Final Exam: Osteoporosis, Stress, Chronic Diseases, Body Weight, Infectious Disease

2. New guides for hypertension. Cutoff was 130/90 and now is?

(Please note that all numbers refer to mm Hg, or, millimeters of mercury.) The guidelines, in a nutshell, state that normal blood pressure is under 120/80, whereas before normal was under 140/90. Now, elevated blood pressure (without a diagnosis of hypertension) is systolic blood pressure (the top number) between 120 and 129. That used to be a vague category called "prehypertension." Stage 1 high blood pressure (a diagnosis of hypertension) is now between 130 and 139 systolic or between 80 and 89 diastolic (the bottom number). Stage 2 high blood pressure is now over 140 systolic or 90 diastolic. The measurements must be obtained from at least two careful readings on at least two different occasions. What does careful mean? The guidelines provide a six-step tutorial on how, exactly, to correctly measure a blood pressure, which, admittedly, is sorely needed. My patients often have their first blood pressure taken immediately after they have rushed in through downtown traffic, as they're sipping a large caffeinated beverage. While we always knew this could result in a falsely elevated measurement, it is now officially poor clinical technique resulting in an invalid reading.

5. Role of some medical conditions in loss of bone mass

1) Lupus and Rheumatoid Arthritis Nearly 3 million adults in the U.S. have either lupus or rheumatoid arthritis. Both of these diseases are autoimmune conditions, in which the body attacks its own healthy cells and tissues, causing inflammation. Any chronic inflammatory disease can put you at greater risk of osteoporosis, says Edwards, because it appears to increase the rate of bone turnover, in which old bone is replaced with healthy new bone. People with both lupus and RA usually take corticosteroids for an extended period of time to manage their symptoms. Long-term use of steroids such as prednisone is also a leading cause of osteoporosis, possibly because they slow the activity of bone-building cells. Lupus is a particular problem because it is common in women between the ages of 15 and 45 -- often during the peak bone-building years up to age 30. "Anything that impedes the growth of bone during these years puts you at greater risk for osteoporosis," says Edwards. 2) Diabetes Mellitus and Osteoporosis Studies show that people with type 1 diabetes may have low bone turnover and lower than normal bone formation. "It seems that high blood sugar may shut down bone formation, just as with steroids," says Beatrice Edwards, MD, MPH, associate professor of medicine and director of the Bone Health and Osteoporosis Center at Northwestern University Feinberg School of Medicine. Since type 1 diabetes usually develops in childhood, when the body is still building bone, someone with type 1 diabetes may never have the opportunity to reach their peak bone density. Even if their bone mass isn't that much lower than normal, people with both type 1 and type 2 diabetes have a much higher risk of fractures than other people, adds Edwards. 3)Hyperthyroidism Hyperthyroidism occurs when the thyroid gland -- a small, butterfly-shaped gland at the base of the neck -- becomes overactive and produces too much thyroid hormone. "Hyperthyroidism increases the number of bone-remodeling cycles you go through," explains Edwards. "And after age 30, every bone-remodeling cycle is inefficient. You lose bone mass rather than building it. So the more cycles you go through, the more bone mass you lose." Hyperparathyroidism, a similar condition involving related, but different glands, also ups the risk of osteoporosis. 4) Celiac Disease A number of digestive disorders, such as Crohn's disease, can be causes of osteoporosis. Perhaps the most common such cause, says Edwards, is celiac disease, an allergy to a protein called gluten that is often found in wheat products. Left untreated, celiac disease can damage the lining of the digestive system and interfere with the digestion of nutrients -- including the calcium and vitamin D that are so important to bone health. So even if you're getting the recommended daily amounts of calcium and vitamin D in your diet, if you have celiac disease, you probably don't have enough of those nutrients in your system, and you likely have low bone density. 5) Asthma Asthma itself does not increase your risk of developing osteoporosis, but the medications used to treat it do. Approximately 20 million people in the U.S. have asthma, including some 9 million children under the age of 18. Many people with asthma use corticosteroids -- such as asthma "inhalers" -- to help control their disease. During asthma attacks it is not uncommon to start drugs like prednisone for small periods of time. These are very effective in relieving the shortness of breath and wheezing that are common with asthma or emphysema, but they may also contribute to bone loss and osteoporosis. "In addition to this, many young people with asthma may have more difficulty participating in some activities, which means they might not get as much weight-bearing exercise as they need to help build bone," says Andrew Bunta, MD, associate professor and vice chair of orthopaedics at Northwestern University Feinberg School of Medicine. 6) Multiple Sclerosis Asthma and multiple sclerosis are two very different conditions, but there are very similar reasons why they both increase the risk of osteoporosis. Like people with asthma, people with multiple sclerosis take steroid-based medications to help manage their symptoms, and steroids are associated with bone loss. Since multiple sclerosis also affects balance and movement for many people, someone with MS may find it more difficult to get as much weight-bearing exercise as they need to in order to build and maintain bone.

3. Factors which contribute to the emergence or re-emergence of infectious disease

1. globalization 2. Poor sanitation 3. Other factors include a deteriorating public health infrastructure which is unable to cope with population demands, and the emergence of resistance to antibiotics linked to their increased misuse. 4. Travel has always been a vehicle to spread disease across the world, 5. The transmission of microorganisms can be divided into the following five main routes: direct contact, fomites, aerosol (airborne), oral (ingestion), and vectorborne. Some microorganisms can be transmitted by more than one route.

7. T-scores - ranges and bone density

A T-score of -1.0 or above is normal bone density. Examples are 0.9, 0 and -0.9. A T-score between -1.0 and -2.5 means you have low bone density or osteopenia. Examples are T-scores of -1.1, -1.6 and -2.4.

6. Blood sugar range for Pre-diabetes

A fasting blood sugar level below 100 milligrams per deciliter (mg/dL) — 5.6 millimoles per liter (mmol/L) — is considered normal. A fasting blood sugar level from 100 to 125 mg/dL (5.6 to 7.0 mmol/L ) is considered prediabetes.

13. Cortical vs trabecular bone

A) Both provide structural support for ambulation and ventilation; reservoir for calcium phosphate, amino acids and bicarbonate; protection of interior organs; transmission of sound waves; and nurturing of hematopoietic stem cells B). 80% of bones mass is cortical compartments C). Surface volume ration in cortical bone is much lower than trabecular bone D). in trabecular compartment, 20% of volume is composed of bone and remain space filled with marrow and fat E). Trabecular bone transfers mechanical loads from articular surface to cortical bone F). Material properties of bone compartments differ: trabecular bone has lower calcium content and more water compared to cortical bone G). Trabecular bone larger surface area exposed to bone marrow and blood flow and turnover is higher than the cortical bone H) Resorption takes place along bone surfaces in trabecular bone whereas in cortical bone resorption tunnels through bone itself H). Both men and women testosterone supports periosteal bone expansion while estrogen prevents cortical bone loss I). Trabecular bone loss is prevented by estrogen in women and testosterone in men J) Bone loss after menopause is more rapid in the trabecular bone but because the cortical bone comprises of 80% of the skeleton, the absolute amount of bone loss is similar from each compartment for the first 10 years. The Haversian canals widen, increasing the surface/volume ratio of the bone and further enhancing loss from bone that was formerly cortical but has become trabecularized. In women large canals causing cortical porosity are present throughout the cortex whereas than are closer to endocortex in men. Overall women lose more cortical bone then men but

10. Lipoprotein lipase activity and its role; activity in reduced calorie consumption

A) It is the enzyme that breaks down triglycerides into fatty acids and glycerol for the cell to use. B) Lipoprotein lipase (LPL), located on the capillary endothelium of extrahepatic tissues, catalizes the rate-limiting step in the hydrolysis of triglycerides (TGs) from circulating chylomicrons and very low density lipoprotein (for reviews, see refs. 1 and 2). Quantitatively, most LPL is found in adipose tissue (AT) and muscle, where the liberated free fatty acids are taken up and either stored or oxidized, respectively (3). It has been hypothesized that relative levels of LPL activity in AT and muscle determine how fat calories are partitioned toward storage or utilization, and that imbalances in tissue expression can therefore lead to obesity or weight loss

7. Risks/risk reduction for hypertension

A) Numerous clinical trials have shown that lowering blood pressure (BP) reduces CV risk by 20% - 25% for myocardial infarction, 35%-40% for stroke and by 50% for heart failure. The medical society cannot be proud for this low reduction. It is obvious that a better protection is needed. B)

3. Role of osteoblasts, osteoclasts

A) Osteoclasts are the cells that degrade bone to initiate normal bone remodeling and mediate bone loss in pathologic conditions by increasing their resorptive activity. They are derived from precursors in the myeloid/monocyte lineage that circulate in the blood after their formation in the bone marrow. B). Osteoblasts are the cells that secrete the matrix protein for bone formation ¡Osteoclasts are cells which break down bone

1. WHO recommendations for waist-hip ratio

A) WHR = measured ratio of waist circumference to your hip circumference which determines how much fat is stored in waist, hips and butt B) Healthy = .9 or less in men and .85 or less in women •Waist-to-height appears to be the most accurate measure according to several studies • The calculation measures waist circumference divided by height • Cut off points are 0.53 for men and 0.54 for women for whole body obesity, and 0.59 for abdominal obesity in both genders

3. Define stress vs stressor

A). Stress is the body's reaction to any change that requires an adjustment or response. The body reacts to these changes with physical, mental, and emotional responses. Stress is a normal part of life. You can experience stress from your environment, your body, and your thoughts. B). something that makes you worried or anxious : a source of stress. See the full definition for stressor in the English Language Learners Dictionary. stressor. noun.

Body Weight and Health

Body Weight and Health Cards

4. Influences on Basal metabolic rate

Body size: Metabolic rate increases as weight, height, and surface area increase. Body composition: Fat tissue has a lower metabolic activity than muscle tissue. As lean muscle mass increases, metabolic rate increases. Gender: The basal metabolic rate (BMR) averages 5 to 10 percent lower in women than in men. This is largely because women generally possess more body fat and less muscle mass than men of similar size. Age: A decrease in lean muscle mass during adulthood results in a slow, steady decline of roughly 0 3 percent per year in BMR after the age of about 30. This can be largely avoided by strength training throughout adulthood. Climate and body temperature: The BMR of people in tropical climates is generally 5 to 20 percent higher than their counterparts living in more temperate areas because it takes energy to keep the body cool. Exercise performed in hot weather also imposes an additional metabolic load. Body fat content and effectiveness of clothing determine the magnitude of increase in energy metabolism in cold environments; it takes energy to keep the body warm if you work or exercise in very cold weather. Hormonal levels: Thyroxine (T4), the key hormone released by the thyroid glands has a significant effect upon metabolic rate. Hypothyroidism is relatively common, especially in women near or after menopause. Everyone with a weight problem should have their thyroid function checked by their doctor and treated appropriately if it turns out to be low. Health: Fever, illness, or injury may increase resting metabolic rate two-fold.

Chronic Disease

Chronic Disease

8. BMI -does it work for males and females alike

For the same level of adiposity (using BF%), systematic differences in BMI were found in different gender and age groups from a randomly selected national sample (male n=1420; female n=1573) taken from 30 English parliamentary constituencies (Figure 1). On the basis of these differences, the BMI means (rounded), calculated and reported in Table 1 suggest that younger males and, to a lesser extent female participants have significantly higher levels of BMI compared with their older counterparts, for the same levels of adiposity (BF%). This is unsurprising given that younger males are likely to be more active than younger females and that physical activity will naturally decline in both genders in older people. This trend is well documented with aging in particular the presence of sarcopenia that is characterized by reduced muscle mass and increased adiposity, the latter being the result of lower energy expenditure.

2. How to measure body composition

How Body Composition is measured: 1.Skin folds 2.Bioelectrical impedance 3.Underwater weighing 4.DEXA scan

12. Definition of blood pressure

In the body, the arteries carry blood away from the heart. As blood travels through the arteries, it presses against the walls of the arteries. Blood pressure measures how hard the blood is pushing against the walls of the arteries.

Infectious Disease

Infectious Disease

2. Influence of genetics, lifestyle on osteoporosis

Influence of genetics: Osteoporosis is characterized by two features: low bone mineral density (BMD) and increased risk of fracture. Both of these features have a strong genetic component. For BMD, 60% to 80% of phenotypic variance is explained by genes. Osteoporotic fracture has a lower heritability, but it is still high: 50% to 70% of the risk of osteoporotic fracture is attributable to genetic factors.1 Other bone parameters such as geometry and even bone microstructure are also known to be highly heritable. The gene is called the DARC gene. It makes a protein needed to help break down bone. Some variations in the DARC gene boost production of that protein, ultimately lowering bone mineral density, the scientists say. certain variations in the DARC gene may influence bone mineral density. Influence of Lifestyle:

10. Hormones that control blood sugar (after meals vs when blood sugar is low)

Insulin helps the cells absorb glucose, reducing blood sugar and providing the cells with glucose for energy. When blood sugar levels are too low, the pancreas releases glucagon. Glucagon instructs the liver to release stored glucose, which causes blood sugar to rise

11. Age, males, and osteoporosis

It develops less often in men than in women because men have larger skeletons, their bone loss starts later and progresses more slowly, and they have no period of rapid hormonal change and bone loss. For most people, bone mass peaks during the third decade of life. By this age, men typically have accumulated more bone mass than women. After this point, the amount of bone in the skeleton typically begins to decline slowly as removal of old bone exceeds formation of new bone. By age 65 or 70, however, men and women lose bone mass at the same rate, and the absorption of calcium, an essential nutrient for bone health throughout life, decreases in both sexes. Excessive bone loss causes bone to become fragile and more likely to fracture.

1. Protective HDL level for CVD

Low HDL levels (less than 50 mg/dl) seem to be a stronger risk indicator for women than men. HDL levels of 60mg/dl or higher are considered "cardio protective" because they lower the risk of heart disease

10. Nature vs nurture and body

Most obesity seems to be multifactorial, that is, the result of complex interactions among many genes and environmental factors.Biological •Studies indicate that a child with no obese parent has a risk of obesity of 10%; with one parent the risk increases to 40%; with two obese parents 80% •Studies of identical twins reared apart-weight/fat distribution •Researchers have identified a number of genes that are associated with obesity --Sensitivity to certain tastes --Genetic variation in hormones, e.g., leptin, CCK; ghrelin --Metabolism- ex. How we use or store fat --Gut microbiota --Satiety-less responsive to internal satiety cues (lower satiety responsiveness from very early in life) •Body type Thrifty gene Nature •Couples(or families) & behavior re: food & activity •SES—income, education, access to health, access to fresh foods ----Think about low income & food insecurity •Rural environment -rural women tend to be heavier than those in metro areas •Race and Ethnicity • Most obesity seems to be multifactorial, that is, the result of complex interactions among many genes and environmental factors.

14. Age of peak bone mass

Most people will reach their peak bone mass between the ages of 25 and 30. By the time we reach age 40, however, we slowly begin to lose bone mass.

Osteoporosis and Bone Health

Osteoporosis and Bone Health

15. Alcohol consumption, tobacco use and body fat location

Our results showed that alcoholics are habitually less active and that alcohol drinking is an independent predictor of lower percent body fat especially in male alcoholics. Cigarette smoking was negatively associated with BMI independent of genetic influences. The influence of genes on BMI was moderated by alcohol drinking, such that for individuals who were regular drinkers, genetic factors became less influential. Our findings highlight gene-alcohol interaction in finding candidate genes of BMI and elucidating the etiological factors of obesity.

8. Metabolic Syndrome-list of risk factors

Overweight and obesity. An inactive lifestyle. Insulin resistance, a condition in which the body can't use insulin properly. Insulin is a hormone that helps move blood sugar into your cells to give them energy. ... Age - your risk goes up as get older. Genetics - ethnicity and family history. A large waistline, also called abdominal obesity or "having an apple shape." Too much fat around the stomach is a greater risk factor for heart disease than too much fat in other parts of the body. Having a high triglyceride level. Triglycerides are a type of fat found in the blood. Having a low HDL cholesterol level. HDL is sometimes called the "good" cholesterol because it helps remove cholesterol from your arteries. Having high blood pressure. If your blood pressure stays high over time, it can damage your heart and lead to other health problems. Having a high fasting blood sugar. Mildly high blood sugar may be an early sign of diabetes. The most important risk factors for metabolic syndrome are Abdominal obesity (a large waistline) An inactive lifestyle Insulin resistance increased blood pressure (greater than 130/85 mmHg) high blood sugar levels (insulin resistance) excess fat around the waist. high triglyceride levels. low levels of good cholesterol, or HDL. According to the American Heart Association and the National Heart, Lung, and Blood Institute, there are five risk factors that make up metabolic syndrome. Large Waist Size For men: 40 inches or largerFor women: 35 inches or larger Cholesterol: High Triglycerides Either 150 mg/dL or higher or Using a cholesterol medicine Cholesterol: Low Good Cholesterol (HDL) Either For men: Less than 40 mg/dLFor women: Less than 50 mg/dL or Using a cholesterol medicine High Blood Pressure Either Having blood pressure of 130/85 mm Hg or greater or Using a high blood pressure medicine Blood Sugar: High Fasting Glucose Level 100 mg/dL or higher

1. Primary and secondary osteoporosis

Primary osteoporosis is bone loss that occurs during the normal human aging process. Secondary osteoporosis is defined as bone loss that results from specific, well-defined clinical disorders. Many times reversible, secondary causes of bone loss are not considered in a patient with low bone mineral density (BMD).

1. Prolonged stress results in increased body fat and blood pressure effects

Psychosocial stress was associated with greater weight gain among both men and women with higher baseline body mass indexes if they experienced job-related demands, had difficulty paying bills, or had depression or generalized anxiety disorder. In this nationally representative cohort of US adults followed longitudinally over 9 years, psychosocial stress was associated with greater weight gain among both men and women with higher baseline body mass indexes if they experienced job-related demands, had difficulty paying bills, or had depression or generalized anxiety disorder. Among women with higher baseline body mass indexes, perceived constraints in life and strain in relations with family also were associated with greater weight gain. Among men with higher baseline body mass indexes, lack of skill discretion or decision authority at work was associated with greater weight gain. Our results also highlight apparent sex differences in the influence of stress on weight gain. Some stressors outside of work or finances, including general life constraints and strain in relationships with family, were associated with weight gain among women but not among men, suggesting effects on weight from a broader range of life domains in women. Prior cross-sectional studies have shown some differential effects by sex. These studies assessed fewer measures of stress than our study evaluated and provided only limited information about specific types of stressors that might differentially influence weight gain found that men with higher baseline body mass indexes gained weight over 5 years if they experienced higher levels of work stress, but men with lower body mass indexes were more likely to lose weight under stressful job circumstances. Among women, weight gain was associated with higher job demands in main effect models, but the association was no longer significant when an interaction with baseline body mass index was included. In the subsequent analysis of the same cohort, men with chronically elevated levels of job strain and low social support at work were more likely to become obese and to develop a high waist circumference than those with no job strain (15); these associations were not significant among women.

2. Susceptibility to stressors is different in individuals based on what? Breakout group discussion.

Recent studies in animal models combining behavioral, molecular, functional imaging and optogenetic techniques reveal maladaptive, dysregulated gene expression and impaired stress-neurocircuit function across multiple brain regions as sources of individual stress-vulnerability.

Factors of Osteoporosis

Risk factors for osteoporosis1 include: Advanced age. Those over 65 years of age are at particular risk. Gender. Women are at much greater risk, losing bone more rapidly than men due to menopause. However, men are also at risk and constitute 20% of the patient population with osteoporosis. Family and personal history. This includes family history of osteoporosis, history of fracture on the mother's side of the family, and a personal history of any kind of bone fracture as an adult (after age 50). Race. Caucasian and Asian women are at increased risk. Body type. At greater risk are small-boned women who weigh less than 127 pounds. advertisement More Osteoporosis Info Osteoporosis Treatment Spine Fractures Kyphoplasty Surgery Menstrual history and menopause. Normal menopause alone increases a woman's risk of osteoporosis. Early menopause or cessation of menstruation before menopause increases the risk even more. (Males) Hypogonadism. This condition is also knows as testosterone deficiency. Lifestyle. Lifestyle behaviors that increase osteoporosis risk include: calcium and/or vitamin D deficiency; little or no exercise, especially weight-bearing exercise; alcohol abuse; cigarette smoking. Chronic diseases and medications. Certain types of medications can damage bone and lead to what is termed "secondary osteoporosis". This type of osteoporosis is estimated to occur in almost 50% of pre-menopausal women with osteoporosis and from 30% to 60% of men with osteoporosis. Also, secondary osteoporosis can cause further bone loss in postmenopausal women and older men with primary osteoporosis2. Included in this category are certain medications to treat endocrine disorders such as hyperthyroidism, marrow disorders, collagen disorders, gastrointestinal problems and seizure disorders. Use of glucocorticoids (steroids) to treat diseases such as asthma, rheumatoid arthritis and inflammatory bowel disease, especially the oral form of these medications (at higher doses and over longer periods of time e.g., more than 2 months), can be particularly damaging to bone. Given the serious nature of the diseases these medications treat, it is not advisable to alter or stop taking these drugs unless under a physician's advice.

12. Smoking, alcohol, and bone density

Smoking in any amounts has a detrimental effect on bone density. Alcohol intake of greater than 3 ounces per day (or about 2-3 typical drinks) has been shown to increase bone loss.

11. Risks for and potential outcomes of type 2 diabetes

Some of the potential complications of diabetes include: Heart and blood vessel disease. Diabetes dramatically increases the risk of heart disease, stroke, high blood pressure and narrowing of blood vessels (atherosclerosis). Nerve damage (neuropathy).

Stress and Health

Stress and Health

9. Role of dietary fat vs saturated fat for blood cholesterol levels

Studies show that eating foods rich in monounsaturated fatty acids instead of saturated fats improves blood cholesterol levels, which can decrease your risk of heart disease and may also help decrease the risk of type 2 diabetes.

14. Define the systolic phase of heart action

Systole is when the heart muscle contracts. When the heart contracts, it pushes the blood out of the heart and into the large blood vessels of the circulatory system. From here, the blood goes to all of the organs and tissues of the body. During systole, a person's blood pressure increases.

13. High blood pressure can result in what other CVDs

The excess strain and resulting damage from high blood pressure (HBP or hypertension) causes the coronary arteries serving the heart to slowly become narrowed from a buildup of fat, cholesterol and other substances that together are called plaque. This slow process is known as atherosclerosis.

3. Role of viral infection in diabetes

The most popular hypothesis circulating within and beyond the scientific community is that viral infections enhance or elicit autoimmune disorders such as type 1 diabetes. Indeed, viruses can injure β-cells and have been isolated in pancreatic tissues from diabetic patients.

2. Direct vs indirect transmission of infectious disease-methods

There are two types of contact transmission: direct and indirect. Direct contact transmission occurs when there is physical contact between an infected person and a susceptible person. Indirect contact transmission occurs when there is no direct human-to-human contact.

5. Role of tumor suppressor genes

Tumor suppressor genes are normal genes that slow down cell division, repair DNA mistakes, or tell cells when to die (a process known as apoptosis or programmed cell death). When tumor suppressor genes don't work properly, cells can grow out of control, which can lead to cancer

4. Ethnicity and bone mass differences

Variations in body size and composition are likely to contribute to reported differences.

4. Maladaptive stress management techniques.

What Does Adaptive and Maladaptive Mean to Cope? How you react to events and situations you encounter in life is how you cope. Coping can be negative or positive. Throughout your life, you have developed emotional survival skills that help you get through tough times. These emotional survival skills are not always healthy. Just because something works, does not mean it is the right way of handling a situation. Coping mechanisms need to be positive for you to lead a mentally healthy lifestyle. Learning how to properly cope can happen at any time, it is never too late. Maladaptive Coping Reacting to stress in a maladaptive manner can cause several types of anxiety disorders. It can also cause you to become reliant on objects or people. For example, if you have a stuffed animal that when held, makes you feel less anxious, you will want to have that stuffed animal with you always. You may even feel like you can't go anywhere without the stuffed animal, keeping it near you for easy access. You do this because it provides you with a sense of security. You can see how dysfunctional this behavior is. And not too many of your adult friends are going to want to associate with you if you are holding a stuffed animal all the time. So, while the stuffed animal stopped your anxiety temporarily, it created more problems for you in the long run. Using the stuffed animal as a way to feel secure is an example of maladaptive coping. Maladaptive coping can also cause you to go out of your way to avoid stressful situations and eventually you begin to isolate yourself from society. You are too great to be isolated and filled with anxiety. That's why it is important to learn about adaptive coping now.

9. Frax test and its role

What is Frax score? The test tells if you need to get further testing and or treatment plan for osteoporosis. Risk factors: Age, sex, weight, height, previous fracture, genetics, current smoking, glucocorticoids, rheumatoid arthritis, secondary osteoporosis, 3 more alcoholic drinks per day, mineral bone density. Estimates 10 yr percentage for major osteoporotic fracture and 10 yr risk of a hip fracture. Lifestyle changes that are essential: behaviors, no weight bearing exercise, quitting smoking and limiting alcohol. Ways to reduce fall risk: throw rugs or mini rugs to be avoided, grab bars in the bathroom, improving floor lighting at night, wearing shoes that aren't going to make you slip. Who should be tested: if you have more than 5% hip fracture who is over the age of 70 in the next 10 years. Any women over 50 and any men over 70 but especially the high risk group of people like Asians and Caucasians. Someone with eating disorder or low body weight from genetics. Someone who is younger than 50 who may have a condition that causes brittle bones. • Developed by the WHO and called FRAX • Based on BMD of the femoral neck combined with other factors & gives an estimate of the 10-yr risk of fracture

15. Define senile osteoporosis

a condition of significantly diminished bone mass due to long-standing imbalance between bone resorption and bone formation. Bone resorption and formation are the essential components of remodeling in the adult skeleton that continue throughout life.

4. Differences between cancer cells and normal cells

look at flashcards from quiz 2

1. What are fomites?

objects or materials which are likely to carry infection, such as clothes, utensils, and furniture.

6. T-scores and fracture incidence

• WHO recommends using data for a 30-year-old white female for everyone - the T score! • Values for 30-year-olds are used in post-menopausal women and men over age 50 because they better predict risk of future fracture An estimated 8.2 million women and 2.0 million men had osteoporosis and an additional 27.3 million women and 16.1 million men had low bone mass.

8. Alternative markers for body fatness (other than BMI or with BMI)

•Alternative markers for body fatness include: •Waist circumference •Waist-hip ratio •Waist-height ratio •% body fat

6. BMI range for increased risk of chronic disease in White European vs Asians

•At the same BMI, Blacks have less body fat than do Whites and Asians have more body fat than do Whites

7. BMI ranges and variations in body fat females vs males, African Americans vs White Europeans

•At the same BMI, women tend to have more body fat than men •At the same BMI, Blacks have less body fat than do Whites and Asians have more body fat than do Whites •At the same BMI, older people, on average, tend to have more body fat than younger adults •At the same BMI, athletes have less body fat than do non-athletes

5. BMI ranges

•BMI is gender neutral; a marker for overweight, not overfat •BMI is determined by considering weight in relationship to height •BMI "works" for the majority of the population. Generally the overweight are overfat. Who might we exclude? •Healthy: 18.5-24.9 •Overweight: 25-29.9 •Obese: 30 and over •Severely obese is 40 and over

3. Supports for the set point theory

•Set point theory: 1.Consider basal metabolism & calorie intake 2.The cost of weight bearing activity 3.Lipoprotein lipase activity & change w/ weight loss in the obese 4.Leptin levels reduced w/in 24hrs of calorie restriction •Settling Point Theory: Weight based on circumstances, i.e., different social and emotional situations, physical environments •The "dual intervention point" model: Weight is based on a combination of two set points and a settling point between them

9. Support for set point theory

•Set point theory: 1.Consider basal metabolism & calorie intake 2.The cost of weight bearing activity 3.Lipoprotein lipase activity & change w/ weight loss in the obese 4.Leptin levels reduced w/in 24hrs of calorie restriction •Settling Point Theory: Weight based on circumstances, i.e., different social and emotional situations, physical environments •The "dual intervention point" model: Weight is based on a combination of two set points and a settling point between them