Chap.76-Osteoporosis

Question 0

______ reflects the peak adult bone mass and the amount of bone lost in adulthood
_____ is determined by bone architecture, bone geometry, bone turnover, mineralization, and damage accumulation.

Answer 0

1. bone density

2. bone quality

Question 1

What are the 3 most common fractures?

Answer 1

1. Hip (most common)
2. vertebral
3. radial

Question 2

Morbidity is decreased with vertebral fractures, but mortality is increased. WHY?

Answer 2

risk for cardiovascular and pulmonary diseases that is associated with an escalating number of vertebral fractures

Question 3

What are the major risk factors for osteoporosis?

Answer 3

• white woman postmenopausal
• history; fracture history in a first degree relative
• low body weight (2drinks perday)

Question 4

What are the additional risk factors for developing a HIP fracture due to osteoporosis?

Answer 4

age, history of maternal hip fracture, weight, hight, poor health, PREVIOUS HYPERTHYROIDISM, current use of long-acting BENZODIAZEPINES, poor depth perception, TACHYCARDIA, previous fracture, low bone density

Question 5

Peak bone mass is determined primarily by _____ factors.

Answer 5

genetic

• men have a higher bone mass than women
• african americans and hispanics have a higher bone mass than whites

Question 6

Bone loss is greater in sites rich in ____ bone rather than in ____ bone.

Answer 6

trabecular bone (spine)
cortical bone (femoral neck)

Question 7

______ deficiency during menopause contributes significantly to bone loss in women.

Answer 7

estrogen deficiency

Question 8

Women during menopause experience an acceleration of bone loss……. then it happens again… what age?

Answer 8

after age 75 women experience another acceleration of bone loss

Question 9

What are some medications that cause bone loss?

Answer 9

excessive thyroid hormone
glucocorticoids
anti seizure medications
heparin
gonadotropin releasing hormone agonists
aromatase inhibitors
depomedroxyprogesterone

Question 10

What are some endocrine diseases that result in bone loss?

Answer 10

Hypogonadism
Hyperparathyroidism
Hyperthyroidism
Hypercortisolism

Question 11

ALL patients should have a work up for secondary causes of bone loss. THis would include ALOT

1. _______ to access vitamin D deficiency
2. ______ to assess for Paget disease, malignancy, cirrhosis, or vitamin D deficiency
3. _____ to evaluate for hypercalciuria or malabsorption
4. a test for _____ in patients with anemia or hypocalciuria
5. _____ to rule out hyperthyroidism
6. ______ to rule out myeloma in older adults with anemia

Answer 11

1. 25-hydroxyvitamin D level to access vitamin D deficiency or insufficiency
2. Alkaline phosphatase level to assess for Paget disease, malignancy, cirrhosis, or vitamin D deficiency
3. 24-hour urine calcium and creatine to evaluate for hypercalciuria or malabsorption
4. a test for SPRUE in patients with anemia or hypocalciuria
5. THYROTROPIN to rule out hyperthyroidism
6. Serum protein electrophoresis to rule out myeloma in older adults with anemia

Question 12

Often measurement of the _____ level is needed to interpret calcium and vitamin D levels.

Answer 12

parathyroid hormone levels

Question 13

Osteoporosis is considered a _____ until fractures occur. Whereas 90% of hip fractures occur after a fall, two thirds of vertebral fractures are silent and occur with minimal stress such as lifting, sneezing, and bending. An acute vertebral fracture can result in significant ______, which decreases gradually over several weeks with analgesics and physical therapy.

Answer 13

silent disease

back pain

Question 15

Patients with significant vertebral osteoporosis may have ____, ____, and ____.

Answer 15

height loss
kyphosis
severe cervical lordosis (known as DOWAGER’s HUMP)

Question 16

What test is the gold standard for assessing bone mineral density?

summed it up in one slide lol

Answer 16

dual energy x-ray absorptiometry (DXA), which has excellent precision and accuracy
Measurements are taken of the hip and spine, and about 30% of the time, discordance is found between these measurements
Therefore, classification is based on the lowest value (total spine, total hip, or femoral neck)
**RADIOGRAPHS ARE POOR INDICATORS OF OSTEOPOROSIS
**QVC= quantitative computed tomography = significantly higher dose of radiation :/ & not as precise with vertebrae
** single photon absorptiometry of forearm and peripheral measures (such as finger DXA and heel ultrasound, have also been used to assess bone mass

Question 17

Classification can vary significantly by the skeletal site and the device used for assessment. Although all of the measurements are accurate, precision is best with ____ and _____ DXA.

Answer 17

Forearm or Spine DXA

**Classifications with WHO should be used with DXA

Question 18

Experts recommend that bone mineral density be monitored for ________, depending on the site to be assessed and the type of therapy prescribed. For example, ______ bone, which is more metabolically active than _____ bone, is more likely to show improvements with stronger actuating antiresorptive agents.

Answer 18

trabecular bone

cortical bone

Question 19

changes in bone mass with potent antiresorptive therapy are more prominent in the ____ compared with other areas. Seeing no changes in ___ bone mineral density over time is common, despite good precision. Although the _____ has a high percentage of trabecular bone, precision is poor, and monitoring should not be done at this site.

Answer 19

1. trabecular bone
2. cortical bone
3. forearm
4. heel

Question 20

In general bone mass measurements with DXA examine the spine and hip. However, in patients with hyperthyroidism, in which ______ loss is often seen, ______ should be assessed.

Answer 20

cortical bone

forearm DXA should be assessed

Question 21

Older patients with osteoporosis often have falsely elevated bone mineral density measurements at the ________ as a result of atypical calcifications from degenerativee joint disease, sclerosis, or aortic calcifications.

Answer 21

spine
***Although lateral bone mineral density measurements eliminate these artifacts, they are often difficult to perform because of overlap of the ribs on L2 and overlap of the pelvic brim on L4.

Question 22

What is the recommended daily allowance of calcium for postmenopausal women?

Answer 22

1200 mg

Question 23

The 1200 mg recommended calcium intake for postmenopausal women can be accomplished by dietary consumption or supplementation. What supplements should generally be taken?

Answer 23

1. Calcium Carbonate - taken with meals

2. Calcium Citrate - either

Question 24

T/F Vitamin D has been associated with improvement in muscle strength, prevention of falls, and decrease in prostate, breast, and colon cancer.

Answer 24

true

Question 25

What two sources does vitamin D come from?

Answer 25

1. diet | 2. photosynthesis

Question 26

Vitamin D dietary sources are limited (e.g. fortified milk), and patients are advised to avoid sun exposure leading to an increase in Vitamin D deficiency in patients. Vitamin D deficiency can lead to ______.

Answer 26

secondary hyperparathyroidism

Question 27

Vitamin D can be taken in a multivitamin, in calcium supplement, or in pure form. In the pure form, cholecalciferol (D3) is preferable to ergocalciferol (D2). What is the current recommended dose for adults taking multivitamin for vitamin D supplementation?

Answer 27

1000 IU

Question 28

Older patients with severe vitamin D deficiency may be given 50,000 IU once per week for 3 months to bring serum Vitamin D into the normal range. Activated vitamin D is rarely needed and should not be given on a regular basis for ______.

Answer 28

postmenopausal osteoporosis

Question 29

What are the 4 guidelines recommending patients for bone mineral density testing?

Answer 29

1. all postemenopausal women younger than 65 years who have one or more additional risk factors for osteoporosis (besides menopause) 2. all women aged 65 years and older regardless of additional risk factors 3. postmenopausal women who present with fractures ( to confirm diagnosis and determine disease severity) 4. all men aged 70 years or older

Question 30

``` Which class of drugs are the "mainstay" for osteoporosis prevention and treatment? *They inhibit cholesterol synthesis pathway in the osteoclasts, thereby causing early apoptosis and inhibiting osteoclast migration and attachment. ```

Answer 30

Bisphosphonates 1. Alendronate 2. Risedronate 3. Ibandronate 4. Zoledronic acid

Question 31

Which bisphosphonate cannot be used for prevention?

Answer 31

zoledronic acid

Question 32

Which 2 bisphosphonates did not show a reduction in hip fractures?

Answer 32

ibandronate & zoledronic acid

Question 33

When should bispohosphonates be taken orally?

Answer 33

in the morning because they are poorly absorbed; also on an empty stomach and with plenty of water

Question 34

What should hormone replacement therapy be used for?

Answer 34

to relieve menopausal symptoms | *should not be used for prevention or treatment of osteoporosis

Question 35

Estrogen agonists-antagonits can be used for the treatment and prevention of osteoporosis. Treatment is associated with bone mass increase at spine and femoral neck, reduction in vertebral fractures, and improved lipid status. ______ = Not associated with endometrial hyperplasia, thus patients do not have bleeding or spotting, also reduces the risk for invasive breast cancer in postmenopausal women with osteoporosis and in women at high risk for invasive breast cancer.

Answer 35

Raloxifene *Patients do have the same small risk of deep vein thrombosis or pulmonary embolus that is found with hormone replacement therapy. Raloxifene will NOT relieve postmenopausal symptoms and may exacerbate hot flashes.

Question 36

______ is a 32 amino acid peptide produced by parafollicular of the thyroid gland. It is currently approved in a subutaneous dose but is rarely used. Is it used for prevention & treatment? See a reduction in vertebral and hip fractures?

Answer 36

Calcitonin - not used for prevention - no reduction in hip fractures

Question 37

_____ = an anabolic agent, increases bone mineral density and reduce both vertebral and nonvertebral fractures over 18 months. taken as a subcutaneous daily dose. Often prescribed to patients who fail, cannot tolerate, or have a contraindication to bisphosphonates.

Answer 37

Parathyroid hormone - TERIPARATIDE * not used for prevention * No reduction in hip fractures