feet/footwear problems
- Syncope/dizziness
- Medications like antidepressants, antipsychotics
- Poor vision
- Environment
How do you fail the single leg stance test?
If you cannot complete all three trials of 10 seconds -> indicates significant sensory and strength impairment
How do you fail the Time Up and Go (TUG) test?
If a patient takes more than 15 seconds to stand up from a chair, walk 3m, turn and return to sit on the chair
What does a failed TUG test indicate?
Those with a high risk of falling
What % of community living people over 65 fall every year?
33%
What % of residential facilities/nursing home residents fall every year?
50%
WHat % of emergency admissions are accounted for falls in 65 year olds?
17%
What % of falls are responsible for hip fractures?
90%
What are some fall prevention strategies in the community dwelling elderly?
- Exercise - more than 2 hours per week
- High level balance based exercise i.e. Tai Chi
- High Dose Vit D if low
- Occupational therapy home visits
- Restriction of multifocal glasses in those who take part in outdoor activity
- Multifac assessments in high risk populations with targeted interventions
- Psychoactive medication withdrawal
- Expedited cataract surgery
- Podiatry intervention
What are evidence based fall strategies for elderly living in residential care?
- High dose Vit D
- Medication review
- Hip protectors - this is only a good practise point
WHat is associated with low bone mineral density in men over 50 and postmenopausal women?
BW 10% of 25 year old weight
WHat is the importance of height loss?
Increased risk of vertebral fracture
WHat is the significance of rib/pelvis distance?
Less than 2 finger breadths apart is associated with vertebral fractures
WHat percentage of 80 year olds have a vertebral body fracture?
50%
How many low-trauma vertebral fractures present?
No recognizable symptoms
- Self-limiting episode of back pain
- Thoracic kyphosis - excessive curvature of the spine
What is a fragility fracture?
Spontaneous fracture after minimal trauma falling from standing height or less
-Excludes craniofacial, hand, ankle and foot
What is the fracture cascade?
Minimal trauma fractures increase 2-4 times in likelihood after a fracture at any site
- approx half subsequent fractures occurred within 2 years of initial fracture
Define osteopororis
A disease characterised by low bone mass and microarchitectural deterioration of one tissue, leading to enhanced bone fragility and a consequent increase in fracture risk
How do you diagnose OP?
BMD T-score of -2.5 or lower in lumbar spine or hip
OR
Occurrance of one or more minimal trauma fractures in a patient over 50 years
WHat % of australians over 50 have OP or osteopenia?
66%
What % of fractures relating to osteoporosis and osteopenia are accounted for by men?
30%
What are the annual predicted costs of osteoporosis, osteopenia and fractures between 2013-2022
$33.6 billion
What is FRAX?
Fracture risk assessment tool
What does FRAX measure?
10-year probability of fracture
What do you need to use FRAX?
Country BMD from Fem-neck T-score Age Gender Clinical risk factors i.e. low BMI, previous frag fract, smoking, alcohol intake etc
How does RDI of calcium change as you get older?
Moves from 1000mg/day to 1300mg/day for women over 50 and men over 70
WHat kind of exercise is effective for OP?
- Weight-bearing i.e. walking, running, dancing, tennis
- Resistance training
- Balance/mobility
What kind of impact does a femoral neck fracture have?
Loss of confidence/fear of falling
