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35 Cards in this Set
- Front
- Back
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Three characteristics of osteoporosis?
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Loss of bone mass, deterioration of bone tissue, and disruption of bone architecture.
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What % of female caucasians will experience an osteoporosis-related fracture in their lifetime? Males?
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50% of females, 20% of males.
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What are three common fracture sights?
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Vertebrae (2/3 of which are asymptomatic, proximal femur (hip), and distal forearm.
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What are ten common medications that contribute to osteoporosis?
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Glucocorticoids, phenytion, cyclosporine, tacrolimus, chemotherpaeutic drugs, GnRH agonists, depo-medroxyprogesterone, lithium, heparin, and aromatase inhibitors.
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Eight common osteoporosis risk factors to consider?
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Advanced age, female gender, low BMI, family history of fractures, heavy smoking, excessive alcohol intake, inflammatory arthritis, medications.
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Five common risk factors for falling?
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Previous history of falls. muscle weakness. Balance and visual deficits. Environmental factors in home. Fear of falling.
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What does a dual-energy x-ray absorptiometry measure?
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Bone mineral density.
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Who should be screened for osteoporosis?
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women > 65 yo, men>70 yo, women and men aged 50-69 with significant risk factors for osteoporosis, any adult with a fracture after the age of 50 yo.
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What is required for the diagnosis of osteoporosis?
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T-score of </= -2.5 (BMD at least 2.5 SD below that of a young normal adult of same sex).
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What is required for the diagnosis of osteopenia (low bone mass)?
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T score of -1.0 to -2.5
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What are the three components of preventing and treatin osteoporosis?
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Lifestyle, dietary, and medications.
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What are the lifestyle changes that can help in treatment/prevention of osteoporosis?
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Regular weight-bearing and muscle-strengthening exercise. Avoidance of tobacco and excessive alcohol
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What are the dietary changes that can help in treatment/prevention of osteoporosis?
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Calcium intake (1200-1500 mg per day). Vitamin D (800-1200 IU per day)
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What is the recommended dose of Ca for treatment/prevention of osteoporosis? Vitamin D?
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1200-1500 mg per day. 800-1200 IU per day.
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Three reasons to give medications for osteoporosis?
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1) a history of hip or vertebral fracture 2) Osteoporosis on DXA 3) Osteopenia on DXA plus a 10-yr hip fx probability >/= 3% or or 10 yr osteoporosis-related fx probability >/= 20%
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Alendronate: Daily dose (cost)? Weekly? Monthly? Yearly?
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10 mg ($87.80). 70 mg ($81.95). NA. NA.
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Ibandronate: Daily dose (cost)? Weekly? Monthly? Yearly?
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2.5 mg ($100.12). NA. 150 mg ($100.11). NA.
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Risedronate: Daily dose (cost)? Weekly? Monthly? Yearly?
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5 mg ($99.02). 35 mg ($92.44). 150 mg ($100.15). NA
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Zoledronic acid: Daily dose (cost)? Weekly? Monthly? Yearly?
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NA. NA. NA. 5 mg ($1250 /infusion).
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Whatis the one year mortality for hip fracture?
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20-30%
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What is required for optimal outcomes after hip fracture?
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Surgical intervention.
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What should patients with hip fractures be evaluated for?
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Medical causes (including syncope)
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Four examples of decompensated medical conditions that keep patients with hip fractures from getting early surgery?
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Decompensated heart failure. Acute coronary syndrome. Uncontrolled rhythm disturbance. Severe valvular disease.
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What is early surgery of hip fractures associated with? (three things)
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Lower mortality, shorter length of stay, and fewer complications.
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What 8 key componenets are important in medical management of patients with hip fractures?
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Bone health and recurrent fracture prevention. Venous thromboemblism prevention. Pain management. Delirium. UTI prevention. Strength and mobility. Pressure sore prevention. Fall prevention.
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What is one of the most common causes of death after hip fracture?
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Fatal PE.
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Four prophylactic agents for VTE?
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LMWH. Warfarin. Heparin. Fondaparinux.
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What prophylactic agents should be used preoperatively if surgery will be delayed?
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LMWH or heparin.
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What is teh duration of prophylaxis after hip fracture surgery?
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beyond 10 days and up to 35
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What is inadequate pain control associated with in hip fractures? (three things)
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poor recover, longer stay, delirium.
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What % of hip fracture patients get delirium?
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10-40%
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When can indwelling catheters be removed after hip surgery?
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within 24 hours
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Can patients be allowed to bear weight after hip fracture surgery?
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Most can.
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Is physical and occupational therapy recommended after hip fracture surgery?
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Yes
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How can pressure sores be prevented?
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Minimized with attention to mobility and good nursing care.
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