Osteoporosis and Fibromyalgia

Graduate Nursing 554 with Ura at Emory University

About this deck

By: Mitzi Williams
Textbook:

CURRENT Medical Diagnosis and Treatment 2012, Fifty-First Edition (LANGE CURRENT Series)
Created: 2011-11-12
Size: 22 flashcards
Views: 11

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osteoporosis definition

•A skeletal disease marked by low bone mass and microarchitectural deterioration that leads to an increased susceptibility to fracture.

Etiology of Osteoporosis

•Multifactorial

•Genetics account for 60-80% of bone mass

•Peak bone mass – age 25

•Stable until menopause in females

•2 to 3% decline in first 5 years of menopause

Risk Factors for Osteoporotic Fractures

Nonmodifiable- Personal history of fracture as an adult, History of fracture in first-degree relative, Caucasian race, Advanced age, Female sex, Late menarche

Modifiable- Low body weight (<127 lbs), Current cigarette smoking, Estrogen deficiency, Early menopause (< age 45) or bilateral Oophorectomy, Prolonged premenopausal amenorrhea

(> 1 yr) , Low lifelong calcium intake, Impaired eyesight, Recurrent falls, Inadequate physical activity, Poor health/fragility

Additional risk factors for development of osteoporosis

alcohol use, chronic steroid use (prednisone >10mg/day), immobilization, thyroid overreplacement, anticonvulsants (dilantin and tegretol)

measurement of BMD

•Essential for the diagnosis of low bone mass

•Assessment of future fracture risk and response to therapy

Central skeleton devices (hip & spine)

•Peripheral skeleton devices (finger, heel, tibia, and wrist/forearm)

•The DEXA (or DXA) is the most commonly used central device (dual-energy x-ray absorptiometer)

Diagnosis of osteoporosis

•Normal = BMD not more than 1 standard deviation below peak adult bone mass or T-score > -1

•Osteopenia = T-score between –1 and –2.5

•Osteoporosis = T-score < -2.5

•Severe osteoporosis = T-score < -2.5 plus one or more fragility fractures

Who gets BMD tests?

•Women aged 65 and older

•Postmenopausal women < 65 with risk factors

•Men aged 70 and older

•Adults with a fragility fracture

•Disease or medications associated with ¯ bone mass or loss

•Anyone being considered for Rx therapy

•Anyone being treated to monitor effect

Clinical features of osteoporosis

fracture sites- hip, wrist, spine

•Most common site is the spine.

•Vertebral fractures may be asymptomatic.

•Acute vertebral fx symptoms – intense localized pain & reduced spine motion.

•Acute pain lasts 4 to 6 weeks.

vertebral fractures lead to...

progressive kyphosis

flatening of lordotic curve

abdominal protrusion

loss of height

Pharmacologic Treatment for osteoporosis

Indicated for women with an osteoporotic fracture.

•National Osteoporosis Foundation recommends preventive treatment if T-score is –2.0 in absence of other risk factors and –1.5 if other risk factors are present.

biphosphanates, calcitonin, estrogen, forteo, evista, calcium, vit D

Biphosphanates

•Take on empty stomach upon arising with full glass of water. Do not eat for 30 minutes. Do not lie down until after eating.

•OK to take delayed-release Atelvia immediately after breakfast.

•Don’t take with antacids, vitamins, calcium

•Avoid in patients with active upper GI disease and those who cannot sit upright.

Increase risk of atypical fractures with prolonged use, Consider stopping bisphosphonates x 1 yr in those who are stable & had 5 yrs of Rx

Calcium and Vit D doses

Calcium=1200 mg qd > age 50. Calcium carbonate is cheapest. Calcium citrate - ↓ GI distress, ↑ absorption

•Vitamin D = 800 IU qd

Prevention/Treatment- osteoporosis

Avoid high caffeine

Avoid falls- good lighting, avoid rugs, cane, eyesight correction, rails and bars, items within easy reach

Vertebroplasty & kyphoplasty

Fibromyalgia (FMS)- talking points and definition

Most common cause of chronic diffuse pain

•Female:male ratio of 8:1

•Prevalence increases with age

•2 to 5 % of U.S. population

•Often seen in other family members

FBS= A syndrome or group of symptoms rather than a disease-Chronic widespread musculoskeletal pain of at least 3 months duration in all 4 quadrants of the body

Etiology - Fibromyalgia

•Thought to be a central sensitization syndrome

•Amplified afferent sensory signals overwhelm the “gated” protective mechanisms in the spine

•Perceive more pain from nonpainful stimuli (allodynia) & greater pain from painful stimuli (hyperalgesia)

Clinical Features – Fibromyalgia

Diffuse aching, stiffness, fatigue

•Multiple tender areas

•May have pain with light stroking

•Sleep disturbances

•Labs usually normal

Others:

•Irritable bowel syndrome

•Headaches

•Restless legs, cramps

•Numbness, tingling

•Multiple chemical sensitivities

•Impaired memory, concentration

•Cold intolerance

2010 FMS Diagnostic Criteria

•Based on a point system looking at:

- Location & number of painful areas

- Symptom severity & life impact

- Number & impact of somatic sx

(add “Widespread Pain Index” & “Symptom Severity Score”)

•No other disorder to explain problem

•Similar symptoms ≥ 3 months

Labs for FBS

(probably normal)

CBC, chemistry, thyroid panel, ESR and CRP

Treatment - Nonpharmacologic FBS

•Education & reassurance – neither rare nor a psychiatric disorder per se

•Stretching/ low impact aerobics – start slow & build

•Heat, massage, biofeedback, meditation

•Regular sleep schedule*

•Balance rest & activity

•Cognitive behavioral therapy

Medications - Sleep for FBS

•TCAs - Amitriptyline (Elavil) & cyclobenzaprine (Flexeril) are most studied FMS agents

•Start low (10 mg) several hrs before HS

•Build to 40 mg of cyclobenzaprine or 70 – 80 mg of amitriptyline

•Trazadone (Desyrel)

•Zolpidem (Ambien)

Lyrica

•FDA approved for FMS 6-21-2007

•Decreases substance P

•300 – 450 mg per day

•SE’s – dizziness, blurred vision, wt gain dry mouth, impaired motor function

Pregnancy category C. Caution with labor & delivery. Don’t use in lactation

Additional FBS Meds

•Both are SNRIs – serotonin & norepinephrine reuptake inhibitors

•Cymbalta (duloxetine) – 30 mg qd x 1 wk then 60 mg qd

•Savella (milnacipran) – progressive dosing up to 50 – 100 mg bid

•Caution with renal/liver/cardiac disease

Serotonin-boosting drugs – Prozac, Paxil, Zoloft, Effexor, Celexa, Lexapro )Analgesics – acetaminophen, NSAIDS, tramadol (Ultram). Try to avoid narcotic agents (not shown to be helpful long-term.) NSAIDs work best when combined with an antidepressant

About this deck

By: Mitzi Williams
Textbook:

CURRENT Medical Diagnosis and Treatment 2012, Fifty-First Edition (LANGE CURRENT Series)
Created: 2011-11-12
Size: 22 flashcards
Views: 11

About StudyBlue

“Simply amazing. The flash cards are smooth, there are many different types of studying tools, and there is a great search engine. I praise you on the awesomeness.”
Dennis