B6.052 - CBCL Osteoporosis Prework 7 Management

Question 1

compliance of women taking drugs for osteoporosis

Answer 1

25%

Question 2

factors affecting undertreatment of osteoporosis

Answer 2

under recognized fractures not recognized as sentinel events under treatment

Question 3

patient care goals

Answer 3

ID patients at risk of fractures reduce incidence of fractures maintain quality of life

Question 4

major clinical recommendations for osteoporosis

Answer 4

diet, vit D, exercise, smoking dx - BMD, vertebral imaging, causes of secondary osteoporosis monitoring tx

Question 5

who should have a bone density test?

Answer 5

F >65, M>70 Postmenopausal women & men ages 50-69 with clinical risk fx Adults who have a fracture after 50 adults w/ RA, on steroids, associated with low bone mass or bone loss

Question 6

benefits fo FRAX

Answer 6

derives 10 year probability of clinical event from measurable parameters internationally recognized and validated based on data from multiple cohors easily accessible helps ID pts needing tx can be used to reassure low risk pts

Question 7

limitations of FRAX

Answer 7

not valid to monitor patients on tx only femoralnexk BMD is considered risk is y/n no consideration of dose of drugs not all risk fx considered clinical judgement required not know if pts w/ high FRAX benefit from med

Question 8

NOF guidlines of who to treat

Answer 8

Question 9

what are the bisphosphonates

Answer 9

Alendronate

Risedronate

Ibandronate

Zolendronic acid

Question 10

moa of bisphosponates

Answer 10

attach to exposed bone mineral sufaces

osteoclasts take up bisphosphonates leading to loss of ruffled border, inactivation, detachment, new bone formation by osteoblasts renders bisphosphonate inert, inaccessible

Question 11

bisphosphonate side effects

Answer 11

upper GI irritation

osteonecrosis of the jaw

severe MSK pain

hypocalcemia

atypical femur fracture

Question 12

teriparatide and abaloparatide MOA

Answer 12

anabolic bone building agent

very quick increase in bone density

can be used right after a fracture

black box: osteosarcoma, paget disease, high alk phos, open epiphyses, prior beam radiation, implant rad

Question 13

denosumab

Answer 13

MAB againts RANKL

inhibits osteoclast fxn

decreaes bone resorption

consider pts with kideny dysfunction

Question 14

denosumab uses

Answer 14

post menopausal osteoporosis

cx tx induced bone loss

Question 15

monitoring for osteoporosis

Answer 15

monitor DXA every 1-2 yrs

secondary fracture prevention FLS

Question 16

post menopausal osteoporosis treatment algorithm

Answer 16

1. lumbar spine or fem neck or total hip T score of <-2.5 or high FRAX
2. eval for secondary causes
3. correct calcium/vit D causes
4. recomend pharma, education, lifestyle meaures
5. No prior fragility fractrures/mod risk –> reasses yearly, alendronate, denosumab, risendronate,zoledronic acid, ibandronatle raloxifene
6. prior fragility fractures or high risk –> denosumabd, teriparatide, zoledroninc, alendronate, risedronate

Question 17

fracture liaison services

Answer 17

FLS coordinator orchestrates car following minimal trauma fracture