1 / 28

Osteoporosis

Osteoporosis. Nick Camposeo POPPF DidacticsOnline.com. Case Presentation . CC: R wrist pain HPI: 42 yo female, pain is constant for past 6 hours, after slipping and falling forward in kitchen. Pain is 8/10 localized to R medial wrist ROS: Gen: No fever, + weight loss, + fatigue

rachel
Download Presentation

Osteoporosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Osteoporosis Nick CamposeoPOPPF DidacticsOnline.com

  2. Case Presentation • CC: R wrist pain • HPI: 42 yo female, pain is constant for past 6 hours, after slipping and falling forward in kitchen. • Pain is 8/10 localized to R medial wrist • ROS: • Gen: No fever, + weight loss, +fatigue • HEENT: No blurry vision, No HA, No difficulty swallowing • Chest : No SOB, No palpitations • GI: No N/V + diarrhea • EXT: No N/T/W in UE

  3. Case Presentation • Past Medical History • Celiac’s disease, 1986 • GERD 92 • Surgical Hx • Non contributory • Social • +TOB ½ pack /day • +EtOH2-4 drinks/week • Diet/Exercise • No gluten, Vegetarian • No exercise • Meds • Omeprazole • NKDA • Sexual: • married • LMP – irregular, 6 months ago, occasional spotting

  4. Case Presentation • Objective • Vitals: BP 142/84 HR:74 Resp: 16 O2 :99% • Weight 115, Height 5’6 BMI: <18 • GEN: Scaphoid appearance, AAOx3, in moderate distress • HEENT: NC, PERRLA, EOM intact, No AV nicking , No papilledema, no polyps, no bulging eyes • CHEST : CTA BL, S1S2 no murmurs no gallops • ADB: BS present, no abd bruits, No CVA tenderness • EXT: DTR 2/4 symm BL, sensory and motor intact, edema and tenderness at medial R distal radius, no ecchymosis. No scaphoid tenderness. • Osteopathic: Hypertonic R wrist extensors, C5C6 FRlSl, hypertonic upper R thoracic paraspinals

  5. Case Presentation • A/P • R Arm pain, secondary to possible colles fracture or distal radius, or possible scaphoid fracture. • Plain radiograph of distal R arm • Possible Iron def. anemia, Osteoporosis due to poor nutrition and malabsorption • Biochemistry profile • 25-hydroxyvitamin D • Complete blood count • Urinary calcium excretion • Serum PTH

  6. Osteoporosis, what is it? • Osteoporosis • skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fractures. • Multifactoral • Primary or secondary

  7. Osteoporosis, what is it? • Osteoporosis • estimated nine million osteoporotic fractures worldwide in 2000 • Reduction of primarily trabecular (spongy) bone and cortical bone. • Osteoporosis related fractures • 50% in women over 65yo • 20% in men over 65yo

  8. Osteoporosis, what is it? • Reduced bone mineral density • leads to microarchitectural disruption • leads to increases skeletal fragility • Osteoclasts >osteoblasts • Increase in reactive oxygen species • Estrogens • RANKL/RANK/OPG axis • Receptor activator for nuclear factor kBligand • IL-1, IL-6, TNF

  9. What do you look for? • Evaluation • HISTORY!! • Past medical • Surgical • Meds • Family history • Social

  10. Objective findings • Look for declining weight and height • Increased kyphosis , dowagers hump

  11. What do you look for? • Evaluate fall risk • Hip fractures • Increase DVT risk • Fat emboli • 25% fatal • OSTEOPOROSIS IS SILENT UNTIL FRACTURE

  12. Who is at risk for osteoporosis? • Age • Death, taxes and the jets not making the superbowl. • Menopause • Endocrine disorder • Family history of osteoporosis • Idiopathic osteoporosis • Previous fracture

  13. Who is at risk for osteoporosis? • Tobacco smoking • Malnourished • Underactive • Chronic disease (esp kids) • Lactation

  14. What do you look for? • Labs • Biochemistry profile • 25-hydroxyvitamin D • Complete blood count • Urinary calcium excretion • Serum PTH

  15. Who should you diagnose? • Candidates for BMD testing • Pt with risk factors • Fracture Risk Assessment Tool • women 65 years of age and older and in postmenopausal women younger than 65 years of age with clinical risk • FRAX • World health organization fracture assessment tool • Assess 10year fracture risk

  16. Diagnosis • Dual energy X-ray (DEXA) • Testing • Femoral neck, lumbar spine, one third radius • T-Score • Based on average bone density of 30yo man/women • Peak bone mass • Used to compare post menopausal, men over 50 • Z score • Number of SD a pt’s BMD differs from average BMD of their peers • Used in premenopausal women, • men under 50yo • And kids

  17. Diagnosis • Biomarkers • urinary N-telopeptide (NTX) or serum carboxy-terminal collagen crosslinks (CTX) • By products of type 1 collagen breakdown • Useful in pts where DEXA scan is a contraindications • Pregnancy • to skeletal structural abnormalities, such as severe osteoarthritis, surgical hardware, or scoliosis.

  18. How can we prevent osteoporosis? • Screening • Best defense is a good offense • LIFE STYLE CHANGES! • Change any modifiable risk • Diet • Exercise • Smoking • Alcohol

  19. How can we prevent osteoporosis? • Maximize peak bone mass in younger years • Adequate Ca++ intake and Vit. D • Calcium supplements • Postmenopausal women need at least 1200mg daily • Vit. D supplementation • 600 international units daily in younger • 800 international units for older adults • Physical activity • No TOB and EtOH

  20. How can we treat osteoporosis? • Osteoporosis is silent until fracture! • Osteopathic • Normalize joint motion • Balance • Normalize gate

  21. Well, how do you treat it? • Bisphosphonates • Aledronate – fosamax • Risedronate – Actonel • Ibandronate – once a month

  22. Well, how do you treat it? • Bisphosphonates • Oral • Poorly absorbed (less than 1% per dose) • Must be taken on empty stomach to increase absorption • IV (Zoledronic acid) Zoledro nick • Ideal for pt who cannont tolerate oral • Difficulty swallowing, unable to sit upright for 60 mins, poor compliance • Osteonecrosis of Jaw

  23. Well, how do you treat it? • Selective Estrogen Receptor Modulator • Raloxifene • Who cannot tolerate bisphosphonates • Relative contraindications • Achalasia, scleroderma esophagus, esophageal strictures.

  24. Well, how do you treat it? • PTH • calcium and phosphate homeostasis, calcitriol • PULSATILE • Double edged sword • For severe osteoporosis • T score < -2.5 and at least one fragility fracture.

  25. Well, how do you treat it? • Denosumab • Inhibits RANKL, a protein involved with osteoclastogenesis. • acts like osteoprotegerin as both act as decoy receptors

  26. Well, how do you treat it? • Calcitonin • Directly inhibits osteoclast activity

  27. Monitoring • monitoring • For patients starting out on therapy • DXA scan every 2 years of hip and spine • If BMD is stable or improved less frequent monitoring s needed • Chemical biomarkers • urinary N-telopeptide (NTX) or serum carboxy-terminal collagen crosslinks (CTX • Biomarkers increase urine conc. when increase bone reabsorption. • This approach (with markers of bone resorption) is only useful with antiresorptive therapy, not with recombinant PTH (markers would increase).

  28. The end • Any q or comment please send them to us at didactics online.

More Related