NR 601 Week 4 -Osteoporosis Lecture

NR 601 Week 4 -Osteoporosis Lecture

NR 601 Week 4 -Osteoporosis Lecture

Osteoporosis
Age, gender, ethnicity factors
Risk Factors
Clinical Screening
USPSTF Screening Recommendations
Guidelines may conflict, just make sure you’re using EBP
Diagnostic tests
Treatment
Follow up screening

NR 601 Week 4 Osteoporosis Lecture

• Osteoporosis
  • Metabolic skeletal disease
    • Decrease in bone mass and micro architectural deterioration of bone tissue – consequent increase in bone fragility and susceptibility to fracture
    • WHO definitions
      • Bone mineral density less than 2.5 standard deviations or more than the mean of a young adult
      • Testing – T score of -2.5
      • T score -1 to -2.5 = osteopenia
    • Occurrence
      • Affects more than 10 million people in the US
    • Signal symptoms
      • Occur late in disease
        • If these signs are present, fractures are present
      • Screening is important!
      • Kyphosis
      • Decreased height
      • Vertebral fractures
      • Severe back pain
    • Signs and Symptoms
      • Kyphosis of the spine
      • Evidence of oral bone loss
      • Restrictive pulmonary problems
        • Due to decreased volume of the thoracic cage/chest expansion
      • Vertebral fractures
        • Swelling, tenderness, and ecchymosis from fracture
      • Limited ROM and painful movement
      • Protuberant abdomen
        • Due to spinal changes
      • Prevention/prophylaxis
        • Focus on prevention at an early age
          • Peak bone mass in adolescence
          • If there is a failure to produce quality bone in adolescence, effects bone for lifetime
          • Diet, exercise
          • Avoiding smoking, reducing alcohol intake
          • Quality/quantity effects fracture risk
        • Reduction of risk factors
        • Screening
      • Age, gender, ethnicity factors
        • Increased risk with age
        • Increased rate of bone loss in women after menopause along with increased risk of falling
        • Risk twice as great in white women compared w/ African American women
        • Men are at risk too
      • Risk Factors
        • Modifiable
          • Medication
            • Steroids, lithium, thyroid hormones, chemotherapy, aluminum acids, tetracycline
          • Tobacco use
          • Alcohol consumption
          • Sedentary lifestyle
          • Diet
            • Calcium & Vit D consumption
            • Carbonated beverages are known to contribute to bone loss
          • Low BMI
            • As much as a 2% weight loss in a man can reduce mineral density
          • Non-modifiable
            • Age
            • Family history
            • Female gender
            • Small bone structure
            • Disease
              • HTN, diabetes, RA, CKD, Cushings disease, liver disease, hyperparathyroidism, alcoholism, hx or gastric bypass or organ transplant
              • Women who experience early menopause w/o HRT
              • Malabsorption problems
              • Anorexia
            • Medication
          • Clinical Screening
            • Physical assessment
              • Yearly height measurement
              • Assess gait
              • Assess dentition and bone loss
              • FRAX screen

• USPSTF Screening Recommendations
  • Women
    • 65 or older
    • Younger women whose fracture risk is equal to or greater than that of a 65 yr. old white women with no additional risk factors
  • Men
    • Insufficient evidence to assess the balance of benefits and harms of screening for osteoporosis
    • NOF
      • Men older than 50 are more likely to break a bone than they are to get prostate cancer
    • Other risk factors – NOF guidelines support screening
  • Guidelines may conflict, just make sure you’re using EBP
  • Diagnostic tests
    • BMD measurements
      • DEXA
        • T scores
          • Compares patient’s bone mass to the mean bone mass of a young adult
          • T score of -2.5 = osteoporosis
          • -1 to -2.5 osteopenia
        • Z score
          • Compares patient to average person in their age range
        • QCT
          • Expensive test
          • 3 dimensional study
        • US of heel
          • Inexpensive screen
          • Often seen at health fairs
        • Lab tests

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• Treatment
  • Focused on preventing fracture
  • Diet
  • Exercise
  • Fall prevention strategies
    • Review meds that increase risk of falls
      • Pain meds, anything that sedating
    • Medications
      • Calcium supplements
      • Vit D replacements
      • Bisphosphonates, SERMS and calcitonin
    • Follow up screening
      • Normal bone density or mild osteopenia
        • Rescreen in 15 years
      • Moderate osteopenia
        • Rescreen in 5 years
      • Advanced osteopenia
        • -2.5 score PLUS 1 or more fragility fractures
        • Rescreen yearly