15 - Osteoporosis

Question 1

What are the primary risk factors for osteoperosis?

Answer 1

• Race (white and Asian at higher risk)
• Female (80% of osteoporosis is seen in females)
• Low weight
• Age (most hip fractures occur after age 80)
• Genetics

Question 2

What are the secondary causes of osteoporosis?

Answer 2

• Hypogonadal problems (early menopause or late menarche, androgen insensitivity, over-training in females)
• Vitamin D deficiency
• Lifestyle factors (smoking, alcohol, sedentary, diet of low Ca, low protein, soda)
• Medications (steroids, seizure medications, PPIs*, SSRIs, depo-provera shot)
• Other diseases (GI, endocrine, CA, CHF, immobility, renal, liver, rheumatoid)
• Deficiency in calcium, vitamin D, magnesium

Question 3

What is a T score?

Answer 3

After measuring bone density with DEXA (dual energy xray absorptiometry) of the hip and spine, you compare the patients values to the same sex, healthy 30 year old

** This is the score that helps you decide whether or not to treat osteoporosis **

T score = compare to 30 year old

Question 4

What is a Z score?

Answer 4

After measuring bone density with DEXA (dual energy xray absorptiometry) of the hip and spine, you compare the patients values to the same sex, same age, same race as the patient

Z = compare to same age as pt

Question 5

How do you prevent osteoporosis?

Answer 5

• Not smoking
• Good diet in childhood and 20s (by 30s it doesn’t help much)
• Vitamin C and D in foods or supplements
• Avoid soda, caffeine
• Limit salt (pushes out Ca)
• Enough (but not too much) protein
• Avoid too much soy
• Limiting alcohol
• Exercise
• Healthy weight

Question 6

How do you treat osteoporosis?

Answer 6

First line of treatment
- Bisphosphonates (max out on benefits after 5 years, no longer effective)

Other treatment options

• Calcium and vitamin D supplements*
• Exercise*
• Hormone replacement therapy (HRT)*
• SERM (selective estrogen receptor modulators)
• Calcitonin
• Parathyroid hormone
• RANKL antibody therapy
• Balloon kyphoplasty procedure
• Vertebroplasty procedure

Question 7

Who needs to be screened/tested for osteoporosis?

Answer 7

NEED TO KNOW

• All women 65 or older
• Women under 65 whose 10 year risk factor of fracture is equal to or greater than a 65 year old

Use FRAX tool online to determine 10 year risk