27: Osteoporosis - Ronkar

Question 1

define osteoporosis

Answer 1

bone deterioration with reduced bone mass and disruption of micro-architecture of bone

Question 2

why is a hip fx so bad?

Answer 2

• 20% elderly who have low trauma hip fx die within one yr

- 20% of all pt with hip fx go to nursing home w/i 1 yr

Question 3

one yr after hip fx

Answer 3

• 20% death
• 30% permanent disability
• 40% unable to walk independently
• 80% unable to carry out at leas 1 ADL

Question 4

most dangerous fxs in terms of mortality

Answer 4

hip and spine

Question 5

gold standard for osteoporosis diagnosis ***

Answer 5

DXA

Question 6

T score v. Z score

Answer 6

T score - compared to young adults (used for osteoporosis)

Z score - compared to age-matched adults

Question 7

T scores

• osteoporosis
• osteopenia
• normal

Answer 7

less than or equal to -2.5

• 1 to - 2.5
• 1 to +1

Question 8

anyone with a fragility fx by definition has …

Answer 8

osteoporosis

Question 9

who automatically gets BMD testing?

Answer 9

women greater than 65 and men greater than 70

Question 10

initiate therapy at what tscore level

Answer 10

less than -2.5 at femoral neck, total hip or spine by DXA

consider if t score is in osteopenic range and their 10 yr risk is greater than 20% for all fx or 3% for hip fx

Question 11

general MOA of bisphosphonates

Answer 11

-inhibit resorption, so tip the balance back in favor of building, but do not stimulate higher level of synthesis

Question 12

MOA teriparatide-forteo

Answer 12

stimulates both building and resorption, in favor of building, so net effect is that bone mass and strength increase

Question 13

MOA denosumab

Answer 13

• fully human monoclonal Ab that inhibits bone resorption by neutralizing RANKL
• RANKL is a key mediator of osteoclast differentiation