osteoporosis
osteoporosis
osteoporosis
drug therapy
100
what is osteoporosis
Chronic, progressive metabolic bone disease marked by
•Low bone mass
•Deterioration of bone tissue
•Leads to increased bone fragility
bone resorption exceeds bone deposition
100
clinical manifestations of osteoporosis
•Occurs most commonly in spine, hips, and wrists
•Back pain
•Spontaneous fractures
•Gradual loss of height
•Kyphosis or “dowager’s hump “
100
supplement calcium
•Take in divided doses
•Calcium carbonate
•40% elemental calcium
•Take with meals
•Calcium citrate
•20% elemental calcium
•Less dependent on stomach acid
100
bisphophonates
•Inhibit bone resorption
•Side effects: anorexia, weight loss, gastritis
•Proper administration
•Take with full glass of water
•Take 30 minutes before food or other meds
•Remain upright for at least 30 minutes
200
why is it more common in women
•Lower calcium intake
•Less bone mass
•Bone resorption begins earlier and becomes more rapid at menopause
•Pregnancy and breastfeeding
Longevity
200
Dx studies
•History and physical exam
•X-ray and lab studies not diagnostic
•Bone mineral density (BMD) – DEXA scan)
•Quantitative ultrasound (QUS)
•Dual-energy x-ray absorptiometry (DEXA)
•Know what a DEXA scan is measures bone density in the spine, hips, and forearm. These represent the most common sites of fragility fractures
•Know T-score ranges and interpretations
200
vitamin D
necessary for calcium absorption/function; bone formation
•Sunlight for 20 minutes adequate
•Supplemental (800-1000 IU/day)
•Postmenopausal
•Older adults
•Homebound/long-term care
Minimal sun exposure
200
calcitonin
•Inhibits bone resorption
•Give IM form at night to minimize side effects
•Alternate nostrils when using nasal form
•Calcium supplementation is needed
300
screening guidelines fro osteoporosis
•Initial bone density test in women over age 65
•Repeat in 15 years if normal
•Earlier and more frequent if high risk
•Currently no evidence of benefit for screening in men
300
focus on
•Proper nutrition
•Calcium supplements
•Exercise
•Prevention of fractures
•Changing modifiable risk factors
•Drug therapy
300
pt education
•Weight-bearing exercise
•Build up and maintain bone mass
•Increase strength, coordination, balance
•Walking, hiking, weight training, stair climbing, tennis, dancing
•Quit smoking
Decrease alcohol intake
300
raloxifene (evista)
•Selective estrogen receptor modulator
Reduces bone resorption
400
risk factors of osteoporosis
•Advancing age (>65 yr)
•Female gender
•Low body weight
•White or Asian
•Current cigarette smoking
•Prior fracture
•Sedentary lifestyle
•Estrogen deficiency
•Family history
•Diet low in calcium/vitamin D deficiency
•Excessive use of alcohol (>2 drinks/day)
•Low testosterone in men
•Certain drugs
•Steroids, anti-seizure, chemo, aluminum antacids
400
how much calcium should they intake?
1000 mg/day for
•Women ages 19-50 years
•Men ages 19-70 years
1200 mg/day for
•Women 51 years or older
Men 71 years or older
400
Denosumab (Prolia)
•Given when other medicines cannot be used or after other medicines did not work well
admin subQ
ae: numbness or tingling in your fingers, toes, or around your mouth. hives, rash, itching, difficulty breathing or swallowing, swelling of the face,
500
preventative factors of osteoporosis
•Regular weight-bearing exercise
•Fluoride
•Calcium
Vitamin D
500
what are some good sources of calcium
•Milk
•Yogurt
•Turnip greens
•Cottage cheese
•Ice cream
•Sardines
Spinach