Please enable JavaScript.

Coggle requires JavaScript to display documents.

Osteoporosis - Coggle Diagram

- - - - Nutrition
        
        1200-1500mg Ca daily, supplement if low
        
        High Na and protein intake may lead to urinary calcium excretion
        
        Risk of excess caffeine --> increased Ca absorption
        
        Spinach contains oxalate which may prevent Ca absorption
        
        Fiber may interfere with ca absorption
        
        Vit D: min rec: 600-1000IU/day
        
        Read nutrition labels
        
        ex: Soymilk: not always calcium fortified or contain vit d
    - - National Osteoporosis Foundation https://www.bonehealthandosteoporosis.org
      - Medical alert devices (ie Life Alert)
    - - EHR
      - Mobile health apps
  - - - Low bone density: A T-score of 2.5 or lower as measured by DEXA scan
      - Fragility fracture
        
        fracture that occurs from minor fall or injury
      - High fracture risk: A ten year probability of a major osteoporotic fracture of 20% or more, a hip fracture of 3% or more calculated using FRAX tool
    - - Continued bone loss or new fractures despite being on conventional therapy
      - Inability to tolerate medication
      - Secondary causes
      - Complex cases
        
        low bone mass in premenopausal women
        
        Situations where central bone density cannot be accurately measured.
    - - Physical therapy
      - Orthopedics
      - Social work
      - Nutritionist
- - - - 50% postemeopausal woment affected
    - - Most likely seconday causes
  - - - Thyroid disease
      - Cushing's syndrome
      - Hypogonadism
      - RA/IBD
      - Chronic renal insufficiency
      - malabsorption syndromes
      - Early/surgical menopause
    - - PPIs (chronic use)
      - Anticonvulsants
      - Corticosteroids (>3 mo, >5 mg/day)
      - Aromatase inhibitors
      - Androgen deprivation therapy
    - - Low dietary calcium
      - Smoking
      - Excessive Alcohol
      - Low body weight (BMI<21)
      - Sedentary lifestyle
      - Vitamin D deficiency
    - - Weigh-bearing exercise
      - Adequate Ca (120mg/day)
      - Vitamin D (800-1000 IU/day)
      - Healthy Body weight
      - Non-smoker
- - - - Systemic Skeletal Conditions
      - Vulnerable sites: Hips, Vertebrae, wrist, proximal humerus, pelvis
    - - Gradual & Asymptomatic early stages
      - Often discovered incidentally or after fracture
      - Postmenopausal women most affected (Estrogen deficiency)
    - - Chronic progressive (develops over years to decades)
      - Peak bone density ~age 30, then declines
      - Accelerated loss: first 5-10 year post menopause
    - - loss of height over time
      - Kyphosis (dowager's hump)
      - Fractures from minimal trauma
      - Severity: BMD T-score
        
        Normal: T-score > -1.0
        
        Osteopenia: T-Score -1.0 to -2.5
        
        Osteoporosis: T-score < -2.5
        
        Sever: T-score <2.5 + fragility fracture
    - - General
        
        Gait abnormalities
        
        Posture: Kyphosis, scoliosis
        
        Height/Weight measurement
      - Musculoskeletal
        
        Asymmetry or deformity
        
        ROM assessment
        
        BUE.BLE stregth
        
        Pain in long bones, hips, pelvis
  - - - Screening Criteria
        
        Postmenopause women <65 with 1+ risk factor
        
        All postmenopausal women >65 years
      - Diagnostic Criteria: T-score of -2.5 or less
    - - Clinical screening tool calculating 10- year probability of hip fracture or major osteoporotic fracture (MOF)
- - - - :arrow_up:ROS
        
        :arrow_up:Oxidative stress
        
        :arrow_up:osteophyte destruction
        
        :arrow_down:bone formation
        
        Decreased BMD
    - - :arrow_up:activity of osteoclasts
        
        :arrow_up:bone resorption
        
        :arrow_up:bone loss
        
        Impaired bone quality
        
        Osteoporosis
  - - - :arrow_down:blood supply to bone
        
        Alterations in osteogenesis
        
        :arrow_up:Bone resorption :arrow_down:bone formation
      - :arrow_up:free radicals
    - - Stimulates apoptosis of osteoblasts and osteocytes
      - :arrow_up:activity of osteoclasts
        
        :arrow_up:bone resorption
    - - :arrow_up:osteoclast activity
        
        :arrow_up:bone resorption
        
        :arrow_up:bone loss
    - - :arrow_down:Vit D
        
        :arrow_down:Calcium absorption
        
        :arrow_down:bone formation