Geriatric Health Assessment Quiz

Osteoporosis (et al)

• Osteoporosis is a chronic, progressive disease characterized by low bone mass and impaired bone quality.
• Primary osteoporosis is most common and often follows menopause in women.
• Secondary osteoporosis is associated with medications, other conditions or diseases.
• The annual turnover of cortical and trabecular bone is about 10% of the adult skeleton and is important for maintaining structural integrity and calcium/phosphorous storage.

Metabolic Bone Changes

• The human skeleton undergoes continuous remodeling throughout life.
• Remodeling relies on two cells: osteoclasts which break down bone and osteoblasts which secrete the matrix for bone formation.
• Bone remodeling progresses through three phases: activation, resorption, and formation.

Osteoporosis Overview

• Osteoporosis is a metabolic bone disease that's expected to increase in prevalence with an aging population.
• Estrogen deficiency is relevant because it promotes osteoblast activity.
• Primarily, osteoporosis is more common in postmenopausal women.
• Over 80% of fractures in people aged 50+ are due to osteoporosis.

Osteoporosis: Epidemiology

• Osteoporosis-related fractures are more common than heart attacks, strokes, and breast cancer combined.
• At least one in three women and one in five men will suffer an osteoporotic fracture in their lives.
• Osteoporosis and fractures account for over 60% of inpatient rehabilitation admissions, costing over $2.3 billion CAD annually.

Osteoporosis: Etiology (Causes)

• Bone mass peaks between 25 and 35 years old, and then bone resorption is greater than bone formation.
• Significant risk factors are post-menopause; genetics; inactivity/immoblization; smoking and diet deficiencies in, calcium and Vitamin D.

Osteoporosis: Pathogenesis

• Osteoporosis occurs due to an imbalance in the normal bone remodeling process, with bone resorption by osteoclasts favored over bone formation by osteoblasts.
• This results in a loss of bone mass.
• Age-related osteoporosis (type 2) arises from decreased Vit D and calcium absorption. –Post-menopausal osteoporosis (type 1) is driven by estrogen withdrawal.

Primary Osteoporosis Classification

• Post-menopausal osteoporosis (type 1): Affecting post-menopausal women.
• Age-related osteoporosis (type 2): Commonly impacting elderly men and women.

Post-Menopausal Osteoporosis (Type 1)

• This type is strongly linked to estrogen withdrawal.
• It most affects trabecular bone, causing a 5-20% yearly loss of spinal trabecular bone mineral.
• Trabecular bone is also known as spongy bone, due to its open honeycomb-like structure.

Age-related Osteoporosis (Type 2)

• Age-related decreases in dietary calcium and vitamin D absorption contribute to this kind of osteoporosis.
• Kidney function reduces the body's ability to activate vitamin D.

Secondary Osteoporosis

• This type of osteoporosis is less common than the primary type.
• Secondary osteoporosis is characterized by conditions such as corticosteroid use, hyperparathyroidism, and immobilization negatively impacting bone formation.

Clinical Presentation

• Initial symptoms may include a "Dowager's hump" (spinal kyphosis): increased curvature, stooped posture, loss of height, lower rib settling, and decreased spinal mobility.

Diagnosis of Osteoporosis

• Diagnostic criteria are based on bone mineral density (BMD) measured by dual-energy x-ray absorptiometry (DEXA).
• A DEXA scan involves the patient lying on a table while radio waves assess bone thickness.

Osteoporosis to Fractures

• Fractures occur when applied forces exceed the bone's capacity.
• Factors influencing bone capacity are mineralization level and the architecture of the bone.
• Osteoporosis progressively deteriorates both mineralization and architecture increasing fracture risk.

Osteoporosis and Fracture Location

• Osteoporosis often starts with "silent" fractures as the spine, hip, or wrist (Colle's fracture).
• Pathological fractures from normal daily activities are highly indicative.
• Spinal fractures denote a severe sequela of osteoporosis.
• Hip fractures are common in older adults and represent the worst complication.

Vertebral Fractures

• Women with vertebral fractures have a significantly increased risk of future fractures, with a 5-fold risk of another vertebral fracture and a 2-fold risk for a hip fracture.
• One woman in five experiences another vertebral fracture within a year after a vertebral fracture.

Hip Fracture

• Hip fractures carry substantial morbidity, with significant complications for the individual.
• One year after a hip fracture, 30% experience permanent disability, 50% cannot walk independently, and up to 80% cannot independently perform daily tasks.

Usual Bone Repair

• Bone repair progresses through several stages: hematoma formation, procallus formation, hard callus formation, callus replacement, and remodeling.

Speed of Bone Healing

• Factors like the age and nutritional status of the patient, existing medical conditions, severity of bone damage, blood supply & nutrition at the site, effective treatment, and mobilization promote healing.

Bone Healing Complications

• Delayed union: Inability for bone to properly unite due to insufficient blood supply, infection, or poor mobilization.
• Malunion: Union where the bone heals with improper alignment.
• Nonunion: When bone does not heal. Causes possibly due to insufficient blood supply or non-treatment of delayed union.
• Avascular necrosis: Death of bone tissue occurs due to inadequate blood supply, impacting healing or causing other damage.

Hip Fracture & Frailty

• After a hip fracture, there is a substantial mortality rate within 6 months, usually related to complications from immobilization.

What is meant by Frailty?

• Frailty is a physiological decline and increased vulnerability in older adults.
• Frailty is indicated by factors like weight loss, weariness, limited capacity for exercise, slow mobility, and possible cognitive impairment.

Geriatric Giants

• Major causes of impaired functionality, like immobility, instability, incontinence, impaired memory, that frequently lead to frailty.

Chronic Disease, Age, & Frailty

• Chronic diseases increase in prevalence with advancing age, regardless of gender.

Polypharmacy & Elderly

• Polypharmacy represents the use of 5 or more medications by an elderly person, usually increasing frailty due to increased risks of falling, interactions, or other severe risks associated with multiple medications.

Osteoporotic Fractures, Frail Elderly & Fall Risk Factors

• Extrinsic factors, chronic disease burden and medication, acute health care events, and muscle weakness, vision, and balance issues are associated with falls in osteoporotic patients.

Osteoporosis Summary

• Osteoporosis is the most common bone disease caused by an imbalance of bone formation and absorption.
• Two main forms exist: primary osteoporosis, predominantly post-menopausal and age-related; secondary osteoporosis associated with other conditions.
• A major fall risk factor for the elderly.

Framing the RS 3060 Course

• The first element of the course focuses on an anatomical-physiological view of common issues, covering anatomy to physiology.
• The second element of the course focuses on clinical cases and the impact of the issues on patients' lives, covering etiology to pathophysiology and clinical presentation.

Health Conditions & Life Cycle Approach to Disabilities

• Presents a wide array of health challenges across various stages of life.

Ignorance is Bliss

• Clinical presentation should not be generalized with any client; the professional must take into account the nature of client need and differing factors.
• Different needs mean different providers or settings such as acute care vs. chronic care vs. long term care.
• Different needs and time expectations are critical to a patient's success, which vary by medical condition.

In going forward

• These study notes end with wishes for success and good luck.

Test your knowledge on the common health risks and conditions associated with the elderly population. This quiz covers topics such as osteoporosis, falls, and traumatic brain injuries. It's essential for those studying geriatric health or working with aging patients.