Bone Health Flashcards
MOA of bisphosphonates?
Inhibition of osteoclast resorption of bone
(Alendronate, risedronate, ibandronate, zoledronate)
Is hormone therapy a treatment for osteoporosis?
No! Hormone therapy is approved for the PREVENTION of osteoporosis in women at increased risk of osteoporosis and fracture
Action of estrogen is to STOP/SLOW bone breakdown, it does not promote bone formation activity
When should DEXA screening start?
Age 65 or younger if risk factors
Define Z-score
compares patient to cohort at same age
Define T-score
compares patient to cohort of young healthy people
“T for TEEN” compares to teenager
Define osteopenia (low bone density)
T-score between -1.0 to -2.5
Define osteoporosis
T-score = -2.5 or less
When should you treat osteopenia?
Do FRAX
if 10 year risk of major fracture is > 20% OR risk of hip fracture is > 3% then TREAT
Recommended daily allowance of Calcium?
Age 19-50 is 1,000 mg
> 50 is 1,200 mg
POSTMENOPAUSAL = 1,200
Recommended daily allowance of Vit D?
600 IU daily until age 70 (then 800 IU daily)
When should you repeat a DEXA w/ T-score = -2.5
Approximately every 2 years
If normal DEXA, optimal screening interval uncertain (2-8 years recommended)
What is a FRAX score? When do you use it?
“Fracture Risk Assessment Tool”
Use if T-score is -1 to -2.5 (plan to treat if > 20% overall risk, or >3% risk of hip fracture)
Use if postmenopausal < age 65 with risk factors ( treat if > 8.4%)
Components of FRAX:
Age
Sex
Weight
Height
Previous Fracture
Parent w/ hip fracture
Smoking
Alcohol > 3 drinks
Steroid Use
RA
Secondary Osteoporosis
Previous BMD
Which factor is associated with highest risk of osteoporotic fracture?
Age
Strongest predictors = Age, previous hx of fracture, BMD
Other factors = smoking, steroid, fm hx, low body wt, alcohol, RA, liver disease, early menopause
Compare/contrast Tamoxifen and Raloxifene
Treatments for osteoporosis?
First line = Bisphosphonates (inhibit bone resorption)
Second line = Raloxifene (SERM)
Third line = Rank Ligand Inhibitor
