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53 Cards in this Set
- Front
- Back
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Where does osteoporosis occur in the bone?
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trabecular bone
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what is osteoporosis?
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Osteoporosis is a systemic skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in fragility of bone and susceptibility to risk of fracture.
Osteoporosis occurs when the holes between the bone become bigger, making it fragile and easier to break. |
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In who is osteoporosis most common?
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--women who have had early oophorectomy or POF (premature ovarian failure or ovarian HYPOfunction)
--Whites, then Asians, Hispanics and African Americans |
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which fractures are most common in osteoporosis?
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Most common fractures are the wrist, spine, and hip
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What is the pathophysiology of osteoporosis?
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Inadequate calcium intake results in chronic calcium deficiency, which is an important cause of reduced bone mass and osteoporosis. Most of the calcium (99%) in the body is found in the skeleton.
Over time the ability of bone to take in more calcium decreases. Poor intestinal absorption of calcium as well as the effect of certain drugs and metabolic conditions also contributes to reduced bone mass and osteoporosis. |
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Good food sources of calcium
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The best food sources of calcium are milk and milk products (such as cheese, yogurt, cottage cheese), which also have added vitamin D needed for calcium to be absorbed from the intestinal tract.
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CALCIUM AND VITAMIN D REQUIREMENTS for 51-70 years old
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1,200 mg calcium (120% DV) 400 IU vitamin D (100% DV)
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CALCIUM AND VITAMIN D REQUIREMENTS for over 70 years old
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1,200 mg calcium (120% DV) 600 IU vitamin D (150% DV)
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what happens to stomach acid as we age?
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we have less of it
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how are calcium carbonate supplements dissolved?
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needs acid to dissolve and and for absorption
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when are calcium carbonate supplements taken?
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Often taken at meals when more stomach acid
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does calcium citrate require stomach acid for absorption?
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no
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does calcium carbonate supplements require stomach acid to dissolve?
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yes
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when are calcium citrate supplements taken?
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anytime
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which cost more - calcium carbonate or citrate?
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citrate
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risk factors for osteoporosis
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early menopause (before 45) - estrogen loss
smoker poor health underweight for height (slender body size) has never taken calcium more than 2 drinks ETOH per week a fall in the last year or multiple falls physically inactive close relatives with osteoporosis - family Hx eating disorders abnormal/absent menstrual periods hyperthyroidism vit D deficiency medications advanced age chronic medical conditions |
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medical conditions assoc with osteoporosis
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Chronic lung disease
Cancer Inflammatory bowel disease Chronic liver or kidney disease Hyperthyroidism Hyperparathyroidism Vitamin D deficiency Cushing's disease Multiple sclerosis Rheumatoid arthritis |
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how do older people fall?
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collapse downward, often landing on a hip because there is little forward momentum
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symptoms of osteoporosis
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--Minimal symptoms
--Bone loss leads to reduced skeletal strength --More susceptible to fractures --Most common site of fracture is vertebral body --Fractures can also occur in the hip, upper femur and distal forearm, humerus and ribs |
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normal T score
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between 0 and -1
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T score for osteopenia
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T Score between -1 and -2.5 indicates the beginning of bone Loss (osteopenia)
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what is the most predictive test for osteoporosis?
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bone densitometry (density measurement)
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how are bone mineral density results reported
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T and Z scores
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What is the T score
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number of standard deviations above or below the mean bone mineral density for gender-matched young controls
Compares bone density with that of healthy young women |
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what is the Z score
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Compares the patient with a population adjusted for age and gender
Compares your bone density with that of other people of your; Age Genger Race |
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who are bone mineral density measurements recommended for?
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All postmenopausal patients younger than age 65, who have one or more additional risk factors for osteoporosis
All women age 65 years and older regardless of additional risk factors Postmenopausal women who present with fractures Women considering therapy for osteoporosis if testing would facilitate the decision Women who have been on hormone replacement therapy for prolonged periods |
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does bone mineral density predict the certainty of developing a fracture?
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no, just the risk of it
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Why is BMD important to see the risk of fracture
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Absolute amount of bone as measured by BMD testing generally correlates with bone strength and its ability to bear weight
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what is DEXA and what are the types
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Dual-energy X-ray absorptiometry
two types: central and peripheral |
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What occurs during CENTRAL DEXA
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Lay on a soft table and the scanner passes over your lower spine and hip
*Best to predict your risk of fractures* |
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what is peripheral DEXA
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Smaller machine measures bone density in your
Wrist Fingers, Leg or heel |
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What is the T score of osteoporosis
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T score of -2.5 indicated osteoporosis
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T and Z scores:
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In either score a negative number means you have thinner bones that the standard.
The more negative the number, the higher your risk of a bone fracture |
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Prevention/treatment of osteoporosis
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1200 mg Ca per day
pharmacologic therapy for patients with BMD under -2 with no risk factors OR with T score under -1.5 with risk factors regular weight bearing exercises Vit D 400-800 IU/d stop smoking and avoid alcohol |
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current pharm treatments for osteoporosis
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bisphosphonates
calcitonin estrogens (with or without progestins) PTH raloxifene annual IM injections of Vit D |
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how does calcitonin work in the body to prevent osteoporosis
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Calcitoin prevents bone loss by inhibiting bone resorption
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how does estrogen work in the body to prevent osteoporosis
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Estrogen increases calcium absorption increases calcitonin, and increases vitamin D receptors
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how do bisphosphonates work
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Potent antiresorptive agents that bind to hydroxyapatite crystals on the surface of bones --> enter osteoclasts and decrease resorptive actions by reducing the production of hydrogen ions and lysosomal enzymes
Indirect effects causing osteoblasts to produce substances that inhibit osteoclasts Increase bone mineral density at the spine, wrist and hip in a dose dependent manner and decrease the risk of vertebral fractures by 30-50% |
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What are the three bisphosphonates that are currently available
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Alendronate
Risedronate Ibandronate |
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which bisphosphonates are for postmenopausal women
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Risedronate
Ibandronate |
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how should bisphosphonates be taken by the patient
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Intestinal absorption of bisphosphonates is poor and therefore these medications should be taken in morning with 8 ounces of water, prior to consumption of any food or beverage
Nothing else should be taken by mouth for at least 30-60 minutes after oral dosing Patient should remain upright for 30 minutes after taking the medication |
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how does calcitonin work in the body
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Peptide hormone that inhibits osteoclast activity and therefore inhibits bone resorption
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for which patients is calcitonin therapy preferred
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Preferred therapy in patients with pain from vertebral fracture, due to calcitonin’s analgesic properties
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Is osteoporosis prevention an FDA-approved indication for estrogen therapy?
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Yes but it is not first line
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for which patients with PARATHYROID HORMONE, TERIPARATIDE (PTH{1-34}) indicated
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FDA approved for use in women and men who are at high risk for fracture
Despite its potential deleterious effect on bone, intermittent administration of recombinant PTH stimulates bone formation and clinical trial support its use in treatment of osteoporosis |
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how is PTH administered
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daily injections which are costly
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What are SERMS
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Selective estrogen receptor modulators
Nonhormonal agents that bind to estrogen receptors and may exhibit either estrogen agonist or antagonist activity. |
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what are the risks of PTH injections?
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Possible risk for osteosarcoma
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What SERMS are available on the market
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tamoxifen, toremifene, and raloxifene
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which SERM is for the prevention and treatment of osteoporosis
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Raloxifene
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what is the MOA of raloxifene
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It exhibits estrogen agonist properties in the bone (inhibits osteoclast function)
Raloxifene 60 mg daily for 24 months is associated with 1-2% increase in lumbar spine and hip bone density |
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Causes of breast lumps
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–Infections
–Injuries –Non-cancerous growths –Cancer |
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risk factors for breast cancer
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The most significant risk factors for breast cancer are gender (being a woman) and age (growing older).
white race first degree relative BRCA 1 or BRCA 2 previous history of endometrial cancer previous history of contralateral cancer early menarche late menopause nulliparous or late first pregnancy |
