CC January 2015 Nonpharmacologic management of osteoporosis

echoecho's version from 2015-05-20 21:17


Question Answer
Nonpharmacologic treatments for osteopenia and osteoporosis are often overlooked in spite of evidence for their effectiveness. Certain nonpharmacologic interventions are recommended for the entire population, rather than just ____ and ____ at risk for bone loss and fracture?men; women
____ and ____ _____ are important to overall health as well as prevention and treatment of osteoporosis?exercise; muscle strengthening
*** A Cochrane review of postmenopausal women found that what type of exercise increased bone density in the lumbar spine and hip?weight-bearing exercise
List 6 activities that are weight-bearing and will increase bone density and muscle strength?1) walking 2) dancing 3) climbing stairs 4) aerobics 5) elliptical training 6) tennis
List addition benefits of the above activities?prevents fractures by increasing agility and balance
Exercise for ____ minutes on most days of the week in one session or in several short sessions is recommended?30
List activities that may improve strength, balance and cardiovasccular fitness but do not increase bone density since they are nonweight bearing?swimming, bicycling
Activities that involve flexion or twisting of the spine (abd crunches) are beset avoided in pts w/ osteoporosis, why?may precipitate fractures
Resistance and strenghtening exercises are also recommended. List exercises? What is a reasonable goal?1) exercises against gravity (climbing stairs, getting in and out of a chair, exercise against resistance using weights or rubber bands) 2) goal: 2 sets of 10 repetitions with a rest period in between
Exercises that reduce rounded shoulders and improve posture by stengthening back extensors help prevent vertebral fractures. Give some examples?1) standing straight and raising the stenum while pinching the shoulder blades together 2) standing with the heels 2 inches from the wall and pressing the back and shoulders against the wall 3) keep back as straight as possible in all activities
What can be used to increase back extensor strenght and decrease pain after vetebral fracture?Weight-containing posture-training support vests
Other lifestyle issues should be address. List these?1) smoking cessation (smoking is associated with decreased bone density) 2) consumption of > 3 alcoholic drinks/day increases fracture risk (although bone density is not affected)
____ prevention is vital to preventing fractures?fall
What 2 things should be checked and corrected if necessary?hearing and vision
Evaluation for ______ problems and medications reviewed for effects on balance and stability?neurological
Home should be evaluated for safety with ____ and _____ ____ installed as needed?handles; grab bars
*** The use of padded ____ _____ can be considered but compliance is often poor and there is little evidence of effectiveness?hip protectors
The Institute of Medicine calcium recommendation is _____ mg/day for men 51-70 y.o. and _____ mg/day for women 51-70 y.o.?1000 mg; 1200 mg
For patients > 71 years of age, _____ mg /day is recommended?1200 mg
Give examples of foods and their calcium content that shows that most adults do not get that much from their dietary intake?Calcium 300 mg = 8 ox milk, 6 oz yogurt, 1.5 cubic inches of cheese
Calcium supplements are absorbed best when given in divided doses of less than _____ mg per dose?1000 mg
Daily intake of calcium > ______ mg isunlikely to be beneficial and may contribute to kidney stones and cardiovascular disease?1500 mg
Inadequate intake of calcium requires bone ______ to keep serum levels constant?resorption
The effectiveness of osteoporosis meds is reduced when pt fails to consum adequate ____ and ____?calcium; vitamin D
What vitamin is essential for calcium absorption, bone health, and muscle performance and balance and decreases fall risk?vitamin D
Another study showed that vitamin D supplementation reduces falls in pt > ___ years of age, with a number needed to treat of 15?60
Define vit D insufficiency?vit D level of 20-30 ng/mL
Define vit D deficiency?vit D < 20 ng/mL
List the risk factors for vitamin D deficiency?1) obesity 2) dark skin 3) fat malabsorption (sprue, cystic fibrosis, celiac diseae or Crohn's disease) 3) chronic renal insufficiency 4) lack of sun exposure
Why does measurement of 1,25-dihydroxy vit D3 not dx vit D deficiency?because renal mechanisms keep this level at a steady state.
The major source of vitamin D in the body results from incidental ___ exposure?sun
What occurs from the sun to the biologically active form?ultraviolet B radiation (UVB) from the sun converts 7-dehydro-cholesterol in the skin to cholecalciferol (vitamin D3). This is then metabolized in the liver into 25 hydroxyvitamin D3 and is finally metabolized by the kidneys into the biologically active form, 1,25-dihydroxy vitamin D3.
What are the current recommendations to prevent vitamin D deficiency?5-10 minutes of sun exposure of the hands, arms, and face or the arms and legs 2 or 3 times per week near solar noon.
List the 5 objects that can block UVB?1) plain window glass 2) sunscreen 3) polllution 4) cloud cover 5) melanin
Aging skin ___ _____ (is or is not) efficient in producing vitamin D?is not
Latitudes above ____ degrees have a 4-6 month "UVB winter"?32
What is a "UVB winter"?when the sun is low on the horizon and ozone, clouds, and pollution deflect UVB away from the earth.
Why is exposure to sunlight never result in vitamin D toxicity?since the same mechanism that produces vitamin D also metabolizes excess vitamin D
Suprisingly, vitamin D deficiency is also prevalent, in warm and sunny climates, true or false?true
List natually occurring dietary sources of vitamin D?oily fish (salmon, mackerel and sardines ) = 400 IU per 3.5 ox and some fish oils like cod liver oil
List other sources of vitamin D?vitamin-fortified dairy products, juice and cereal
*** The NOF recommends an intake of _____ to _____ IU of vitamin D per day for adults age 50 years and older?800 to 1000 IU
Higher doses may be required in patients who are severely vitamin D deficient (< 10 ng/mL). Repeat 25-hydroxyvitamin D levels is appropriate following an oral dose of what?50,000 IU, per week of vitamin D2 for 8 weeks.
Vitamin D toxicityhas been seen when daily intake exceeded what?10,000 IU
Do doses of 4,000 IU per day for 3 months and 50,000 IU per week for 2 months been given without toxicity?yes
How is toxicity usually manifested?asymptomatic hypercalcemia
The USPSTF concludes that current evidence is ______ (sufficient vs. insufficient ) to assess the balance of the benefits and harms of combined vitamin D and calcium supplementation for the primary prevention of fractures in premenopausal women and in men?insufficient
The USPSTF concludes that the current evidence is _______ (sufficient vs. insufficient) to assess the balance of the benefits and harms of daily supplementation with greater than 400 IU of vitamin D3 and greater than 1000 mg calcium for primary prevention of fractures in noninstitutionalized postmenopausal women?insufficient
Supplementation in amounts less than those ______ (is vs. is not) recommended?is not