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Osteo risk factors Hx of fx as adult; Hx of fx in 1st degree relative; current SMK/EtOH; wt <127 lb. Low Ca/vit D
BMD values T score: BMD >-1SD below YN = normal. Severe osteoporosis = <-2.5
best predictor of fx risk bone density (75-85% of variance in bone strength)
DEXA used for: PA spine, lateral spine, hip, forearm, total body
Quantitative CT used for: spine (trabecular only)
T-score: osteopenia -1 to -2.5 SD below YN (young normal)
Skeletal response to continuously delivered PTH inc osteoclasts, inc resorption, inc serum Ca
Skeletal response to once-daily delivered PTH inc osteoblasts, inc bone formation, inc bone mass/ strength
Causes of secondary osteoporosis Hypogonadism, Cushing, thyrotoxicosis, hyperPTH, immobilization, malignancy, multi myeloma, DM, liver dz, celiac, heparin, antiseizure Rx
Primary postmenopausal osteo: bone loss is mostly trabecular (very sensitive to estrogen loss) -> vertebral compression fx & distal wrist fx
Primary senile osteo: characterized by trabecular and cortical bone loss -> hip fx
Osteo mgmt Ca citrate (0.7gm) or Ca CO3 (1-1.5gm elemental Ca). Vit D 800-2000IU/QD. Bisphosphonates. Teriparatide. Monitor BMD & height.
Difference between osteoporosis and osteomalacia Osteoporosis: proportional bone mineral and matrix decrease. Osteomalacia: bone mineral decrease only
Osteomalacia patho Decreased deposition of Ca & PO4 in bone matrix -> increased epiphysis width & cortical thinning.
Osteomalacia in kids = rickets (before closing of epiphyseal growth plates)
Sx/sx of osteomalacia in kids Delayed fontanelle closure, growth, & dentition. Rachitic rosary (enlarged costal cartilages), bow legs.
Sx/sx of osteomalacia in adults Proximal muscle weakness. Hip pain & antalgic gait. Tetany, muscle wasting, hypotonia (2/2 low Ca). Fractures w/o trauma.
Osteomalacia tx Vit D (50,000-100,000 U/week) and Ca. Monitor urinary Ca. Calcitriol if renal failure.
Renal osteodystrophy (osteitis fibrosa or osteomalacia) MOA CKD: kidneys fail to eliminate PO4 and poorly synthesize calcitriol -> compensatory increase in PTH
Paget disease patho Hereditary (AD) vs viral. Rapid formation & resorption of bone -> replaced by dense trabecular bone w/abnormal architecture w/areas of weakening -> fx and may compress nerves (CN VIII)
Dietary requirement of Ca: 1000-1500 mg/day
Created by: Abarnard