pc5 2.3/2.4 calcium/osteoporosis

dietary intake, Ca absorption in Small intestine, excretion of Ca in urine

what influences Ca ecf

bones

reservoir for Ca

decreases firing rate

does increased blood Ca increases or decreases the CNS firing rate

increased firing rate

does decreased blood Ca increases or decreases the CNS firing rate

excitation, contraction

Ca is need for muscle cell ___

blood clotting, platelet adhesion

what role does Ca play in blood

forms hydroxyapapatie

(important in bone formation)

what role does Ca play in bone/teeth

bound and unbound clacium

extracellular calcium that is measured includes what

albumin

calcium labs need to be adjusted based on what

serum Ca + [ 0.8 x (4-albumbin)]

corrected Ca

pH corrected ionized calcium

most accurate lab test for calcium

PTH, vitamin D, calcitonin

3 regulators for calcium levels

PTH, vitamin D

what regulators increase plasma calcium levels

calcitonin

what regulators decrease plasma calcium levels

moves ca from bone to blood, increases Ca uptake in kidneys, converts vitamin D to active form

how does PTH raise Ca levels

calcitriol

what is vitamin D's active form

increases calcium absorption from food

how does calcitrol regulate calcium

D3-cholecalciferol

vitamin D form in animal products

D2-ergocalciferol

vitamin D form in plant sources

calcidiol

vitamin D storage form

through cells-active, between cells-passive

what routes are there for Ca absorption across the intestinal epithelium

calcitrol

the active route of Ca absorption across the intestinal epithelium is influenced by what

calbindin

the active route of Ca absorption across the intestinal epithelium utilizes what transporter

decrease Ca absorption

what do loop diuretics do for Ca absorption

increase Ca absorption

what do thiazide diuretics do for Ca absorption

thyroid gland

calcitonin is produced by what

high blood calcium

calcitonin is made in response to what

inhibits resorption of Ca from bone to lower Ca level

what does calcitonin do

under 8.5

hypocalcemia is defined as what Ca levels

neuromuscular, neurlogic, HF, under mineralization, dry brittle nails, soft enamel

(CATS)

signs and symptoms of hypocalcemia

electrolytes, PTH, vitamin D< EKG, chovstek's sign, trosseau's sign

what is used to assess hypocalcemia

replace Ca, treat cause

hypocalcemia tx

over 10.5

hypercalcemia is defined as what level

excessive thirst, frequent urination, n/v, constipation, bone pain, muscle weakness, fatigue, kidney stones, HTN, shortened QT interval, depression, lethargy, psychosis

(painful bones, renal stones, abdominal groans, psychic moans)

signs and symptoms of hypercalcemia

malginancy, primary/secondary hyperparathyroidism, increase ca, granulomatous, thiazide diuretic, immobilizaiton

causes of hypercalcemia

primary hyperparathyroidism

adenoma in one or more parathyroid gland, or hyperplasia of all four glands

seoncdary hyperaparathyroidism

chronic renal diseas

PTH levels

what is assessed in hypercalcemia

decrease intestinal Ca absorption, increase urinary ca excretion, decrease bone resorption, remove excess ca through dialysis

4 main strategies for lowering serum calcium

calcitonin, bisphosphonates, IV fluids + loop diuretics, hemodialysis

tx options for hypercalcemia

osteoporosis

skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture

calcium and phosphorus

parathyroid helps balance what levels

primary or secondary hyperparathryoidism

causes of hyperparathyroidism

malignancy

primary hyperparathryoidism is caused by what

severe calcium deficiency, severe vitamin D deficiency, chronic kidney failure

secondary hyperparathryoidism is caused by what

most often asymptomatic, if not fatigue, depression, aches, loss of appetite, n/v, constipation, confusion

symptoms of hyperparathyroidism

serum Ca, PTH level, vitamin D level, 24 hour calcium

assessment of hyperparathyroidism uses what

calcimimetic, surgery, avoid thiazide diuretics

tx for hyperparathyroidism

acquired, autoimmune, hereditary, cancer radiation, low Mg

causes of hypoparathyroidism

paresthesia, muscle aches, twiching, fatigue, weakness, patchy hair loss, dry skin, ha, depression

symptoms of hypoparathyroidism

Ca, PTH, phosphate, 24h urinary ca

what is evaluated in assess ment of hypoparathyroidism

calcium, vitamin D, thiazide diuretics

tx for hypoparathyroidism

yes

is mild/moderate vitamin D deficiency asymptomatic

hypocalcemia, impaired mineralization of skeleton, proximal myopathy

long standing vitamin D deficiency results in what

dementia, prostate cancer, ED< schizophrenia, heart disease

vitamin D deficiency is linked to what other diseases

decreased nutritional intake, obesity, malasbsorption, genetic disorders, hospitalized/institutionalized pts, geriatrics

groups at risk of vitamin D deficiency

rickets

vitamin D deficiency manifestations in children

osteomalacia, biochemical changes

vitamin D deficiency manifestations in adults

phenytoin, phenobarbital, carbamazepine, isoniazid, rifampin, theophylline, PPIS, H2RAs

what medications can induce vitamin. D deficiency

200-600 IU

daily allowance of vitamin D

800 IU

daily allowance of vitamin D over 70

yes

do older persons confined to indoors or other high risk groups require more vitamin D

1000 IU

NOF and AGS suggest how much vitamin D if over 65 yo

fortified cerals, dairy, egg yolks, salmon, mackeral

dietary sources of vitamin D

osteoclasts resorb bone then osteoblasts form bone

bone remodeling cycle

CTX, PINP

bone turnover markers

CTX

target of antiresorptive tx

PINP

target of anabolic agents

18-25

(small gains to 30)

peak bone mass occurs when

age, female, caucasian, asian, menopause, medical conditions, family history, previous fracture

non modifiable risk factors for osteoporosis

low calcium/vitamin D, inadequate physical activity, current cigarette smoking, alcohol, low weight/BMI, glucocorticoid use, fall risk

modifiable risk factors for osteoporosis

aluminum antacids, anticonvulsants, aromatase inhibitors, canagliflozin, furosemide, glucocorticoids, heparin, hiv m eds, medroxyprogesterone, PPI, SSRI, thiazolidedione, thyroid

what medications make osteoporosis more likely

T score

what compares bone mineral density of patient to BMD of healthy young adult

-1 or higher

what T score is normal

-1 to -2.5

what T score is osteopenia/low bone mass

-2.5 or less

what T score is osteoporosis

z score

compares BMD of patient to mean BMD of patients of same age, sex, and ethnicity

secondary causes

z score helps identify what

fracture of spine or hip, T score of -2.5 or below, T score between -1 and -2.5 and fragility fracture of humerus/pelvis/forearm, T score between -1 and -2.5 and high frax probability

diagnostic criteria for osteoporosis

3% or higher

what frax probability for hip fracture is diagonistic with a T score between -1 and -2.5

20% or higher

what frax probability for major osteopororisis related fracture is diagonistic with a T score between -1 and -2.5

-2.5 or less at spine, femoral neck, total hip, or 1/3 radius

what T score classifies one as High risk osteoporosis

-3.0 or less

what T score classifies one as VERY High risk osteoporosis

3% or more hip or 20% or more major osteoporortic fracture risk

what FRAX score classifies one as High risk osteoporosis

4.5% or more hip or 30% or more major osteoporortic fracture risk

what FRAX score classifies one as VERY High risk osteoporosis

prior fragility fracture of hip or spine (with T score -1 to -2.5)

what fracture history classifies one as High risk osteoporosis

recent fracture or multiple fractures

what fracture history classifies one as VERY High risk osteoporosis

very high risk

does fracture while on approved therapy stratify a patient into high or very high risk osteoporosis

very high risk

does fracture while on drugs causing skeletal harm stratify a patient into high or very high risk osteoporosis

very high risk

does high risk of falls or history of injurious falls stratify a patient into high or very high risk osteoporosis

prevention, calcium/vitamin D intake, weight bearing and muscle strenghtening exercise, counsel on risks, smoking cessation, avoid excess EtOH, avoid problematic meds

universal recommendations for osteoporosis management

dietary

for calcium sources are dietary or supplements preferrered

1000mg daily

recommendation for calcium intake for adult 50 yo+

1000mg daily

recommendation for calcium intake men 50-70 yo

1200 mg daily

recommendation for calcium intake for women 51 yo+

1200 mg daily

recommendation for calcium intake for men 71 yo +

calcium carbonate, calcium citrate

what supplements for Ca are there

carbonate

does Calcium citrate or carbonate have more elemental calcium

carbonate

is calcium citrate or carbonate more common

carbonate

is calcium citrate or carbonate least expensive