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Osteoporosis Study Notes

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EPI 390
EXAM 2
Lecture 11
2/15/2018
Osteoporosis PowerPoint
exposurefragility fracture
Question from epidemiological and public health perspective:
o Why do different groups of individuals (age, sex, ethnicity, lifestyle, diet) have
significantly different rates of OP?
o Why does OP distribute itself non-randomly temporally and spatially?
o Golden triangleperson, place time
o Risk factors, how to identify risk factors. What are variables consistent with risk
factors, do we want to put them on secondary/tertiary pathway?
Heterogeneitywho should we target, is it inevitable? Is it a process? Are
there primary preventions? Is there anything we can do/when? What are
risk factors we can ID if any?
Fragility fracture
o Fracture that goes on with osteoporosis
o Directly related to osteoporotic bone
o Not talking about non-fragility fracture (fall off bike and break leg, that is
traumatic fracture)
Epi perspective
o How do I go about identifying risk factors at population level? How do I go about
ID (genetic, etc) disease process?
o Target population may not be perimenopausal women (@ or around time of
menopause)
What about in growth and development? Growth spurt. Is there primary
prevention so when women get perimenopausal (around 50), anything we
can do so when we start to lose bone we can buffer?
Bank account example: have checking and have savings (buffer). Can we
put bone cells in reserve so when we drain checking account (skeleton),
can we build savings account so when checking account becomes
dangerously low we have a bit of reserve? Draw down from savings
account to checking account. This predispose you less (RR), better off
over long run.
How do we increase mass (quantity)building up checking and saving
account? Quality is more difficulttake what you have and redistribute it
to biomechanically sensitive sites.
Primary prevention
o Stopping something before it even starts
Secondary prevention
o Lessening symptoms after disease established
Tertiary prevention
o Disease to the point to where nothing you can do except surgery
o Last resort

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Ex) hip replacement, surgical intervention
Palliative carepain management
EPI of OP
OP: skeletal disease characterized by low bone mass and microarchitectural deterioration
of bone tissue with a consequent increase in bone fragility and susceptibility to fracture
o How qualitatively sound is your bone? How much bone mass do you have at any
given moment in your life?
o Bone is susceptible to fracture at a few anatomical areas especially, due to
evolution
Ex) you could have normal bone given to age, sex, etc. but you
could be susceptible to fracture
Biomechanically sensitive (proximal femur)
Anatomical site: hip fracture
o You don’t have a ‘hip’
o Ileum + ischium + pubic bone = hip, and you don’t break
that
o You actually are breaking your femur, biomechanically
sensitive areafemoral neck
o Hip is only major joint that works in three dimensions,
move it forward, back, medial, lateral, torsion **not good
for skeletal system**
Lost stability in hip (teeter totter)
Due to evolutionary locomotion: used to have 4 legs
(quadrupedal), now were bipedal (2 legs).
o Problematic: reorientation of female pelvis *difficult
skeletal structure accommodating to child birth*
o Problematic:
o Definition based on BMD may not encompass all risk factors for fracture and a
fracture based definition will not ID at risk populations
WHO
Defined OP in terms of BMD and previous fracture
This definition doesn’t take into account microarchitectural changes that may weaken
bone independently of any effect of BMD
Move toward assessment of individualize 5 or 10 year absolute risk advantages:
incorporate risk factors that are independent of BMD (age and sex and ethnicity), thus
allowing decisions regarding therapy commencement to be made more historically
o Derive models to make HR/RR <1, meaning protective. Exposure to variables that
are risk factors for outcome of interest
Crude model
Adjusted modeladd covariates and see which covariates bring model
down closer to 1, less than 1
Incorporate quantative pieces and qualitative pieces.
o HR >1, compared to controls, individuals have higher risk of outcome of interest.
WHO diagnostic Criteria for OP
Category & definition by BMD
o NormalBMD <1 SD below the young adult mean value

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EPI 390 EXAM 2 Lecture 11 2/15/2018 Osteoporosis PowerPoint • • • • • • exposure→fragility fracture Question from epidemiological and public health perspective: o Why do different groups of individuals (age, sex, ethnicity, lifestyle, diet) have significantly different rates of OP? o Why does OP distribute itself non-randomly temporally and spatially? o Golden triangle—person, place time o Risk factors, how to identify risk factors. What are variables consistent with risk factors, do we want to put them on secondary/tertiary pathway? ▪ Heterogeneity—who should we target, is it inevitable? Is it a process? Are there primary preventions? Is there anything we can do/when? What are risk factors we can ID if any? Fragility fracture o Fracture that goes on with osteoporosis o Directly related to osteoporotic bone o Not talking about non-fragility fracture (fall off bike and break leg, that is traumatic fracture) Epi perspective o How do I go about identifying risk factors at population level? How do I go about ID (genetic, etc) disease process? o Target population may not be perimenopausal women (@ or around time of menopause) ▪ What about in growth and development? Growth spurt. Is there primary prevention so when women get perimenopausal (around 50), anything we can do so when we start to lose bone we can buffer? ▪ Bank account example: have checking and have savings (buffer). Can we put bone cells in reserve so when we drain checking account (skeleton ...
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