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MSK > Lecture 8: Osteoporosis > Flashcards

Lecture 8: Osteoporosis Flashcards

1
Q

What is osteoporosis?

A
  • Low bone mass
  • Microarchitectural disruption
  • Skeletal fragility

Decreased bone quality or quantity.

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2
Q

When does osteoporosis affect women usually?

A

Starting around age 50

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3
Q

What are the 3 primary bone cells?

A
  • Osteocytes
  • Osteoblasts (B for builders)
  • Osteoclasts (C for cut calcium)
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4
Q

What hormone is the primary mediator of calcium utilizing osteoclasts?

A

PTH

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5
Q

What exactly does estrogen do for bones?

A

Inhibition of osteoclasts

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6
Q

Where is trabeculae found?

A
  • End of long bones
  • Vertebrae
  • Pelvis
  • SKull

Also known as cancellous bone

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7
Q

When are the two general times to have osteoporosis?

A
  • Postmenopausal (loss of bone mass)
  • Adolescence (poor acquisition)
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8
Q

Primary cause of osteoporosis

A

Old age

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9
Q

RFs for Primary osteoporosis

A
  • Caucasian/white
  • Smoking
  • Malnutrition (vit D/calcium)
  • Decreased physical activity
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10
Q

RFs for secondary osteoporosis (drugs)

A
  • Steroids
  • VPA
  • Heparin
  • Depo-Provera
  • Aromatase Inhibitors
  • Cyclosporine
  • Antacids
  • Lithium
  • Methotrexate
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11
Q

How much is chronic steroid use?

A

> 5mg Prednisone QD or equivalent for > 3 months

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12
Q

RFs for secondary osteoporosis (Diseases)

A
  • Hyper PTH
  • Hyperthyroidism
  • Liver dz/alcoholics
  • CKD
  • Hypogonadism
  • Cushings
  • Malignancy
  • Diabetes
  • Immobility caused by dz
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13
Q

What could be a S/S of osteoporosis?

A
  • Pathologic fx (compression vertebrae, hip, distal radius: colle’s)
  • Loss of vertebral ht > 1.5 cm (upper L/T, shortening, kyphosis)
  • Back pain w or w/o fx

Most back pain is NOT osteoporosis!

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14
Q

What are the USPSTF recommendations for osteoporosis screening?

A
  • 65+ females
  • High risk females under 65

Males is an I for insufficient, but everyone else says screen over 70.

Both are B

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15
Q

What T score corresponds to osteoporosis?

A

T < -2.5

Always use worst score to diagnose

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16
Q

What T score corresponds to osteopenia?

A

-2.4 < T < -1.0

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17
Q

What are DEXA T-scores compared to?

A

A 30 year old

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18
Q

What do DEXA Z-scores compare to?

A

Peer of equal age and gender

Not used for osteoporosis diagnosis

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19
Q

What does a significantly low Z-score suggest?

A

Concerning for secondary osteoporosis

Normal aging would have a minimal Z-score.

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20
Q

What is the other way to diagnose osteoporosis without a DEXA scan?

A

Fragility fx

If occurs with mild trauma

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21
Q

What can XR show for someone that is osteoporotic?

A

Can show demineralization, primarily in the axial skeleton

22
Q

What is a FRAX score?

A

10-year likelihood of osteoporotic or hip fx.

23
Q

When should you consider tx based off a FRAX score?

A
  • Osteoporotic fx risk >= 20%
  • Hip fx risk >= 3%
24
Q

What kind of exercise increases osteoblast activity?

A

Weight bearing

Walking 1hr/ week is amazing! 20% reduction in risk of hip fx

25
Q

What are the lifestyle modifications for osteoporosis and osteopenia?

A
  1. Exercise
  2. Smoking cessation
  3. ETOH moderation
  4. Fall prevention

2/d/males, 1/d/females max

26
Q

What mineral supplementation is indicated for osteoporosis/osteopenia?

A
  • Vit D replacement (at least 800 IU, preferably D3)
  • If labs < 20, high dose 50k IU for 3-6 months then daily supp
  • Ca replacement via calcium citrate. Can also use calcium carbonate but must take w food and cant use PPi with it.

Generally, you can get up to a level of 100, and toxicity is 150.

Avoid the annual bolus of 500k

27
Q

What is the concern with ordering a Vit D test?

A

Not a normal screening test.

28
Q

What are the ways to order a Vit D test and get insurance to pay for it?

A
  • CKD 3 or higher
  • Cirrhosis
  • Hypo/hypercalcemia
  • Hypercalciuria
  • Hypervitaminosis D
  • Parathyroid disorders
  • Malabsorptive states
  • Obstructive jaundice
  • Osteomalacia
29
Q

How much calcium intake is sufficient daily?

A

1200mg

Aim for 50% from food, since dairy has 300mg per serving.

30
Q

Which calcium formulation is not affected by food or PPI use?

A

Calcium citrate

31
Q

When is calcium supplementation indicated?

A

Low serum calcium or diet is insufficient

32
Q

When do we use bisphosphonates?

A

Osteoporosis/penia with + FRAX

33
Q

What is the patient education associated with bisphosphonates?

A
  • 8oz of water first thing in the morning (no other food or water for 30 mins)
  • Do not recline for 30mins to prevent reflux
  • D/C if reflux symptoms occur
34
Q

What is the primary SE to discuss with bisphonates and teeth?

A

Osteonecrosis of the jaw

35
Q

Who should not use bisphosphonates?

A
  • eGFR < 35
  • Significant GI disorders
  • Can’t sit up for 30-60 mins post ingestion
  • Use IV zoledronic acid for other CIs besides kidney dz
36
Q

How long is a drug holiday usually for bisphosphonates?

37
Q

What is the advantage of denosumab injections over bisphosphonates?

A

No drug holiday, no CKD CI

Usually expensive af though

38
Q

What is the last resort drug for osteoporosis/osteopenia with + FRAX?

A

Estradiol

Olny for women

39
Q

Who might SERMs be preferred in for osteoporosis/osteopenia + FRAX?

A

Those with breast cancer risk

Used for people that also need breast cancer risk reduction + osteo

40
Q

When is a PTH analog used? (Romosozumab)

A
  • Osteoporosis/penia + FRAX
  • Corrected vit D and calcium beforehand
  • Consider use during bisphosphonate drug holiday
41
Q

When do you get a repeat DEXA scan after starting pharmacotherapy?

42
Q

When is referral to endocrinology for osteoporosis indicated?

A
  • Premenopausal or men < 50
  • Hx of fragility fx + normal DEXA
  • Failed tx
  • Can’t take normal tx
  • Needs advanced therapy
43
Q

What is osteogenesis imperfecta?

A

Inherited CT Disorder causing brittle bones.

44
Q

What are the primary manifestations of osteogenesis imperfecta?

A
  • Eye sclera: Blue/gray eyes
  • Hearing loss
  • Weak joints
  • Soft bones
  • Dentinogenesis imperfecta: discolored teeth + softness
45
Q

What does osteogenesis imperfecta affect in terms of connective tissue?

A

Collagen 1

46
Q

What are the 4 main types of osteogenesis imperfecta?

A
  • Type 1: Mild (early osteoporosis)
  • Type 2: Lethal (Will die immediately pretty much)
  • Type 3: Severe (Short, frequent fx, triangle face)
  • Type 4: Moderate (blue/gray eyes)

NOT IN ORDER!!

47
Q

What might imaging show for osteogenesis imperfecta?

A
  • Bowing
  • Low bone density
48
Q

What do you consider first in a child presenting with multiple fx?

49
Q

What are the two main distinctive signs of osteogenesis imperfecta?

A
  • Blue eyes
  • Hearing loss
50
Q

Generally, how do you tx osteogenesis imperfecta?

A
  • Combo PT/exercise
  • IV bisphosphonates
  • Supplemental GH for ht
  • All depend on type

MSK (27 decks)

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