Paget's Disease
Diagnostic studies to confirm Paget's...
thermography to find hot spots
bone scans (most sensitive test for bones, reveal hotspots and/or increased activity)
CT scans are used to rule out other possible disorders
Osteoporosis defined...
chronic condition that leads to the deterioration of bone tissue and density
A typical location for osteoporosis fractures to occur are.... (3 locations)
How is BMD measured?
DEXA scan (dual energy x-ray absorptiometry)
Why aren't xrays used to diagnose osteoporosis?
xrays won't show any signs of osteoporosis until at least 35-40% of bone have been changed. at that point, they have already had their first fracture and have been diagnosed
Goal of medications for paget's disease
No effective treatment for paget's
medications are used to treat pain
calcitonin given to decrease bone breakdown (not a long term solution)
biphosphonates used to suppress bone reabsorption keeps these bones from breaking down
zodronic? acid known to put patients in remission
Primary risk factors for osteoporosis
non-modifiable
age, race, sedentary lifestyle, low calcium intake, smoking
Best way to treat osteoporosis is to ________
prevent the development
Normal: >-1
Osteopenia: -1 to -2.5
Osteoporosis: <-2.5
Severe Osteoporosis: <-2.5 plus a fragility fracture
Best treatment for osteoporosis? (2 interventions)
prevention and screening
Is surgery an option for Paget's disease?
yes, surgery is an option. aids in secondary degenerative changes
Secondary risk factors for osteoporosis
modifiable
other conditions or diseases that put the patient at risk:
i.e. cushings disease, steroid use, down syndrome
A patient who had a hysterectomy at 30 yo will be at greater risk of osteoporosis. Why?
lower estrogen levels
What lab values are associated with osteoporosis?
calcium, vitamin D, phosphorus, ESR (erythrocyte sedimentation rate)
Why is weight loss and muscle strengthening important for osteoporosis patients?
both will work to reduce falls and fractures
weight bearing exercises will build strong bones, the stronger somebody is, the less likely they are to fall
Types of surgery used for paget's disease include...
joint replacement
spinal decompression
stabilization
At what age does bone density start to decrease?
30 yo
A patient with osteoporosis should have what measured every single visit to the doctor
their height using a wall mounted measuring device
Why is hematocrit an important level to obtain with patients?
low hematocrit levels can indicate an underlying condition with bone marrow which may be causing secondary osteoporosis
Dietary recommendations for osteoporosis
supplementation, cessation of alcohol and smoking
osteoporosis is sometimes called the ______ disease. why?
silent
it usually isn't diagnosed until after the first fracture
What is the gold standard diagnostic for osteoporosisis? At what age for women? what age for men?
Bone mineral density (BMD)
women > 65
men > 70
How can you confirm a contributing factor or ruling out/in another?
Lab values
Estrogen therapy for osteoporosis:
Why estrogen?
What are some complications associated with estrogen therapy?
estrogen aids in bone remodeling
a lot of estrogen use will predispose a patient to cancer