May 24, 2016 - Osteoporosis

Question 1

Risk Factors for Bone Loss

Answer 1

Age > 50

Estrogen / Testosterone deficiency

White race

Glucocorticoids

Smoking

Alcohol abuse

Weight loss

Genetics

Drugs

Chronic inflammatory processes

Question 2

Risk Factors for Fracture

Answer 2

Lone bone mass

Prior fragility fracture

FHx of hip fracture

Age > 65

Question 3

Bisphosphonates

Answer 3

Bind to the surface long-term of bone, and are taken up by osteoclasts which then become inhibited and undergo apoptosis. Net effect is to reduce the extent and rate of bone resorption.

30-50% relative risk reduction.

Side effects: GI upset (10-30%), fever and acute phase reaction with IV (10%), osteonecrosis of the jaw (RARE), transverse femur fractures (RARE).

May last up to 10 years after drug cessation.

Question 4

Denosumab

Answer 4

Anti-RANKL Antibody

Very potent inhibition of RANK-L and therefore osteoclast function. Requires a subcutaneous injection q6mo

Reduces fractures up to 50%

Side effects include skin reactions, ONJ, abnormal femur fractures

Question 5

Raloxifene

Answer 5

Selective estrogen receptor modulator

Estrogen agonist on bone, but an estrogen antagonist at the breast and uterus.

Reduces vertebral fracture risk by 30-50%, but no proof on hips

Question 6

Estrogen

Answer 6

Clearly maintains BMD

Cheap

May increase risk of CVD, thromboembolic disease, breast cancer, and stroke

Question 7

Parathyroid Hormone for Osteoporosis

Answer 7

Subcutaneous injection that has a very short half life.

Taken once daily, this decreases osteoblast apoptosis, increases osteoblast number and function, increases new bone formation, increases bone mass, and decreases the fracture risk. Given in small doses, this does the opposite of long-term PTH.

Fracture risk reduction at LEAST 50%.

$13,000 / year