Term
| to be considered osteoporosis bones mass has to meet this criteria: |
|
Definition
| more than 2.5 SD below peak bone mass |
|
|
Term
| primary etiology of osteoporosis: |
|
Definition
|
|
Term
| which part of the bone thins first? trabecular or cortical: |
|
Definition
| trabecular (spongy) followed by cortical thinning |
|
|
Term
| pathophysiology of osteoporosis: |
|
Definition
| decreased calcium levels cause the rsorption of ca++ from bones, osteoclasts brak down the matrix to release the Ca++ into the circulation. It all begins with parathyroid hormone |
|
|
Term
| major risk factors for osteoporosis: |
|
Definition
1. menopause
2. caucasian or asian
3. low body weight
4. not using hormone therapy/Ca++/V. D
5. Etoh/tobacco |
|
|
Term
| correlate BMI with RF hip fx: |
|
Definition
| The lower the BMI the greater risk of Fx |
|
|
Term
| 3 spinal formations assoc w osteoporosis: |
|
Definition
1. lordosis
2. kyphosis
3. scoliosis |
|
|
Term
| fractures that the pt may be unaware of: |
|
Definition
|
|
Term
| most accurate and precise dx imaging: |
|
Definition
| DEXA; dual energy x-ray absorptiometry |
|
|
Term
| osteopenia is defined as: |
|
Definition
| btwn 1-2 SD of peak density |
|
|
Term
| serum lab test to identify secondary causes of osteoporosis:3 |
|
Definition
1. 25-OH Vit D
2. PTH & ionized Ca++
3. TSH |
|
|
Term
| recommended dietarty tx for osteoporosis: |
|
Definition
1. 12-1500mg/day Ca++
2. 800mg/day Vit D |
|
|
Term
| lifestyle recommendations for osteoporosis: |
|
Definition
1. regular physical activity (aerobic and weight bearing)
2. smoking cessation
3. reduce etoh intake |
|
|
Term
| who are candidiates for medical therapy in osteoporosis? |
|
Definition
1. density score below 2.5 SD
2. density score below 1.5 SD w RF
3. pts w vertebral or hip fx |
|
|
Term
| therapeutic options for osteoporosis: |
|
Definition
1. bisphosonates (Alendronate, ..dronate, etc.)
2. hormone replacement
3. selective estrogen receptor modulators SERMs (riloxifene)
4. Calcitonin
5. PTH analogs (teriparatide) |
|
|
Term
| bisphosphonates mechanism of action: |
|
Definition
| inhibits bone resorption by reducing the recruitment of osteoclasts and increasing apoptosis = increases bone mineral density and decreases fx |
|
|
Term
| risk factors for hormone replacemnt therapy: |
|
Definition
1. breast CA
2. stroke
3. thrombosis
4. CVD |
|
|
Term
| do you continue with hormone replacement therapy once osteoporosis has been dx? |
|
Definition
|
|
Term
| with estrogen only tx there is an increased risk for: |
|
Definition
|
|
Term
| mechanism of action for SERM: |
|
Definition
| estrogen agonist on bone and lipid metabolism in the breast and endometrium |
|
|
Term
| SERMs reduce the risk of: |
|
Definition
| vertebral fx but have not been shown to reduce the risk of non-vertebral fx |
|
|
Term
| SERM: example and dosing: |
|
Definition
| Raloxifene 60mg once daily |
|
|
Term
| who are candidates for calcitonin? |
|
Definition
| osteoporitic women who have been post-menopausal for >4yrs |
|
|
Term
| calcitonin mechanism of action: |
|
Definition
|
|
Term
|
Definition
| 200 IU daily (intranasal spray) |
|
|
Term
| mechanism of action for parathyroid analogs: |
|
Definition
| stimulate osteoblasts improve bone density and microstructure |
|
|
Term
| place in therapy for PTH analogs: |
|
Definition
| tx for postmenopausal osteoporosis in women at high risk for fx |
|
|
Term
| PTH analog: example and dosing: |
|
Definition
| Teriparatide 20 micrograms/daily SQ |
|
|
Term
|
Definition
|
|
Term
| clinical PEARL about Ca++ absorption: |
|
Definition
| can only absorb 500mg of Ca++ at one time - multiple doses throughout the day |
|
|
