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19 Cards in this Set
- Front
- Back
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Etiology of OP
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Postmenopausal,
Senile, Disease states, Prolonged bed rest (at any point in their life) |
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Disease states associated with OP
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Cushings,
Hyperthyroidism*, Hyperparathyroidism*, Hyperprolactin states, Anorexia nervosa, Mal abdsorption, Severe liver disease, Metastatis neoplasm Multiple Myeloma** |
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Drugs assocaited with OP*
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Anticonvulsants (phenytoin),
Steroids, Thyroid hormone, Heparin (long-term) |
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What is the MC presentation of OP?
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Usually silent until fracture. MC are 1. vertebral compression fractures (wedge-shaped) and 2. Hip fractures
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Risk factors for OP
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Small white or asian female,
Early menopause, Smoking/ETOH, Poor Ca intake, Deconditioning/prolonged immobility, Family history |
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What is the work up for OP?
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H&P,
Hematology and chemistry studies, Check for associated diseases (MM w/ serum electrophoresis, bence jones proteins in urine, XR), Bone density measurements |
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Bone Densiometry levels in OP?
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Normal T score: -1 or greater,
Osteopenia: T score -1 to -2 Osteoporosis: T score < -2 |
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What does the T score compare you to?
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a normal 30 yo. Not as reflective of disease state. Z score uses age match controls but are not used as often.
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General management for OP?
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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. |
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Treatment options for OP?
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Estrogen replacement (for sxs only - not commonly used),
Sodium Fluoride (rarely - causes GI upset), Calcitonin spray, Bisphosphonates, Evista (not used) |
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Why does kathy like Calcitonin Spray (myocalcin)?
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Kathy likes it because it is also an analgesic.
Good especially for vertebral compression fractures. Can cause nasal irritation and HA. |
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Complications of Bisphosphonates?
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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) |
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When is bisphosphonates CI and relatively CI?
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Contraindicated in esophageal stricture and relatively CI in severe GERD.
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Complications of OP?
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Fracture,
Acute/chronic pain, Kyphosis (lead to restrictive lung dz, discomfort, & pressure wounds), Depression, Dependency, Deconditioning (causes more fx), Death |
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Prevention of OP?
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Start young with education,
Use BMD when needed (w/ chronic steroid use or on anticonvulsant), Avoid risks where possible. |
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MC location of vertebral compression fracture?
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Involves the thoracic spone,
T -10 is the most common. |
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Presentation of vertebral compression fractures?
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Acute pain, +/- radiation to anterior torso,
Point tenderness, Schorl's nodules (seen as the 'triangle' on XR). |
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Treatment for compression fractures?
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Pain relief: Miacalcin*, mild analgesics/narcotics, kyphoplasty (very effective but increase risk for surrounding vertebrae).
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Treatment for unstable compression fracture?
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Back brace - the only time you use this is with UNSTABLE!
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