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21 Cards in this Set
- Front
- Back
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What are the most common fractures associated with osteoporosis?
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Hip, spine and wrist
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What are the 6 lifestyle risk factors for osteoporosis?
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1. Low calcium intake
2. Low (or no) Vit. D in diet 3. High Caffeine intake 4. Tobacco use 5. Alcohol use 6. Immobilization |
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What are the seven biological risk factors for osteoporosis?
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1. Females > Males
2. Race - Caucasians and Asians 3. Age, increased risk starting at 30 4. Family History 5. Body Frame - Thin body frame/low weight 6. Post Menopause - decreased estrogen leads to increased risk of losing bone mass 7. Low Estrogen |
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What are the 4 medical risk factors for osteoporosis?
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1. Medication use - ie. steroids
2. Nutritional conditions - ie. anorexia, chronic liver disease 3. Endocrine disease or Metabolic cause - ie. thalassemia, uncontrolled DM 4. Other medical disorders - Down's syndrome, myeloma, RA |
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What are the signs and symptoms of osteoporosis?
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Usually asymptomatic until Fx occurs.
Compression Fxs occur - pain in the mid back, often stabilize by themselves and pain eventually subsides. Pain my persist if the crushed bone continues to move, Dowager hump (exaggerated kyphosis), Loss in height. |
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What are the laboratory findings with osteoporosis?
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Serum Ca - Normal
Serum phosphate - Normal PTH - Normal Vitamin D - Commonly decreased |
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What test measures bone density?
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DEXA bone scan - can not differentiate between osteoporosis and osteomalacia
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What are the two scores associated with the DEXA scan and what do they mean?
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T and Z score
T - Simplified way to report bone density, compares bone mineral density to young normal mean. Z - Describes bone density in premenopausal women, younger men and children. Gives standard deviation in comparision with age-matched, race-matched and sex matched means. |
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What are the score ranges for T-score?
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T score great than or equal to -1.0 = normal
-1.0 to -2.5 = Osteopenia < -2.5 = Osteoporosis < -2.5 w/Fx = severe Osteoporosis |
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What are two things that you must rule out in your differential diagnosis with osteoporosis?
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Bone marrow neoplasm such as myeloma
Metastatic bone disease |
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What are the _ treatments for osteoporosis?
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Vitamin D + sun exposure
Ca Supplementation Bisphosphonates - PO, IV Sex Hormones Selective Estrogen Receptor Modulators Calcitonin Teriparatide |
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This osteoporosis Tx inhibits bone resorption by osteoclasts by binding to active bone remodeling sites. Increases bone density significantly. Decreases risk of vertebral and non vertebral fractures.
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Biphosphonates
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When taking bisphosphonates what is the special instruction that should be followed?
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It has to be taken in the AM at least 30 minutes before consuming anything else to ensure intestinal absorption. Pt has to remain upright to reduce the risk of esophagitis.
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What are the three major PO bisphosphonate drugs?
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Alandronate (fosamax), Risedronate (actonel), Ibandronate sodium (boniva)
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What are the IV bisphosphonate drugs?
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Zoledronic acid (zometa), pamidronate (aredia)
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These drugs include Raloxifine, it prevents development of osteoporosis, increases bone density, decreases risk of vertebral fxs by 40%, does not decrease risk of non-vertebral fxs, does not decrease hot flashes, and the side effects are an increased risk of thromboembolism.
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Selective Estrogen Receptor Modulators
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This Participates in Ca and phosphorus metabolism. It is a nasal spray that is given in 1 puff, every day, alternating nostrils daily.
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Calcitonin
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This drug stimulates formation of new collagenous bone matris, patients must have sufficient intake of vitamin D and Ca, dramatically improves bone density in most bones except the distal radius. This is contraindicated in patients with a history of osteosarcoma or chondrosarcoma. This drug is given every day via SC injection.
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Teriparatide (Forteo, Parathar)
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What are 8 general measures for treating osteoporosis?
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1. Adequate protein, total calories, Ca and Vit. D intake
2. decrease or d/c corticosteroids 3. Avoid EtOH and smoking 4. Start high impact physical activity 5. Increase strength and balance 6. Use walker or cane 7. Brace or corset to protect spine 8. Hip protector |
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Hypogonadal women not on HRT must ensure what?
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Ensure adequate Vit D and Calcium intake
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Hypogonadal men w/prostate cancer who may not receive testosterone may benefit from?
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bisphosphonates
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