Bones

Question 1

Healthy patient with Tscaore of -2.7, normal labs, no other risk factors. Tx?

Answer 1

Vitamin D and Calcium.
(Vit D: Load 50,000 U 2xwk for 10 weeks, then 2,000 U daily forever)

NOT estrogen!!

Question 2

What is the normal range for calcium, phosphorus, PTH, alkphos, and vit D?

Answer 2

calcium: 8.4-10.2
phos: 3-4.5
PTH: 10-65
AlkPhos: 30-120
vitD: 15-80 (usually

Question 3

What are the effects of PTH?

Answer 3

Increases Calcium and Vit D, decreases phosphate

Question 4

At what age should you start screening for osteoporosis with dual-energy x-ray absorptiometry?

Answer 4

Age 65 (or 60 if have high risk)

Question 5

What is the most predictive risk factor for osteoporosis?

Answer 5

Weight

Question 6

Random: Who is the pneumococcal vaccine indicatd for?

Answer 6

• Age>65
• Living in a long term care facility
• Has a chronic illness
• Live in Alaska or Native American place

^only 1 of the above criteria need to be met

Question 7

First line treatment for osteoporosis?

Answer 7

I think calcium+vitD is first line overall, then bisphosphanates (ex: alendronate) are first line DRUGS

Question 8

Which part of the body does calcitonin decrease fractures in?

Answer 8

The spine (not the hips). So only give to women >5 yrs after menopause

Question 9

Second line treatment for osteoporosis?

Answer 9

Raloxifene (selective estrogen receptor modulator…. agonist at the bone, antagonist at the breast and uterus)

Question 10

Where in the body does raloxifene decrease fractures?

Answer 10

The spine (not the hips). Like calcitonin!

Question 11

What are side effects of raloxifene?

Answer 11

Hot flushing, thromboembolism (but NOT cardiovascular disease or breast cancer, unlike other estrogen agonists)

Question 12

What is the MOA of teriparatide?

Answer 12

It’s recombinant-PTH, so it stimulates osteoblastic bone formation when give INTERMITTENTLY. No more than 2 yrs. Shown to significantly increase bone mass and decrease risk of ALL fractures (even hips).

Question 13

What is the scary side effect of teriparatide? For that reason, who should not get the drug?

Answer 13

Osteosarcoma. So don’t give to patients with Paget disease of the bone, unexplained alkphos elevation (because this suggests paget disease), previous radiation to the skeleton, or a history of bone cancer

Question 14

Who is teriparatide indicated for?

Answer 14

Patients who are intolerant of bisphosphanates, raloxifene, etc and/or have T scaore

Question 15

Which meds reduce the risk of hip fracture?

Answer 15

Yes: Bisphosphanates (alendronate), PTH-analogues (teriparatide)
No: Estrogen modulators (raloxifene), Calcitonin

Question 16

What should you give a patient who is intolerant of alendronate because underlying GERD?

Answer 16

IV zolendronate yearly, or IV ibandronate every 3 months

Question 17

How must bisphosphanates be taken?

Answer 17

In a fasting state (because poorly absorbed), and sitting upright for 30-60 minutes after dosing (because can erode esophagus I think?)

Question 18

Who cannot get bisphosphanates?

Answer 18

• Esophageal stricture (will erode esophagus)
• Achalasia (will erode esophagus)
• Bed rest unable to sit up (will erode esophagus)
• Uncontrolled celiac disease (wont absorb)
• Crohns disease (wont absorb)
• Ulcerative colitis (wont absorb)

Question 19

Diagnosis of osteoporosis

Answer 19

• Fragility fractures (ex: falling from standing position)
  OR
• Bone mineral density Tscore

Question 20

What is the difference between a bone mineral density T score and Z score?

Answer 20

T= compared to young healthy population (*memory: TEENS)
Z= compared to age and sex matched group (*memory: Zancient people)

Question 21

What dose a T score of -1 mean?

Answer 21

10% bone loss

Question 22

What is the definition of osteoporosis vs. osteopenia?

Answer 22

Osteopenia: T score -1 to -2.5
Osteoporosis: T score -2.5 or worse