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PR3154 > IC 18 - Osteoporosis > Flashcards

IC 18 - Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

It is a metabolic bone disease characterized by
1. low bone density
2. Microarchitecture disruption (impaired mineralization)
3. Decreased bone strength
4. Increased risk of fractures

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2
Q

List two reasons for decrease in bone mass in osteoporosis.

A
  1. Excessive bone resorption
  2. Decreased bone formation
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3
Q

List two common causes for decrease in bone mass.

A
  1. Age
  2. Menopause
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4
Q

What are three common drugs that may cause secondary osteoporosis?

A
  1. Glucocorticoid
  2. Immunosuppressants (e.g. cyclosporine)
  3. Cancer chemotherapy
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5
Q

What are the clinical manifestation of osteoporosis?

A
  1. Asymptomatic
  2. Fragility fracture (low-trauma) at diagnosis
  3. Pain & disability due to fractures
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6
Q

List three areas for common fragility fractures in osteoporosis.

A

Weight bearing joints such as hip, wrist, spine

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7
Q

What is the main goal of treatment for osteoporosis?

A

Prevent fractures

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8
Q

Who should be assessed for osteoporosis and fracture risk?

A
  1. Post-menopausal women
  2. Men >= 65 yo
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9
Q

What are the risk factors for fragility fractures? Name 5.

A
  1. Family history
  2. Age
  3. Weight
  4. Alcohol
  5. Height loss (>2cm in three years)
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10
Q

What is used for BMD screening for osteoporosis?

A

OSTA (for women only)

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11
Q

What are the two factors that are used in OSTA?

A

Age and weight

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12
Q

What should be done for women who falls in high risk for OSTA?

A

Consider DXA scan as chance of finding osteoporosis (low BMD) is high in this group.

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13
Q

What should be done for women who falls in medium risk (0 to 20) for OSTA?

A

Consider DXA scan if got risk factors for osteoporosis

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14
Q

How is diagnosis made for osteoporosis using fractures?

A
  1. Hx of Fragility fractures that occurs spontaneously or from minor trauma
  2. Asymptomatic vertebral fracture can be visually identified as > 20% dec. in vertebral ht.
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15
Q

How is diagnosis made for osteoporosis using DXA?

A

DXA hip and/or spine with T-score < -2.5 SD (young women and patient comparison)

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16
Q

What does DXA Z-score values < -2 SD suggests?

A

Coexisting problems (eg, glucocorticoid therapy or alcoholism) that can contribute to osteoporosis.

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17
Q

List 4 common lab tests that is used to identify secondary causes?

A
  1. Creatinine
  2. FBC
  3. Corrected Ca2+
  4. 25-hydroxy vitamin D
18
Q

How is fracture risk assessed for osteoporosis?

A

FRAX tool

19
Q

When should one consider starting anti-osteoporosis treatment using the FRAX tool?

A

If 10-year probability is high for
1. major osteoporotic # ()> 20 %)
2. Hip # (> 3 %)

20
Q

List the 3 criteria that can be used as a gauge on when to treat osteoporosis?

A
  1. Those with fragility #
  2. Those without fragility # but DXA BMD T-scores of < -2.5
  3. Osteopaenic without a fragility #, but with high # risk
21
Q

What are the bisphosphonates available for osteoporosis and its doses?

A
  1. Alendronate (PO) 70 mg q week
  2. Risedronate (PO) 35 mg q week
  3. Zoledronic acid (IV) 5 mg q year as 30-min IV infusion
22
Q

What should be communicate to patients taking PO bisphophonates?

A
  1. Take ½-1 hour before breakfast w a full glass of water.
  2. Do not lie down after for at least 30 mins.
23
Q

What should be done prior to administration of IV bisphosphonates?

A

Ensure adequate hydration before infusion

24
Q

What are the contraindications of PO bisphosphonates?

A
  1. CrCl <30 mL/minute
  2. Hypocalcaemia
  3. Oesophageal or gastric abnormalities
  4. Inability to stand/sit upright > 30 min
  5. Aspiration risk (e.g. difficulty swallowing liquids)
25
Q

What are the contraindications of IV bisphosphonates?

A
  1. CrCl <35 mL/minute
  2. Hypocalcaemia
26
Q

What is the treatment duration for osteoporosis patients with low fracture risk?

A
  1. 5 yrs for PO Tx
  2. 3 yrs for IV Tx

Can stop after treatment duration if at goal and restart after 2 yrs if BMD dec. > 4-5% or tx criteria met again.

27
Q

What is the treatment duration for osteoporosis patients with high fracture risk?

A
  1. 10 yrs for PO Tx
  2. 6 yrs for IV Tx
28
Q

What can be given to osteoporosis patients who are intolerant to bisphosphonates?

A

Denosumab (SC) once q6 months

29
Q

What is the contraindication for Denosumab (SC)?

A

Hypocalcemia

30
Q

What are the side effects of osteoporotic drugs?

A
  1. ONJ (RARE: higher likelihood with Zoledronic acid & in cancer patients)
  2. Atypical femoral # (RARE: monitor for thigh/hip/groin pain while on Tx)
31
Q

What may occur when Denosumab (SC) is missed?

A

Increase vertebral fracture

32
Q

What are the risk factors for ONJ of osteoporosis?

A
  1. Tooth extraction or other invasive dental procedures
  2. History of cancer, radiotherapy
  3. Poor oral hygiene
  4. Concomitant therapy (eg: angiogenesis inhibitors, bisphosphonates, chemotherapy, corticosteroids, denosumab)
  5. Comorbid disorders
33
Q

What are some advice to patient on regarding osteonecrosis of the jaw?

A
  1. Smoking cessation
  2. Avoid invasive dental procedures during bisphosphonate Tx
  3. Maintain good oral hygiene
34
Q

How can atypical fractures be managed for osteoporosis?

A

Stop Tx of bisphosphonate

35
Q

Who may continue bisphosphonate treatment after original Tx duration?

A
  1. > = 75 yo
  2. History of hip or vertebral fractures
  3. Sustain fractures on treatment
  4. Those taking oral GC
36
Q

What labs should be done before starting treatment?

A
  1. Serum calcium
  2. 25-hydroxyvitamin D (> 20-30 ng/mL or 50-75 nmol/L but < 50-100 ng/mL or125-250 nmol/L)
37
Q

What are some Tx monitoring that should be done for osteoporosis treatment?

A
  1. Serum creatinine
  2. Serum calcium
  3. Serum 25(OH) vitamin D
38
Q

What are some non-pharm advice that can be given to osteoporosis patients?

A
  1. Sufficient Ca2+ and vitamin D
  2. Exercises: weight-bearing (30 mins “daily”), muscle strengthening & balance (2-3 x weekly)
  3. Limit alcohol intake (< 2 units/day)
  4. Reduce risks for fall
39
Q

When is Calcium considered for osteoporosis patients?

A

Levels < 700 mg/d

19 to 50 year old (800mg/day); ≥ 51 year old (1000mg/day)

40
Q

What is the amount of vitamin D that can be administered for patients with osteoporosis?

A

800 IU/day cholecalciferol (>70yo); 600IU/day (51 to 70yo)

41
Q

What are some DDI associated with Ca2+ for osteoporosis patients?

A
  1. PPI & fibre (dec. calcium absorption)
  2. dec absorption of iron, tetracyclines, fluoroquinolones, bisphosphonates, thyroid suppl
42
Q

What are some DDI associated with vitamin D for osteoporosis patients?

A

Rifampin, anticonvulsants (phenytoin, valproic acid, carbamazepine), cholestyramine, orlistat, aluminum-containing products

PR3154 (16 decks)

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