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Questions and Answers
What is the primary characteristic of trabecular bone compared to cortical bone?
What is the primary characteristic of trabecular bone compared to cortical bone?
Which of the following factors is NOT a non-modifiable risk factor for osteoporosis?
Which of the following factors is NOT a non-modifiable risk factor for osteoporosis?
What percentage of the skeleton's mass is made up of cortical bone?
What percentage of the skeleton's mass is made up of cortical bone?
What method is identified as the most accurate for diagnosing osteoporosis according to WHO?
What method is identified as the most accurate for diagnosing osteoporosis according to WHO?
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Which process within bone tissue occurs approximately at 3% of cortical and 7% of trabecular bone annual remodeling?
Which process within bone tissue occurs approximately at 3% of cortical and 7% of trabecular bone annual remodeling?
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Which of the following statements accurately describes the characteristics of osteoporosis?
Which of the following statements accurately describes the characteristics of osteoporosis?
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What primarily causes osteoporosis to develop?
What primarily causes osteoporosis to develop?
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Which type of osteoporosis is associated with decreased estrogen production?
Which type of osteoporosis is associated with decreased estrogen production?
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In osteoporosis, the microscopic structure of bone appears as what?
In osteoporosis, the microscopic structure of bone appears as what?
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Which hormone is NOT involved in bone remodeling processes that can lead to osteoporosis?
Which hormone is NOT involved in bone remodeling processes that can lead to osteoporosis?
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Which of the following is a modifiable risk factor for osteoporosis?
Which of the following is a modifiable risk factor for osteoporosis?
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What can low vitamin D levels lead to in the context of bone health?
What can low vitamin D levels lead to in the context of bone health?
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Which gender is at a higher risk of developing osteoporosis?
Which gender is at a higher risk of developing osteoporosis?
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Which of the following medications is most commonly associated with secondary osteoporosis?
Which of the following medications is most commonly associated with secondary osteoporosis?
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What lifestyle factor is NOT a risk for osteoporosis?
What lifestyle factor is NOT a risk for osteoporosis?
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Which of the following conditions is least likely to contribute to secondary osteoporosis?
Which of the following conditions is least likely to contribute to secondary osteoporosis?
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What is the role of parathyroid glands in the presence of low calcium levels?
What is the role of parathyroid glands in the presence of low calcium levels?
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Which racial/ethnic group is at the highest risk for developing osteoporosis?
Which racial/ethnic group is at the highest risk for developing osteoporosis?
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The early diagnosis of osteoporosis is crucial for which reason?
The early diagnosis of osteoporosis is crucial for which reason?
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Which of the following is NOT a common cause of secondary osteoporosis?
Which of the following is NOT a common cause of secondary osteoporosis?
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Study Notes
Osteoporosis Management
- Osteoporosis is a metabolic bone disease, characterized by reduced bone mineral density and strength, commonly occurring with increasing age.
- Bone formation and resorption are constant processes throughout the lifespan. Bone remodeling is influenced by hormones (estrogen, testosterone, calcitonin, PTH, vitamin D) and mechanical stress.
- The skeleton comprises appendicular and axial portions. Appendicular includes the upper and lower limbs, while axial includes cranium, vertebral column, ribs, sternum, and pelvis.
- Cortical bone constitutes about 80% of the skeleton's mass and is dense, solid, and made up of lamellae or compact plates.
- Trabecular bone, also called cancellous bone, forms about 70% of the axial skeleton's volume but only 35% of its weight. It has a honeycomb structure filled with marrow and fat.
- Bone remodeling involves resorption and formation. Approximately 3% of cortical and 7% of trabecular bone is remodeled annually.
- Osteoporosis is typically a "silent disease" because it is painless until a fracture occurs. The appearance of healthy bone in microscopic view consists of a honeycomb structure; in osteoporosis, it appears porous.
- Osteoporosis is characterized by low bone mass density and micro-architectural deterioration of bone tissue, leading to increased bone fragility and susceptibility to fractures.
- Bone density is determined by peak bone mass and bone loss. Bone quality refers to factors like remodeling rate, macro-architecture, micro-damage accumulation, mineralization, and matrix quality. Bone strength is the reflection of bone density and quality combined.
- Osteoporosis is caused by an imbalance of bone resorption and bone remodeling, leading to decreased skeletal mass.
Types of Osteoporosis
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Primary osteoporosis is caused spontaneously, affecting more than 95% of women and 80% of men. Types include:
- Postmenopausal osteoporosis: Associated with increased bone loss due to decreased estrogen production.
- Senile osteoporosis: Age-related bone loss often accompanying advanced aging.
- Idiopathic juvenile osteoporosis: An uncommon type of unknown cause, unrelated to other conditions.
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Secondary osteoporosis occurs due to certain lifestyle factors, diseases, or medications. Common causes in men include:
- Exposure to glucocorticoid medications.
- Hypogonadism (low testosterone).
- Alcohol abuse.
- Smoking.
- Gastrointestinal disease.
- Hyper-calciuria.
- Immobilization.
Risk Factors
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Non-modifiable risk factors include:
- Age
- Gender
- Family history
- Genetic disorders
- Early menopause
- Race
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Modifiable risk factors include:
- Sedentary lifestyle
- Vitamin D deficiency
- Immobilization/bedridden state
- Thin build/small-boned frame
- Eating disorders (high protein)
- Prolonged use of certain medications (glucocorticoids, thyroid hormone, anti-seizure medications)
- Smoking and excessive alcohol/caffeine consumption
- Low vitamin D and calcium in diet
Diagnosis of Osteoporosis
- Early and accurate diagnosis is crucial for effective therapy
- Osteoporosis is often referred to as a "silent thief" because there are typically no early clinical signs or symptoms until a fracture occurs.
- Bone Density Testing (DEXA): Frequently used for early diagnosis; measures bone mineral density, quick (15 min), painless, safe, and checks osteoporosis treatment efficacy after 1-2 years of therapy.
- Quantitative Ultrasound (QUS): Measures bone properties using ultrasound, a diagnostic tool for osteoporosis and related fractures.
- Conventional X-rays: Useful for detecting fractures or compressions but not ideal for early diagnosis as bone loss must be extensive to show on X-ray (30-40% bone loss).
- Laboratory investigations: Blood and urine tests for parameters like erythrocyte sedimentation rate, complete blood count, calcium, phosphate, alkaline phosphatase, glucose, creatinine, T3, T4, TSH, estrogen, testosterone, vitamin D levels, and parathyroid hormone. Results are usually within normal limits in primary osteoporosis.
Symptoms of Osteoporosis
- Clinical signs and symptoms: May include medical history of falls or stumbling, and the first symptom is often a bone fracture (i.e., distal radius, proximal humerus, vertebral collapse/fractures, femoral neck fractures). These fractures can result in acute and/or chronic back pain, and other symptoms include loss of height, decreased activity tolerance, and postural deformities (i.e., kyphosis, Dowager's hump).
- Symptoms (specific to this section): include Pain on percussion, compression fractures of the spine, loss of height, bone fractures, decreased activity tolerance, and postural deformities (e.g., stooped posture, Dowager's hump).
- Postural deformities: include spinal compression causing decrease in height, kyphotic posture (stooped posture), and/or Dowager's hump.
Prevention of Osteoporosis
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Dietary and lifestyle changes are critical:
- Maintain a Calcium-rich diet (milk, cheese, yogurt, calcium-rich drinks, fruits, vegetables, and wheat products); consider supplements if needed.
- Ensure adequate Vitamin D supply through diet and/or supplements.
- Quit smoking.
- Maintain ideal body weight.
- Minimize osteoporosis medications.
- Treat underlying diseases that damage bones.
Physical Therapy in Osteoporosis
- Evaluation: Includes a detailed medical history, observing general body mechanics, and performing physical tests (e.g., ROM, balance, posture, strength, endurance) to assess fracture risk at the spine, hip, or wrist.
- Aims: Focus on restoring mobility, function, strength, confidence, and reducing pain; preventing fractures; promoting fracture healing; and enhancing safety in everyday life.
- Physical therapy program (ADL): Includes exercises focused on daily activities, particularly those involving position changes.
- Falling protection: Key aspects of physical therapy include coordination, balance, and posture exercises; identifying home safety hazards; and participating in fall prevention seminars/workshops.
- Balance exercises, co-ordination exercises, pain management, weight-bearing exercises, and strength training (manual/mechanical) are vital components. Safe and effective exercise programs are crucial; Avoid prolonged exposure to cold temperatures to prevent dizziness.
- Weight-bearing exercises: Crucial to maintain/improve bone density (e.g., walking, hopping, exercises with weights/resistance bands)
- Flexibility and strengthening exercises: Enhance overall physical function and postural control eg (Tai chi, Yoga)
- Postural exercises: Include extension exercises (e.g.,chin tucks, scapular retractions, thoracic extensions, hip extensions), strengthening of extensor muscles, and avoiding spinal flexion (contraindicated if spinal fracture risk).
- Education: Education includes top tips for clients, healthy eating habits (calcium and Vitamin D), and safe footwear. Avoid rugs, poor lighting, and sloppy footwear. Eye exams are recommended. Heavy lifting is to be avoided; consider delivery services for heavy shopping needs.
- Resistance Training/Stretching may be part of a physical therapy program for osteoporosis.
Geriatric Fractures
- Fractures in the elderly often result from minimal trauma due to bone loss associated with age (osteoporosis). Common locations include the proximal femur (hip), vertebrae (spine), proximal humerus, distal radius, and the intertrochanteric region of the femur.
- Osteoporotic fractures are caused by 8 abnormalities of bone, including reduced thickness (density), unequal proportions of compact and cancellous bone, decreased number of “knots” in cancellous bone, trans-section of trabeculae caused by osteoclasts, inadequate bone formation, inadequate mineralization of bone matrix (osteoid), anomalies of structure and binding of collagen molecules (“cross-linking”), and faulty repair mechanisms.
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Description
This quiz focuses on the management of osteoporosis, a metabolic bone disease characterized by decreased bone density and strength. It covers the processes of bone formation and resorption, the structure of bone types, and factors influencing bone health. Understand the importance of lifestyle and hormonal influences on osteoporosis progression.
