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32 Cards in this Set
- Front
- Back
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... – most common metabolic bone disease in the elderly
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osteoporosis
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Osteoporosis - Systemic skeletal disease characterized by low ... and microarchitectural deterioration of bone tissue
Osteoporosis -Low bone mass (weak) -Quality of the bone is okay Consequences: -Bone fragility -Fracture ... - Quality of the bone itself is affected |
bone mass
Osteomalacia |
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...:
-Up to 2 standard deviations below young normal females ...: -Below 2 standard deviations |
Osteopenia
Osteoporosis |
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...:
-BMD 1-2.5 standard deviations below young normal female mean (T score) ...: -BMD over 2.5 standard deviations below young normal female mean |
Osteopenia
Osteoporosis |
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bone strength = bone ... + bone ...
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density, quality
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Physical Exam
-Height, weight -Gait, mobility -Kyphosis evaluation -... of spine—(examine for possibility of vertebral fx.) -Signs of ... use (asthmatic inhalers with inhaled ... can result in osteoporosis/osteopenia) |
Percussion
steroid steroids |
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what are these?
Glucocorticoids Excessive thyroid replacement Anticonvulsants Gonadotropin agonists Depot progestational contraceptives Heparin |
Drug causes of osteoporosis
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Risk factors: men
-one of the most common causes of osteoporosis in men is low ... levels -50%-60% of men with osteoporosis have disorders known to produce bone loss including hyperparathyroidism, intestinal disorders, malignancies, and conditions resulting in immobilization |
testosterone
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Prevalence and Epidemiology
In the US, 8 million women and 2 million men have ... An additional 34 million Americans currently have low bone mass (...) In the US, approximately ... of women and one-fourth of men aged 50 years or older will suffer an osteoporosis-related fracture within their lifetime |
osteoporosis
osteopenia half |
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Imbalance of ... and ... leads to osteoporosis
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osteoblasts and osteoclasts
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Biochemical markers of bone metabolism:
Formation -Serum osteocalcin -Serum bone specific ... Resorption -Free deoxypyridinoline -Urinary collagen type I cross-linked N-telopeptide -Urinary collagen type I cross-linked C-telopeptide |
alkaline phosphatase
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Spinal osteoporosis: clinical features:
-Some have no early warning symptoms -... loss -Dorsal ... (increased curvature) -Paraspinal muscle pain -Restrictive lung disease -Protuberant lower abdomen with early satiety, bloating, and nausea |
Height
kyphosis |
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Bone mineral density accounts for about ...% of bone strength
measured by ... scan -Measures density in radius, lumbar spine and greater trochanter -Mass of bone mineral in the path of the beam divided by the cross sectional area of the beam, expressed as g/cm2 |
70
DXA |
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Fracture risk ... by 2.6% with drop in 1 SD in BMD
Not .... 10% increase fx risk with -2.5 SD in BMD Usually fracture in distal forearm, hip or spine -...: Most common nonvertebral fracture in white women until age 75 -...: Usually from compressive loading, can be painless |
increased
linear Distal forearm Spine |
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Potential utility of Bone Density Measurement
-Assess ... fracture risk -Confirm diagnosis of osteoporosis -Monitor effects of ... -Assess rate of bone loss -Enhance patient acceptance of and ... with treatment |
future
treatment compliance |
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... - > or equal to -1.0 SD
... - -1.0 to -2.5 SD ... - < or equal to -2.5 SD ... - < or equal to -2.5 SD (with fragility fractures) |
normal
osteopenia osteoporosis severe osteoporosis |
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What are these?
Calcium, Vitamin D . Exercise, Bisphosphonates, Calcitonin, PTH. Estrogen |
treatments for osteoporosis
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Sunscreens block production of Vitamin ...
in the skin • Vitamin ... supplementation is advisable for those unable to have sun exposure without sunscreen or who are housebound or live in northern latitudes |
D
D |
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intake of Vitamin D should be between ...-... IU/day
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400-800
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NOF Recommendations for Initiation
of Pharmacologic Therapy Initiate therapy to reduce fracture risk in women with: • BMD T-scores below –2.0 by central DXA with no risk factors • BMD T-scores below –1.5 by central DXA with one or more risk factor • History of a prior vertebral or hip fracture that is a ... fracture (fracture sustained without any major trauma) |
fragility
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...:
-Alendronate, risedronate, and ibandronate are approved for use in osteoporosis -are classified as antiresorptive medications - bind to hydroxyapatite crystals in bone and osteoclast-bone interface, inhibiting osteoclast activity - inhibit resorption of bone and lead to increases in bone density and reduced fracture risk -Agents that decrease osteoclastic activity (bone resorption) |
Bisphosphonates
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Bisphosphonates:
Use when T score below ... SD from normal Poorly ... -Take in AM -30 minutes before PO -Standing up or upright in bed (highly irritable to esophagus) -With 8oz plain water (no juice, no other meds) -Daily, weekly or monthly -Use with Calcium/Vitamin D |
2.0
absorbed |
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...:
-Monthly bisphosphonate -q 3 month IV option -Same administration routine except take it 1 hour before 1st meal -Comparable results (50%) in vertebral fracture reduction in those with and without hx fx |
Ibandronate (Boniva)
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...:
- is classified as an antiresorptive medication -In controlled clinical trials, reduced the risk of vertebral fractures -is prescribed for women who are at least 5 years postmenopausal and are unable to tolerate other osteoporosis medications -has been shown to decrease risk of vertebral fracture but efficacy has not been demonstrated for nonvertebral fractures -Administration is as a nasal spray or injectable |
Calcitonin
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Calcitonin:
-32 amino acid peptide -Nasal spray 200IU/spray -1 spray per day, q o nostril -Used for ... -Not very effective as monotherapy for future fracture reduction |
analgesia
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... is a selective estrogen receptor modulator that acts as an estrogen agonist on bone but acts as an estrogen antagonist on both the breast and uterus.
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Raloxifene
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• Raloxifene is approved for the prevention
and treatment of ... Osteoporosis • In controlled clinical trials, raloxifene prevented bone loss in the spine and reduced the risk of spine fractures |
postmenopausal
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Parathyroid Hormone (1-34) (PTH) or Teriparatide
• PTH (1-34) is classified as an anabolic agent that ... new bone • PTH (1-34) is administered daily by ... injection • PTH (1-34) decreases the risk of vertebral fractures and nonvertebral fragility fractures after an average of 18 months of therapy |
builds
subcutaneous |
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PTH (Forteo)
34 amino acid recombinant PTH SC qd Bone ... stimulator ... BMD effect Cost $500/mo—2nd line |
formation
Linear |
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Teriparatide Indications
... women with osteoporosis at high risk of fracture Men with primary or hypogonadal osteoporosis at high risk of fracture “High-risk” includes: – Men and women with previous osteoporotic fracture(s) – Men and women with ... risk factors for fracture – Men and women with extremely low ... (-3 and below) – Those who are unresponsive or intolerant to other osteoporosis therapies |
Postmenopausal
multiple BMD |
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Teriparatide Administration
Teriparatide is available as a daily ... Patients are taught to self-administer the medication that comes in a pre-filled, metered 28-day syringe |
Injection
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...:
-Clinically presents as a nonhealing tooth extraction or exposed bone in the jaw progressing to bone infection -Cancer patients have 4X higher risk of getting this due to concomitant radiation, chemo, steroids -To May 2004, FDA Adverse Event Reporting Database found 152 cases associated with all bisphosphonates -<1/10,000 patients -Associated primarily with IV bisphosphonate use in cancer patients undergoing dental procedures -ONJ precaution labeling has been added to all bisphosponates -Risk factors: CA with chemo, radiation, anemia, infection -1 case so far of ONJ without cancer hx |
osteonecrosis of the jaw
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