Med Aspects Final

• Low bone mass
• Structural deterioration of bone tissue leading to fragility

1 in 8

1 in 2

• Estrogen levels drop postmenapaus, which leads to osteoporosis
• Bone spairing

• 20% white women 50 and older
• 5% black women 50 and older
• 10% hispanic women 50 and older

• Low bone mass
• T score of -1 to -2.5
• 68% fall w/in stan. dev
• 95% w/in 2 stan. dev
• 99% w/in 3 stan. dev

• leads to pre-osteoblast
• eventually leading to mature osteoblast

• Increased secretion of calcitonin which stimulates osteoblasts
• Osteoblasts decrease the calcium in blood

• Increased secretion of parathyroid hormone
• This leads to increases in osteoclast activity and increase in blood calcium levels

• Suction to bone, creates acetic environment through proton pumping
• Seals off by useing alphav-beta3 integrin

• Stimulation of RANKL protein stimulates osteoclast production
• Parathyroid is stimulated by low blood calcium levels
• Osteoprotegrin blocks RANKL protein preventing stimulation of osteoclast activity

• High levels of calcium stimulate thyroids release of calcitonin which is a powerful inhibitor of osteoclasts
• Low levels of calcium stimulates parathyroid gland to secrete parathyroidhormone which stimulates osteoclasts

Vitamin D increases calcium absorption from GI tract

Overload principle applied to bone - A bone will respond to the load imposed on it

BMD increases

Activities that require constant loading - plyometric type activities best

Associated with the process of normal aging (0.5-1.0% loss/yr after 30 y.o.

• Menopause related (post-menopausal)
• -2 to -6.5% bone loss per year (trabecular bone)

• Age related (senile)
• 50-70 y.o., trabecular loss, vertebrae, wrist, and femoral neck fractures

• Caused by certain medical conditions and medications
• Acromegaly, cushing's syndrome, hyperparathyroidism, intestinal malabsorption, Marfan's syndrome, scurvy
• Also can be caused by antacids, cortisone therapy, heparin, lasix, methotrexate, and thyroid hormone

May cause stimulation of GHRH which causes GH release of pituitary leading to acromegaly, and hypothalamus may also release CRH which stimulates release of cortisol which breaks down protein, which is found in the bone matrix

Heparin increases release of thyroid hormone which causes universal breakdown of tissue

chemo drug which inhibits bone growth

Trabecular bone

• Female
• Advancing age
• Caucasian race
• Low body mass
• premature menopause or prolonged premature amenorrhea
• Low calcium intake
• Chronic smoking and/or excessive alcohol
• Chronic corticosteroid

• >70% in people > 70 y.o
• Each 1 SD decrease in bone mass increases fracture risk by 15%

• Women over the age of 65
• Women with post menopause bone fracture
• Women on HRT for prolonged periods
• Men with low testosterone levels

Large antacid use leads to low BMD

hormone replacing therapy is associated with increase risk of cancer

• Collapsed vertebrae
• Kyphosis posture

Kyphosis can cause decreased space in the anterior component of the disk

• Wrist
• Vertebrae
• Femoral neck

25%

Gel portion of disk is pushed thru cartilage and puts pressure on the spinal nerves

• inhibits bone remodeling behavior (osteoclast behavior)
• Also endothelial protecting, decreasing risk of CAD

• Reduces blood Ca++ levels
• decreases Ca++ resoprtion
• decreases osteoclast activity
• decreases Ca++ reabsorption

• Not estrogen, but binds to estrogen receptors
• Increase BMD
• Decrease risk of CAD

Inhibit osteoclast activity

• > 60 y.o. take 1200 mg/day
• But remember, you can only absorb 500 mg/ingestion so spread the doses
• Females > 50 y.o. take 1500 mg/day

Low back pain

Low back pain

Less than three months of pain

Greater than 3 months

• Osteoporosis/arthritis
• spinal stenosis
• Nerve impingement
• Trauma, sprain, strain
• Muscle contracture

• Pain and impingement caused by impingement in the lumbosacral area
• Often due to weak core

• Cervical lordosis
• Thoracic kyphosis
• Lumbar lordosis
• Sacral kyphosis

Ligament damage/tear

Muscle damage/tear

• Abdominals
• hamstrings
• gluteals
• illiacus, quads, sartorius, TFL

• Erector spinae
• Illiopsoas

Lumbar lordosis

anterior pelvic tilt

• ASIS line up with pubic symphysis
• Femoral head should line up with lumbar L5
• Ears and ASIS

• Hip flexors tight
• Abdominals weak

On your ischeal tuberosity, with knees at 90˚

Close to your body to decrease the lever length

• Kidneys unable to hold water (lack of ADH)
• Glucose in urine

Occurs during the third trimester

Hypoinsulinemia

Hyperinsulinemia

• Cancer in the adrenal medulla
• Prevents release of insulin

• Increase glucose uptake, oxidation, and storage in cells
• Increase TAG storage
• Decrease TAG breakdown
• Increase aa uptake and protein synthesis
• Inhibit action and release of anti-insulin hormones

• Increased adipocyte lypolysis
• Increased blood glucose
• Increased FFA (increased LDL, VLDL)
• Increased ketone production
• acetone form ketone production causes fruity breath

• Glycosuria
• Polyuria
• Polydipsia (thirsty)
• Polyphagia (hungry)
• Lethargic/fatigue

• Eventually, glucose binds to hemoglobin. Since this process takes a while it gives a bit of history to how long you have been hyperglycemic
• Normal < 6.5% of Hb

7-20 uU/ml is normal

0.5 - 3.0 is normal

• Deep, labored, gasping
• caused by ketoacidosis

pH dropped too far

Calcification of fatty plaque causing artery to be stiff and hard

• Retinopathy
• Nephropathy (40%-50% will have renal disease) 2/3 of these will have kidney faiure and need a transplant

16-58% will eventually develop gangreen

• Decrease total kcals if obese (300-500 kcals/day to lose 1-2 lbs)
• 55-70% CHO's
• Cholesterol <300 mg

3 meals + 3 snacks

• Muscle contractions stimulate glucose to go from blood to muscle
• May last up to 48 hours
• Prolonged exercise can increase HDL by 50% and drop triglycerides by 50%
• Increase insulin receptors and glut-4 carriers in cell