Learning Goal: I’m working on a health & medical multi-part question and need an explanation and answer to help me learn.
Respond to at least two of your colleagues’ posts on two different days and provide additional insight that might be useful and appropriate for the issue addressed. Use your learning resources and/or evidence from the literature to support your position.
Health conditions and implications for women: Osteoporosis
Osteoporosis is a common bone disease, affecting more females than males. It is characterized by low bone mas and deterioration of bone tissues resulting in reduced bone strength and increased risk for fractures (Akkawi & Zmerly, 2018). The risk factors increase with age and post menopause because of estrogen deficiency (Akkawi & Zmerly, 2018). Other risk factors include low body mass index, ethnic background (Caucasians at higher risk), vitamin D deficiency, low calcium intake, current smoking, alcohol abuse, and long-term use of certain medications, such as glucocorticoids, anticonvulsants, and cancer chemotherapeutic drugs (Akkawi & Zmerly, 2018).
Osteoporosis is categorized into two categories. Primary osteoporosis is associated with age and sex hormone deficiency (Tu et al., 2018). Secondary osteoporosis is caused by several autoimmune or inflammatory diseases, such as Cushing’s syndrome or rheumatoid arthritis, and/or medications, such as long-term glucocorticoid therapy (Tu et al., 2018). In this discussion, I will review common symptoms of osteoporosis, recommended diagnostic tests, and common treatments.
Osteoporosis does not cause symptoms that can be clinically diagnosed. It is usually identified after a bone fracture and/or screening. Fall risk assessment tool (FRAX) and routine lab work for vitamin D and other minerals are essential for prevention and screening (Blackie, 2020). Other laboratory orders to monitor would include serum calcium, serum phosphorus, PTH, TSH, serum electrolytes, BUN and creatinine, and CBC and differential (Blackie, 2020).
Recommended diagnostic tests
The gold standard for diagnosing osteoporosis is to order a dual-energy x-ray absorptiometry (DXA), which measures the bone mass density (BMD) of the person (Blackie, 2020). Measurements are usually taken from the femoral neck and spine, since it has greater predictive values for fracture risk (Blackie, 2020). The results of the DXA are reported as a T-score and Z-score. The T-score compares the mean values of measurements in the certain age group, and the Z-score is a comparison of BMD with others of the same age and ethnicity (Blackie, 2020). Patients with reduced bone density will have a negative or low score, and a T-score of -2.5 or less is diagnosed with osteoporosis (Blackie, 2020).
There are many treatment options for osteoporosis, so treatments need to consider the gender, degree of fracture risk, and additional factors the patient may have. The first option for treatment is bisphosphonates, such as alendronate and risedronate (Tu et al., 2018). These medications inhibit bone resorption and increase the BMD of bones (Tu et al., 2018). The second option is a denosumab, which is a human monoclonal antibody that ultimately increases bone formation, bone mass, and bone strength (Tu et al., 2018). The third option is strontium ranelate (Sr RAN), which increases osteoblast differentiation while inhibiting osteoclast formation simultaneously, reducing the risk of fractures in postmenopausal women (Tu et al., 2018). Estrogen replacement therapy is recommended for postmenopausal women if there are no cardiovascular contraindications. Combination pharmacotherapy is not recommended for treatment. A thorough health history is essential and the use of guidelines is crucial to diagnosing and treating patients with osteoporosis.
Akkawi, I., & Zmerly, H. (2018). Osteoporosis: Current concepts. Joints, 6(2), 122-127. Doi:10.1055/s-0038-1660790.
Blackie, R. (2020). Diagnosis, assessment, and management of osteoporosis. Prescriber, 14-19. https://wileymicrositebuilder.com/prescriber/wp-content/uploads/sites/23/2020/01/Osteoporosis-some-AC-made.pdf.
Tu, K.N., Lie, J.D., Wan, C.K.W., Cameron, M., Austel, A.G., Nguyen, J.K., Van, K., & Hyun, D. (2018). Osteoporosis: A review of treatment options. P&T, 43(2), 92-104. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5768298/.