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19 Cards in this Set

  • Front
  • Back
Etiology of OP
Postmenopausal,
Senile,
Disease states,
Prolonged bed rest (at any point in their life)
Disease states associated with OP
Cushings,
Hyperthyroidism*,
Hyperparathyroidism*,
Hyperprolactin states,
Anorexia nervosa,
Mal abdsorption,
Severe liver disease,
Metastatis neoplasm
Multiple Myeloma**
Drugs assocaited with OP*
Anticonvulsants (phenytoin),
Steroids,
Thyroid hormone,
Heparin (long-term)
What is the MC presentation of OP?
Usually silent until fracture. MC are 1. vertebral compression fractures (wedge-shaped) and 2. Hip fractures
Risk factors for OP
Small white or asian female,
Early menopause,
Smoking/ETOH,
Poor Ca intake,
Deconditioning/prolonged immobility,
Family history
What is the work up for OP?
H&P,
Hematology and chemistry studies,
Check for associated diseases (MM w/ serum electrophoresis, bence jones proteins in urine, XR),
Bone density measurements
Bone Densiometry levels in OP?
Normal T score: -1 or greater,
Osteopenia: T score -1 to -2
Osteoporosis: T score < -2
What does the T score compare you to?
a normal 30 yo. Not as reflective of disease state. Z score uses age match controls but are not used as often.
General management for OP?
Educate about fall risk,
Calcium and vitamin D (increase dosage postmenopause),
Weight bearing exercises* (most important to decrease falls and increase bone formation).
Stop Smoking.
Treatment options for OP?
Estrogen replacement (for sxs only - not commonly used),
Sodium Fluoride (rarely - causes GI upset),
Calcitonin spray,
Bisphosphonates,
Evista (not used)
Why does kathy like Calcitonin Spray (myocalcin)?
Kathy likes it because it is also an analgesic.
Good especially for vertebral compression fractures.
Can cause nasal irritation and HA.
Complications of Bisphosphonates?
Bone, joint and muscle pain, “Funky femoral fracture” (occur w/ minimal/no trauma & show cortical thickening),
Osteonecrotic Jaw* (go to dentist for procedures BEFORE starting treatment),
Esophagitis/esophageal erosions (take with full glass of water and completely swallow)
When is bisphosphonates CI and relatively CI?
Contraindicated in esophageal stricture and relatively CI in severe GERD.
Complications of OP?
Fracture,
Acute/chronic pain,
Kyphosis (lead to restrictive lung dz, discomfort, & pressure wounds),
Depression,
Dependency,
Deconditioning (causes more fx),
Death
Prevention of OP?
Start young with education,
Use BMD when needed (w/ chronic steroid use or on anticonvulsant),
Avoid risks where possible.
MC location of vertebral compression fracture?
Involves the thoracic spone,
T -10 is the most common.
Presentation of vertebral compression fractures?
Acute pain, +/- radiation to anterior torso,
Point tenderness,
Schorl's nodules (seen as the 'triangle' on XR).
Treatment for compression fractures?
Pain relief: Miacalcin*, mild analgesics/narcotics, kyphoplasty (very effective but increase risk for surrounding vertebrae).
Treatment for unstable compression fracture?
Back brace - the only time you use this is with UNSTABLE!