Flashcards in Nutritional Metabolic and Endocrine Deck (106)
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1
what is the most common metabolic bone disorder
osteoporosis
2
what is defined as skeletal disease characterized by low bone mass and micoarchitectural deterioration of bone tissue with increase in bone fragility and susceptibility to fracture
osteoporosis
3
what is osteoporosis
what bones are affected
reduction in bone quantity - decreased bone density -
normal bone just not enough of it
axial skeleton and long bones
4
what is osteopenia
poverty of bone causes increased radiolucency of bone
5
what is regional osteoporosis
what is this due to
decrease bone density in region or segment of body - limb or portion of limb
immobilization after fracture
complex regional pain syndrome - reflex sympathetic dystrophy
6
transient osteoporosis of the hip is seen on what imaging
bone scan - hot
T1 - diffuse zone of low signal intensity - edema
T2- high signal - edema
7
what is localized osteoporosis
causes
focal loss of bone density affecting a small area of bone
inflammatory arthropathy
neoplasm
infection
8
what is senescent osteoporosis
senile or old age osteoporosis
9
what does bone mass start decreases
what percent is lost per year? cortical and trabecular
what percent is lost by age 65
at menopause, bone loss accelerates to what fold? what percent per year
>35 years old
1% of bone mass lost per year of cortical bone
2% of bone mass lost per year of trabecular bone
20-40% of bone mass lost by age 65
menopause - 10 fold increase - 20 fold increase in lumbar spine - 6% lost per year
10
reduction in skeletal mass is gradual and is clinically evident in the __ decades of females life and __ decades of males
females - 5th and 6th decade
males - 6th and 7th decade
11
are men or women more affected by osteoporosis
at what age is the ratio equal
women MC 4:1
age 80 M=F
12
what are the risk factors and things than prevent osteoporosis
stay active and get exercise
eat protein, calcium, vitamin c
dont drink excessively
take estrogen after menopause
vitamin d
13
what are complications of osteoporosis
spinal cord compression fractures
increase thoracic kyphosis
fractures - femur, ribs, humerus, radius
14
incidence of __ fracture __ every __ years after the age of __ with osteoporosis
hip fracture
doubles
5 years
age 60
15
what are complications of bisphosphonates
example of drug
subtrochanteric femoral fracture - atypical stress fractures in femur diaphysis
alendronate
fosamax
actonel
16
what is the swedish study
2009 swedish study
study performed by Aspberger
incidence of mid femur stress fracture is 50x higher for patients on bisphosphonates
17
if osteoporotic patient presents with pain on coughing sneezing and straining what should you consider
acute compression fracture
18
progressive angular kyphotic deformity within a year of spinal compression fracture results in what
spinal stenosis
19
neurological abnormalities are __ with spinal compression fractures
infrequent
20
what is (percutaneous) vertebroplasty
results
complications
polymethylmethacrylate PMMA (acrylic bone cement) is injected into vertebral body to stabilize and strengthen collapsed vertebrae - outpatient
immediate and substantial results in perception of pain and function - strengthen and stabilize vertebrae
may have nerve root pain from leakage of injected material
21
20% of patients with osteoporosis compression fracture will experience what within 1 year
another fracture
22
what uses a balloon dilatation of vertebral body with subsequent instillation of polymethylmethacrylate
kyphoplasty
emphasis on balloon
23
what is a kyphoplasty procedure like
surgeon inserts catheter into vertebrae and then inserts and inflates a small balloon - this creates a cavity as it inflates - balloon is deflated and withdrawn from vertebrae - surgeon inserts needle into catheter to deliver cement into cavity - cement hardens and provides immediate stability
24
in weight bearing joints, preferential resorption of non essential supporting trabeculae occurs during bone loss with sparing of the most important trabeculae that are oriented ___
vertically - most important - they are spared in osteoporosis
25
what are some features of single photon absorptiometry
- high false negative rates - unreliable
- 2-5 mRad
- single photon emitted that is attentuated through bone - calcaneus or radius
- equal degree of association with vertebral osteoporosis
26
what are some features of dual photon absorptiometry
- photons emitted at 2 different levels
- applied to spine and proximal femur
- influenced by osteophytes, scoliosis, vascular calcifications, sclerosis
- 5-15 mRad
- low radiation dose to the patient
- high resolution images have been useful for evaluating vertebral fractures
ALSO CALLED DEXA!
dual energy xray absorptiometry
27
DEXA scores are reported as what
and what do these scores mean
T score and Z score
T score - comparison of bone density with that of a 30 year old of the same sex
Z score - comparison of bone density with that of an average person of same age and sex
28
what do the T scores of a DEXA scan indicate
T score
> -1 = normal
-1 to -2.5 = osteopenia
< -2.5 = osteoporosis
29
what do the Z scores of a DEXA scan indicate
< -2 = may indicate something other than the aging process is causing abnormal bone loss
30
