Rapondament sevena

Response 1

Osteoporosis, the most common metabolic bone disease, is defined as significantly decreased bone mass and the microarchitectural destruction of bone tissue (Barnsley et al. 2021.). Osteoporosis causes almost 9 million fractures globally, as well causing decreased physical and psychological well-being, decreased quality of life, and reduced life expectancy. Primary osteoporosis is either due to age or post-menopausal (Barnsley et al. 2021.).  Post-menopausal women are at higher risk due to the decrease in estrogen, which has a significant role in preventing bone resorption by inhibiting osteoclasts (Barnsley et al. 2021.).

            Unfortunately, osteoporosis does not have specific symptoms until a fracture is present (Keen & Reddivari. 2022.). Common fractures include vertebral fracture, hip fractures, and distal radial fractures (Keen & Reddivari. 2022.).  Vertebral fractures are often present asymptomatically and are noted incidentally on imaging (Keen & Reddivari. 2022.). Diagnosis of osteoporosis occurs by using dual-energy X-ray absorptiometry scanning, which quantifies the bone mineral density of the proximal femur to calculate a T-score (Barnsley et al. 2021.)  A T-score symbolizes the amount of standard deviations (SD) one’s bone mineral density is below the average value of a standard healthy, young population (Barnsley et al. 2021.). A T-score of less than or equal to 2.5 is indicative of osteoporosis (Barnsley et al. 2021.).  Additionally, an x-ray report may reveal low bone density, which is highly indicative of osteopenia or osteoporosis, but is not utilized as a confirmed diagnostic tool (Keen & Reddivari. 2022.). 

            Treatment includes non-pharmacological and pharmacological interventions. Non-pharmacological interventions include increasing physical activity and exercise to prevent injury from falls and fractures (Barnsley et al. 2021.). Furthermore, research has shown that resistance training can improve bone strength through repetitive mechanical loading (Barnsley et al. 2021.).  Additionally, incorporating correct body mechanics, such as strengthening hip flexion and knee extension, can help reduce the risk of falls and reduce pain (Barnsley et al. 2021.). Other lifestyle modifications such as quitting smoking, eliminating alcohol intake, and improving diet to consume more calcium and protein can help prevent the development of osteoporosis (Barnsley et al. 2021.). 

Pharmacological interventions include prescribing Vitamin D and Calcium, antiresorptive therapy, hormonal treatment, and alternative therapies (Barnsley et al. 2021.). Vitamin D and Calcium has been shown to decrease the risk of getting a hip fracture by 30% and reducing the overall fracture risk by 15% (Barnsley et al. 2021.). Antiresorptive therapy, such as bisphosphonates, inhibit osteoclast-mediated bone resorption and increase bone mineral density (Barnsley et al. 2021.). Hormonal treatment, such as selective oestrogen receptor modulators, Testosterone, and PTH analogues, can help replace the depleted hormones that are contributing to the development of osteoporosis (Barnsley et al. 2021.). Alternative therapies such as Rosomozumab may be effective as it binds to sclerostin, which leads to increased bone formation and a reduction in bone resorption (Barnsley et al. 2021.).

Response 2

Bladder Issues: Urinary Stress Incontinence

Stress urinary incontinence is one of the most common bladder issues among women-especially those who had had children.  It is defined as involuntary leakage of urine during exertional things like sneezing, coughing, or jumping. Basic evaluation includes a thorough history and physical with exam, cough test, post-void residual urine evaluation, bladder diary, and a urinalysis (Nygaard & Heit, 2020).  

Treatment Options

· Lifestyle Modification: Caffeine, alcohol, and artificial sweeteners are bladder irritants, and can cause bladder spasm, urinary retention, and, frequency, and involuntary loss of urine. Patients who reduced their caffeine intake to 100mg/day or less showed improvement in urinary symptoms. If overweight, recommend weight loss as a remedy.  Weight loss can significantly reduce bladder leaking (NAFC, 2023).

· Dietary Modification: Acidic or spicy foods are a source of bladder irritation for some. Cutting out things like hot/spicy foods, tomato-based sauces, and acidic fruits/juices should be considered in the setting of stress incontinence (NAFC, 2023).

· Toileting schedule: Make purposeful timed trips to the bathroom every 2-3 hours consistently. A schedule can help reduce incontinence (NAFC, 2023).

· Pelvic Physical Therapy (PPT). This is therapy specifically designed for pelvic care and focusing on issues like incontinence.  Your PCP can make a referral for this service, and it can be scheduled flexibly (Lawson & Sacks, 2018).  

· Duloxetine is an approved medication for stress incontinence. Alpha-adrenergic agonists are another studied modality.  Note that there are no FDA approved medications for stress incontinence, but some that are studied.  For example, Duloxetine wouldn’t be a first-line therapy because of risk for side effects however, if a patient has primary depression and also has stress incontinence, Duloxetine might be a good starting place as a dual purpose therapy (ACOG, 2023).

· Midurethral sling surgery is the most studied modality for incontinence, and the most effective.  It offers a high rate of success, rapid recovery, and immediate resolution of urinary symptoms if effective.   (ACOG, 2023).