Sreening + Fragility Fractures.txt

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  1. Primary Care Questions
  2. Prevention/screening guidelines for Osteoporosis for age 50-64?
    • Assess risk (Dexa risk score)
    • High risk includes prednosone >7.5mg/d x 3 months
  3. When do you screen for Osteoporosis in >50 yrs?
    Only if fragility #
  4. When is the upper age limit for rotavirus vaccine?
    8 months because after then the risk of febrile seizures is too high, outweighs benefit
  5. Screening for Tobacco use?
    All patients at every visit
  6. Screening for diet? And preventative diet supplements?
    Folic acid for all reproductive aged women, Vit D and Calcium > 50 yrs
  7. Obesitie screening?
    Hgt, wgt, BMI and waist circumference each visit
  8. New waist upper limits?
    94cm for men, 88cm for women
  9. Who gets ASA 80?
    Not for primary prevention. Not in ppl with DM unless 2+ VV RF`s
  10. Hypertension screening?
    Take bp in all at all visits
  11. What are definitions of HTN on home monitoring?
  12. Quebec`s recommendation for exercise?
    > 150 min/ wk of moderate (lightly out of breath) for periods of >10 min + 2x per week of stregthening exercise
  13. AAA Screening?
    Abd U/S in men > 65 years with Hx of smoking, or woman >65 with FHx or smoking
  14. Diabetic screening?
    Q3yrs after age 40 if no RF`s, early if higer risk
  15. Colon Cancer Screening?
    • Normal risk � start age 50 with SOBT q2yrs
    • Stop at age 75
  16. If increased risk or family hx of CRC?
    Start screening 10yrs before age of Dx in relative
  17. BrCa screening?
    Starts at age 50 � breast exam and mammography q2yrs
  18. Uterine Ca Screening
    Pap starting at age 21 in all. Q 2 yrs when normal x 3. <
  19. When to stop
    Cease @ 69yrs if all tests �ive � must have 1 done 60-69
  20. Absolute contraindications to
  21. Alcohol abuse screening
    If all at every visit
  22. Fall risk screening
    In elderly with Hx of fall in last year
  23. Cognitive Deficit
    Ask about memory but screen with Folstein only if complaints or positve hx
  24. Osteoporosis Risk Factors in Family Hx?
    Parental Hx of hip #
  25. Osteoporosis RF`s in PMHx?
    Old, frailty, hyperTHY, hyperPTH, malabsorptive syndromes, BMI > 20 or weight loss, Meds � chronic glucocorticoid use, RA, Chronic liver or kidney disease
  26. Osteoporosis RF`s for men?
    Adrogen deficiency
  27. Osteoporosis RF`s for women?
    Estrogen deficiency, early menopause (<45 yrs), cessation of menstruation x 6-12 months (other than during preg, menopause or hysterectomy), taking aromatas inhibitors for BrCa
  28. Life style RF`s for osteoporosis?
    Smoking � ever, EtOH > 3/d, caffeine > 4/d, poor Ca/VitD, lack of sunlight (vit d), prolonged immobility and lack of weight bearing exercise
  29. What is chronic glucocorticoid use?
    More than 3 months @ 7.5 mg per day prednisone
  30. What is the 2nd part of fracture risk screening?
    Estimate 10yr fragility fracture risk � two scoring systems � FRAX (no BMD needed) and CAROC (needs BMD)
  31. What is a previous fragility fracture?
    Fall from standing height, vertebral compression # not 2/2 trauma. Hip, humerus, wrist are most associated with OP
  32. What do you do if low (<10%) ten year risk of #?
    Lifestyle advice + calcium and vit D
  33. What if moderate risk of fracture in 10 years?
    BMD to stratify risk, vit D and calcium, assess for pharmacotherapy (optional)
  34. What if >20% ten year risk OR recent hip # or Hx fragility fracture?
    • Lifestyle + vit d, ca, Rx with pharmacotherapy, fall prevention education
    • +/- BMD to monitor therapy
  35. When to do BMD?
    • Only if 65+ yrs, moderate risk of # (10-20%) and results likely to alter care.
    • Not for Ix of chronic back pain, kyphosis workup (XR is better), women <65 unless very high risk, not for confirmation of OP after fragility fracture
  36. How is OP diagnosed using BMD?
    Osteopenia is -1.1 to -2.4, OP is less than -2.5
  37. What lab tests are indicated for OP work up?
    Only to rule-out secondary causes. Do not order vitamin D levels!
  38. What is the recommended level of calcium?
    • 1000-1200 elemental mg per day � from diet or supplements.
    • Risk of increased CV events with Ca supplementation >500mg/d alone.
  39. Vitamin D recommended level?
    800-1000 IU per day of vitamin D3 (diet or supplements) for > 50yrs
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Sreening + Fragility Fractures.txt
family medicine
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