Patho - Metabolic Disorders

Osteroporosis is chronic, progressive disease is NOT characterized by

high bone mass density

Primary osteoporosis often occurs

later in life

Secondary is associated with

medications or other condition

Most common metabolic bone disease affects

10 million people living in the US

34 million have

osteopenia (low bone mass)

Osteoporosis is much more common in

women

When men develop osteoporosis they will have

a higher morbidity and mortality

Men will be older at time they sustain fracture and will have

comorbid conditions

Primary osteoporosis is typically unknown, but which of the following is NOT contributary factor?

Prolonged negative sodium balance

Secondary Osteoporosis depends on causative factors but which of the following is NOT a typical factor?

Short term use of corticosteroids, heparin, anticonvulsants, etc.

Peak bone mass occurs b/t

25-35 years

Past the period of peak bone density, the rate of bone ________ begins to exceed that of

resorption; formation

Physiologic mismatch of bone formation and bone breakdown can progress to

osteopenia/osteoporosis

Postmenopausal women are at a higher risk to develop

OA

The risk of postmenopasual women developing OA increases b/t

51-75

OA in postmenopausal women is secondary to

DEC prod of estrogen

For the first 10 years after menopause women lose

2-11% of bone density

After year 10, the loss of bone density thru/out menopause slows to

0.5-1% of bone mass/yr

Men experience a gradual slowing of __________ prod with age (linked with __________)

testosterone; osteoporosis

Bone mass positively correlates with

skin pigmentation

Whites have _____ amount of bone mass / blacks have the ______.

least; greatest

Ethnicity is also related to ________

bone width

Blacks have_____ long bones than whites.

wider

Decreased physical activity is associated witth

decreased bone formation

Prolonged inactivity reduces _______ and ________ forces acting on skeleton reducing bone mass.

gravitational ; muscular

Disuse can also result in

greater recruitment of osteoclasts

The risk factor of depression is independent of link to levels of

physical inactivity

For depression, bone loss issecondary to

immune and endocrine mechanisms

For patients with depression bone less is secondary to

immune and endocrine mechanisms

Bone strength is a function of

skeletal load

Bone responds to alterations in

mechanical force

Adaptations are

site specific

Which stimulia is the only type capable of inducing modeling in mature bone?

mechanical

Mechanical loading consists of

Gravitational forces and Muscular pulling

Lack of mechanical loading consists of

Urinary calcium excretion increases and bone density decreases

Changes are not long term so there is a need for

regular site-specific and WB exercises

______ smoking is a well-known risk factor for osteoporosis

Cigarette

What rate of alcohol consumption is linked to osteoporosis?

>2 drinks per day

Alcohol alters

osteoblast gene expression

Alcohol altering osteoblast gene exp reduces

# of osteoblasts created

Animal protein provide

acid precursors

Net acidic protein precursors lead to

bone loss

Plant protein provide

base precursors

Net basic protein precursors have

no effect

Nutritional deficits leads to DEC bone density with

anorexic and bulimic women

Celiac is a GI disorders that impairs the absorption of

Ca++, vitamin D, and various nutrients

Celiac disease leads to DEC

density and formation

Celiac disease effects can be

reversed with intervention

High cholesterol with high-fat diet increases

oxidative stresses

Cholesterol is believed to inhibit

osteoblast formation

Which of the following is not a non-modifiable for osteoporosis?

Mobilization

Which of the following is not a modifiable risk factor for osteoporosis?

Immobilization

Which of the following is not a component of poor diet?

Low-fat diet

Which of the following medications is not a risk factor for osetoporosis?

Ibuprofen

Which of the following diseases/disorders is not a risk factor for osteoporosis?

Hyporthyroidism / Hypoparathyroidism

Osteoporosis is an imbalance of

bone formation and resorption

Osteoporosis is possibly related to declining ____ and influence by _____.

osteoblastic function; genetic factors

Bone Demineralization leads to

osteopenia

Osteopenia occurs with all of the following except:

increased bone formation rate

What are the most common clinical manifestations of osteoporosis?

Loss of height and postural changes

What of the following is not a postural change associated with osteoporosis?

Knee hyperFLX

Most common fractures secondary to osteoporosis (most to least):

1. Ribs

2. Vertebral bodies

3. Radius

4. Hip

5. Femur

2, 4, 1, 3, 5

“Silent” compression fractures is a

Non-obvious traumatic compression fractures of vertebral bodies or femoral neck.

What is the best approach for osteoporosis?

prevention

(there’s no cure)

Prevention for osteoporosis involves

minimizing modifiable risk factors and early intervention

Peak adult bone density depends on factors during

growth and development

Medical management for osteoporosis should include regular exercise/physical activity combined with adequate

calcium while individuals are in their 20’s

Risk reduced by 50% if vitamin and nutrient requirements are met in

the first 2-3 decades of life.

Which of the following foods is not rich in calcium and magnesium?

eggs / yogurt

________ is Insufficient in about 50% of world’s population

Vitamin D

Vitamin D requires

sunlight to fully synthesize in the body

Vitamin D helps body absorb, synthesize and transport

calcium

Lack of Vitamin D results in decrease in absorption of dietary ________and increase in __________.

Ca++ / Phosphorus; parathyroid hormone (PTH)

PTH increases

osteoclastic activity

What is recommended for screening osteoporosis?

Women age 65 and older and men

70 and older should get a BMD test

Screening for osteoporosis should be a(n)

Individualized approach

DEXA scan =

Dual energy x-ray absorptionmetry

DEXA scan measures

bone mineral density

Diagnosis and intervention for osteoporosis are based on

bone density and risk assessment.

Diagnosis and intervention for osteoporosis is composed of what three primary portions?

Hx, imaging studies, lab testing

Bone Mineral Density Testing is the measurement of

mineral content of bone in grams per square cm (g/cm2).

Bone Mineral Density Testing is measured by

DEXA, quantitative US, CT, or radiographic absorptiometry

Person’s BMD is compared to norm values of those of the same age and gender _________ and Young adults of the same gender ______.

z score; t score

Classification for postmenopausal women based on the BMD compared to

mean bone density of a young adult.

T score of -1.0 or higher =

normal; low risk for factor

T score of -1.0 to -2.5 =

osteopenia (low bone mass)

T score of -2.5 or lower =

osteoporosis

Radiographs of osteoporosis reveal

fractures and signs of steopenia

__________ loss is required to be evident on x-ray.

30% or greater

Intervention of osteoporosis is focused on

stopping progression

For secondary osteoporosis address

underlying causes

Primary and Secondary osteoporosis should address

lifestyle changes

Bisphosphonates is a medication for osteoporosis that

Inhibit osteoclasts activity and allow osteoblasts to work

Bisphosphonates has a favorable

safety profile

Selective estrogen receptor modulators maximize beneficial effect of

estrogen on bone retention

Estrogen supplementation combined with exercise is

promising

Whole body vibration builds on the

piezoelectric theory

The piezoelectric theory states that interaction of mechanical vibration with the structures of the body induces

process of bone formation

Whole body vibration might affect all the following levels except:

muscle hypertrophy

Osteoporosis is not curable but

manageable