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ISCD - CCD Examination > ISCD Course > Flashcards

ISCD Course Flashcards

1
Q

What is the NIH consensus definition of osteoporosis?

A

A skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture

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2
Q

Bone strength reflects the integration of which two features?

A
  • Bone density

- Bone quality

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3
Q

Does low bone mass have symptoms?

A

No

Unless a fracture occurs, then there is pain at fracture site

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4
Q

How is a fragility fracture defined?

A

Fracture from a fall from standing position or less.

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5
Q

Worldwide - what are the three ways osteoporosis can be diagnosed by?

A
  • Fragility fracture
  • T-score of -2.5 or less
  • FRAX score with increased fracture risk
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6
Q

What are give functions of the skeletal?

A
  • Supports the body
  • Protects internal organs
  • Muscles attached for movement
  • Cavities for blood formation
  • Reservoir for minerals
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7
Q

What region of the skeletal is included in the central skeletal?

A

Axial skeletal plus hips and shoulders

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8
Q

What region of the skeletal is included in the peripheral skeletal?

A

Appendicular skeletal minus the hips and shoulders

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9
Q

What kind of bone makes up the appendicular skeletal?

A

Cortical or compact bone

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10
Q

What kind of bone makes up the axial skeletal?

A

Cancellous or trabecular bone

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11
Q

What is osteomalacia?

A

A normal amount of bone that is inadequately mineralized

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12
Q

What percentage of the adult skeleton is remodelled at any one time?

A

10%

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13
Q

What is the turnover each year of cancellous bone?

A

25%

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14
Q

What is the turnover each year of cortical bone?

A

3%

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15
Q

What is the mass of cancellous bone?

A

20%

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16
Q

What is the mass of cortical bone?

A

80%

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17
Q

What is the surface area of cancellous bone?

A

80%

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18
Q

What is the surface area of cortical bone?

A

20%

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19
Q

What is bone modelling?

A

Change in size and shape of bone during growth

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20
Q

What is remodelling of bone?

A

Renewal of mature bone through:

  • involves replacement of old bone with new bone
  • occurs in response to fatigue damage, micro-fractures, and other fractures
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21
Q

How long is the bone remodelling cycle?

A

7 - 10 days

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22
Q

How long does osteoblast bone formation take?

A

10 - 12 weeks

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23
Q

What is the peak bone mass?

A

Peak bone mass is the maximum bone mass or density during a lifetime.

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24
Q

At what age do you have peak bone mass (after which it starts declining)?

A

30 years old

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25
Q

What is consolidation?

A

When growth in size of bones and accumulation of bone mineral has stabilised.

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26
Q

Peak bone mineral density:

Trochanter?

A

Mid-teens

14.2 +/- 2.0

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27
Q

Peak bone mineral density:

Femoral neck?

A

Late teens

18.5 +/- 1.6

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28
Q

Peak bone mineral density:

Spine?

A

Early 20’s

23 +/- 1.4

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29
Q

How much do heredity/genetics influence peak bone mass?

A

60 - 80%

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30
Q

Does gender influence peak bone mass?

A

Yes

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31
Q

What are the four nutritional factors influencing peak bone mass?

A
  • Energy intake
  • Protein intake
  • Calcium intake
  • Vitamin D
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32
Q

What are the three endocrine factors influencing peak bone mass?

A
  • Sex steroids
  • Calcitriol
  • GH-IGF-1 axis
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33
Q

What are the two mechanical factors influencing peak bone mass?

A
  • Physical activity

- Body weight

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34
Q

How fast does age-related bone loss occur?

A

~ 0.5 - 1.0% per year

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35
Q

How fast does bone loss occur after menopause?

A

~ 1 - 2% per year

Accelerated

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36
Q

What does a major BMD change in either direction require?

A

Evaluation for technical issues

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37
Q

Is post-menopausal osteoporosis common at age ~ 55 years (after about 5 years of menopause)?

A

No - it’s unusual.

Secondary causes must be sought.

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38
Q

Can you differentiate between osteoporosis or osteomalacia on DXA?

A

No

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39
Q

What should you think of if you have a 24 hour urine calcium

A

Celiac disease

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40
Q

What should you think of in a patient with unexplained iron deficiency and osteoporosis?

A

Celiac disease

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41
Q

What should you think of in a patient with irritable bowel symptoms and osteoporosis?

A

Celiac disease

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42
Q

What should you think of in a patient with decreased BMD, fractures or sustained high NTX/CTX despite oral therapies?

A

Celiac disease

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43
Q

How do you screen for celiac disease?

A

Tissue transglutaminase IgA antibody

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44
Q

What is the sensitivity of transglutaminase IgA antibody for Celiac disease?

A

> 90%

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45
Q

What is the specificity of transglutaminase IgA antibody for Celiac disease?

A

> 95%

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46
Q

Falsely negative transglutaminase IgA antibody screening for Celiac disease may occur in case of IgA deficiency.

True or false?

A

True

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47
Q

What percentage of Celiac disease patients have IgA deficiency?

A

2 - 3%

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48
Q

In what two situations may the transglutaminase IgA antibody screening for Celiac disease be falsely negative?

A
  • IgA deficiency

- Mild disease

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49
Q

What is the gold standard for celiac disease diagnosis?

A
  • Duodenal biopsy
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50
Q

What is the treatment of osteoporosis caused by celiac disease?

A
  • Gluten-free diet

- Calcium and vitamin D supplementation

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51
Q

Are oral bisphosphonates preferable in patients with malabsorption issues?

A

No

52
Q

What view is VFA?

Lateral or PA?

A

Lateral view

53
Q

What does VFA stand for?

A

Vertebral fracture assessment

54
Q

When should VFA or spine imaging be obtained?

A

When fracture status would alter therapy.

55
Q

By approximately how much does 1000 IU of vitamin D raise the serum vitamin D levels?

A

6 - 10 ng/dL

56
Q

How soon after repleting vitamin D should the level be repeated?

A

~ 3 months

57
Q

Should pharmacologic therapy for osteoporosis be delayed if vitamin D level is between 20 - 30 ng/mL?

A

No

58
Q

What is the criteria for treating post menopausal women and men over 50 years on chronic steroids equivalent to prednisone of 7.5 mg a day or greater?

A

They require treatment.

59
Q

What is the criteria for treating post menopausal women and men over 50 years on chronic steroids equivalent to prednisone of 7.5 mg a day or less?

A

If the FRAX is 10% or less they don’t require treatment; if the FRAX is more than 10% they require treatment.

60
Q

What is the criteria for treating pre-menopausal women (non-childbearing) and men under 50 years on chronic steroids equivalent to prednisone of 5 mg a day or greater?

A

Treat only if they have a fracture.

61
Q

What is the criteria for treating pre-menopausal women (childbearing) on chronic steroids equivalent to prednisone of 7.5 mg a day or greater?

A

Treat only if then have a fracture

62
Q

When is lateral spine imaging (radiography or VFA) indicated?

A
  • Women aged 70 or more; men aged 80 or more
  • Historical height loss > 4 cm (1.5 inch)
  • Self reported but undocumented prior vertebral fracture
  • Glucocorticoid therapy equivalent to more than or equal to 5 mg of prednisone per day for 3 or more months.
63
Q

What is the sensitivity of serum protein electrophoresis (SPEP)?

A

82%

64
Q

What is the sensitivity of serum immuno-fixation (IPEP)?

A

93%

65
Q

What is the sensitivity of serum and urine IPEP?

A

97%

66
Q

Persistently low serum phosphate leads to inadequate bone mineralization and osteomalacia.

True or false?

A

True

67
Q

Name three causes of decreased phosphate.

A
  • Renal phosphate wasting due to excess FGF-23
  • Malabsorption
  • Malnutrition
68
Q

Name two causes of phosphate wasting due to excess FGF-23.

A
  • Genetic mutations

- Mesenchymal tumors

69
Q

What syndrome can a small, slow-growing mesenchymal tumor secreting FGF-23 cause?

A

Acquired paraneoplastic syndrome

70
Q

Clinical features:

  • Progressive muscle and bone pain
  • Weakness
  • Fatigue
  • Multiple fractures
  • Low phosphorus

Diagnosis?

A

Tumor-Induced Osteomalacia

Acquired paraneoplastic syndrome caused by small, slow-growing mesenchymal tumors secreting FGF-23.

71
Q

What does laminectomy do to spine BMD?

A

Lowers it.

72
Q

If you’ve already treated a patient with a few years of zoledronic acid then what drug could you consider next…?

A

Teriparatide

73
Q

When can testosterone therapy be used to treat osteoporosis secondary to hypogonadism (in men)?

A

When the serum testosterone is below 200 ng/dL on two different occasions.

74
Q

Is family history of osteoporotic fracture or fragility fracture a risk factor for low bone mass?

A

No - it’s a risk factor for osteoporotic fracture

75
Q

Are falls a risk factor for low bone mass?

A

No - they are a risk factor for osteoporotic fracture

76
Q

Is sarcopenia a risk factor for low bone mass?

A

No - it’s a risk factor for osteoporotic fracture

77
Q

Is sarcopenia a risk factor for low bone mass?

A

No - it’s a risk factor for osteoporotic fracture

78
Q

Is loss of height a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

79
Q

Is late age at menarche a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

80
Q

Is menopause a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

81
Q

Is time since menopause a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

82
Q

Is dietary calcium a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

83
Q

Is alcohol intake a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

84
Q

Are medications a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

85
Q

Are inflammatory diseases a risk factor for osteoporotic fracture?

A

No - it’s a risk factor for low bone density.

86
Q

Are clinical risk factors good predictors of low BMD?

A

No

87
Q

Does acromegaly cause osteoporosis?

A

We are not sure.

88
Q

Do loop diuretics cause osteoporosis?

A

We are not sure

89
Q

Does immobilization cause osteoporosis?

A

Yes

90
Q

Does HIV/AIDS cause osteoporosis?

A

Yes

91
Q

Does organ transplantation cause osteoporosis?

A

Yes

92
Q

Does COPD cause osteoporosis?

A

Yes

93
Q

Does anorexia cause osteoporosis?

A

Yes

94
Q

Does malignancy cause osteoporosis?

A

Yes

95
Q

How often is osteoporosis associated with secondary disorders?

A

~ 50% of the time

96
Q

What does tryptase test for?

A

Mastocytosis

97
Q

Increased bone resorption independently predicts fracture risk in post-menopausal women.

True or false?

A

True

98
Q

Most vertebral fractures occur below ____.

A

T6

99
Q

What are two problems with quantitative morphology?

A
  • May over-diagnose abnormalities that are not fracture

- May under-diagnose mild end-plate deformities

100
Q

How and how often should height be measured?

A

Annually, preferably with a wall mounted stadiometer.

101
Q

Trabecular bone - age related bone loss differs between men and women…

Women?

A

Perforation

102
Q

Trabecular bone - age related bone loss differs between men and women…

Men?

A

Thinning

103
Q

Name the three main sites of osteoporotic fractures starting with most common to least common.

A
  • Vertebral fractures
  • Hip fractures
  • Distal forearm fractures
104
Q

What percentage of hip fracture survivors are permanently incapacitated?

A

~ 50%

105
Q

What percentage of hip fracture survivors require long-term nursing home care?

A

~ 20%

106
Q

Is the radius or the ulnar used for BMD measurement in the forearm?

A

Radius

107
Q

Does a T-score of less than -2.5 always mean that the patient has osteoporosis?

A

No

108
Q

Name five examples of non-osteoporotic causes of low BMD.

A
  • Osteomalacia
  • Genetic disorders e.g. osteogenesis imperfecta
  • Renal bone disease
  • Multiple myeloma / other malignancies
  • Marrow infiltrative diseases e.g. mastocytosis
109
Q

What does it mean if the T-score goes down but Z-score stays the same?

A

The patient lost as much bone density as was expected.

110
Q

Is the diagnosis of osteoporosis based on the mean T-score value or the lowest value?

A

The lowest value

111
Q

Fracture risk increases exponentially with declining BMD.

True and false?

A

True

112
Q

Should FRAX be used to monitor treatment response?

A

No

113
Q

How long should a patient not have had estrogen therapy / hormone therapy to be considered ‘untreated’v

A

One year

114
Q

How long should a patient not have had calcitonin to be considered ‘untreated’?

A

One year

115
Q

How long should a patient not have had PTH to be considered ‘untreated’?

A

One year

116
Q

How long should a patient not have had denosumab to be considered ‘untreated’?

A

One year

117
Q

How long should a patient not have had bisphosphonates to be considered ‘untreated’?

A

Two years

Taking oral bisphosphonates for less than two months is okay.

118
Q

How long should a patient not have had calcium and vitamin D to be considered ‘untreated’?

A

Calcium and vitamin D do not count as treatment in this regard.

119
Q

If you have serial studies on the same machine should you compare T-scores or BMD?

A

BMD

120
Q

What is the minimum acceptable precision error (LSC) for an individual technologist for…

Lumbar spine?

A

1.9% (LSC = 5.3%)

121
Q

What is the minimum acceptable precision error (LSC) for an individual technologist for…

Total hip?

A

1.8% (LSC: 5%)

122
Q

What is the minimum acceptable precision error (LSC) for an individual technologist for…

Femoral neck?

A

2.5% (LSC = 6.9%)

123
Q

Which precision error should be used if there are multiple technologists at a center?

A

The average precision error for all the technologists is used

124
Q

How is a precision analysis done?

A

Measure 15 patients 3 times, or 30 patients 2 times, repositioning patients after each scan.

125
Q

Does precision assessment require IRB approval?

A

No

126
Q

What is least significant change?

A

The precision error at a center ~ desired confidence level 95%

127
Q

How is LSC calculated?

A

LSC = (precision error) x 2.77

to have 95% confidence that the change is real

ISCD - CCD Examination (7 decks)

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