SU 12 Ambulatory Medicine 3-0

a. Take bone samples from the hip and lumbar vertebrae.
b. Compare the density of bone w/a standard control, which is the bone density of a healthy 30-yr old person.
c. Can range from normal to osteopenia to osteoporosis.
d. Be sure to r/o 2° causes: check Ca, phos, alkaline phosphatase, TSH, Vit D, free PTH, creatinine, CBC.

a. Inhibit bone resorption
b. Weight-bearing exercises stimulate bone formation

a. Bisphosphonates
b. Calcium supplements
c. Vit D supplements
d. Calcitonin

a. They are used for tx and prevention of osteoporosis.
b. They decrease osteoclastic activity (by binding to hydroxyapatite) and decrease the risk of fractures.

a. Increases bone density by 5% to 6%.
b. Second-gen bisphosphonates are more effective than first-gen

a. Alendronate
b. Risedronate

a. Etidronate.

a. Long-term benefits are minimal, but it is useful as short-term therapy, esp in elderly female pts w/vertebral compression fractures.

1. Reduce or eliminate modifiable risk factors (such as smoking and alcohol intake)
2. Oestrogen replacement therapy for perimenopausal and postmenopausal women.
3. Raloxifene
4. Calcium supplementation
5. Prevent injuries

a. Oestrogen suppresses bone resorption by osteoclasts
b. Has been shown to increase bone density by 2-3%
c. Reduction in hip, wrist, and vertebral fractures

a. SERM (selective oestrogen receptor modulator
b. Functions as oestrogen agonist in some tissues and antagonist in others
c. Increases bone density by 1-2%.

a. Exercise program w/calcium and Vit D supplementation.

a. No effect at hip
b. Shown to decrease risk of vertebral fractures by as much as 40%.
c. Slight increase in bone density at lumbar spine.

a. ARMD (Age-related Macular Degeneration)

1. Loss of central vision (bc the macula is affected)
2. Blurred vision
3. Distortion
4. Scotoma
b. Complete loss of vision almost never occurs.
c. Peripheral vision is preserved

a. Advanced Age

a. Female gender
b. Caucasian
c. Smoking
d. HTN
e. Family hx

a. Wet and Dry.

a. Exudative ARMD is less common than non-exudative but is more severe.
b. Wet is responsible for most cases of severe vision loss.

a. Causes sudden visual loss due to leakage of serous fluid into the retina, followed by abnormal vessel formation (neovascularization) under the retinal pigment epithelium.

a. Atrophy and degeneration of the central retina.

a. Yellowish-white deposits called drusen form under the pigment epithelium and can be seen w/an ophthalmoscope.

a. Yes, the “wet” form can develop at any time, so pts w/dry must be monitored closely.

a. Effective tx does not exist, although laser photocoagulation may reduce the risk of severe vision loss if there is subretinal neovascularization.
b. Rx: Ranibizumab

a. Given as an intraocular injection.
b. Has been shown to be effective in reducing the rate or visual loss due to “wet” ARMD.

a. Supplements of certain vitamins containing antioxidants

a. Diabetic retinopathy (most common cause in adults <65)
b. ARMD (most common cause in adults >65)
c. Cataracts
d. Glaucoma.

a. One of the most important cause of blindness worldwide.
b. It is a complex disease characterized by ↑d IOP, damage to optic nerve, and irreversible loss of vision.

a. Not fully understood.
b. Ischaemia may play a major role.
c. Over time there is loss of ganglion cells, leading to atrophy of the optic disc (and enlargement of the optic cup, called “cupping”).

a. There are many types of glaucoma, but they generally fall into the following 2 categories:
b. Open-angle glaucoma –accounts for 90% of all cases.
c. Closed-angle glaucoma.