Mehlman Osteoporosis

Question 1

M. Osteoporosis.
At what age done bone densitometry?

Answer 1

at age 65

Question 2

M. Osteoporosis.
What bone density?

Answer 2

> =2,5 SD below mean compared to young adult women.

cia reiskia T score =< - 2,5

Question 3

M. Osteoporosis.
what bone density in osteopenia?

Answer 3

1,5 - 2,4 SD below mean.

cia tipo T score -1,5 - -2,4

Question 4

M. Osteoporosis.
1,5 - 2,5 SD below mean, how called?

Answer 4

osteopenia

Question 5

M. Osteoporosis. most important risk factor.
Female versus age?

Answer 5

choose gender

Question 6

M. Osteoporosis. most important risk factor.
Female. choose age versus family history?

Answer 6

family history

Question 7

M. Osteoporosis. what about male?

Answer 7

unlikely to develop, even with family history of females with disorder

Question 8

M. Osteoporosis. What etnicity is protective?

Answer 8

black

Question 9

M. Osteoporosis.
Case: two women without family history. what most protective against osteoporosis?

Answer 9

etnicity –> black

Question 10

M. Osteoporosis.
Case: Old women + femoral fracture + not mentioned osteoporosis. what is the most important predictor of success in the rehabilitation of the patient?

Answer 10

activity level before fracture

weight-bearing exercise during life is protective agains osteoporosis later.

Question 11

M. Osteoporosis.

Compression fracture = osteoporosis on USMLE.

Answer 11

.

Question 12

M. Osteoporosis.
Case: Patient with RA on steroids has compression fracture –> Tx?

Answer 12

easy Dx of osteoporosis

Question 13

M. Osteoporosis.
what 2 causes, that usmle love?

Answer 13

corticosteroids and Cushing –> cause osteoporosis

Question 14

M. Osteoporosis.
What body weight is HY on usmle?

Answer 14

Low/Low-normal

Case in 2CK: 20F + BMI 19. Has risk for what? –> osteoporosis.

siaip low BMI < 18,5. todel cia ir yra paminets ,,low-normal”.

Question 15

M. Osteoporosis.
What fracture is HY in low weight young women who runs and has low bone density?

Answer 15

Metatarsal stress fracture

Question 16

M. Osteoporosis. Also assess low vit. D in the setting of intestinal malabsoption (CF, Crohn) as a cause of osteoporosis, despite it ,,doesnt make sense”, because low vit. D causes osteomalacia.

Answer 16

.

Question 17

M. Osteoporosis.
what Ca, PO, PTH, ALT levels?

Answer 17

NORMAL

Question 18

M. Osteoporosis.
Tx? First step?

Answer 18

Weight-bearing exercise first (answer ,,go for a long walk outside daily”).

Wrong: increase participation in pool based exercise classes to at least three times weekly.

Question 19

M. Osteoporosis.
Tx? First pharmacological?

Answer 19

Calcium and vit D

Question 20

M. Osteoporosis.
Use Ca and Vit D –> what next medication?

Answer 20

Bisphospohionates
Possible atypical fractures with prolonged use

Question 21

M. Osteoporosis. Tx
Supportive: Weight bearing
Medication first: Ca/vit D
Medication second: Bisphospohonates

Answer 21

.

Question 22

M. Osteoporosis. Tx. What medication stimulates bone development?

Answer 22

Teriparatide

Question 23

M. Osteoporosis. Tx.
Teriparatide - mechanism?

Answer 23

N-terminus PTH analogue –> stimulates bone development

Anabolic medication

Question 24

M. Osteoporosis. Tx.
RANK-L monoclonal antibody?

Answer 24

Denosumab

Question 25

M. Osteoporosis. Tx.
Denosumab group?

Answer 25

RANK-L monoclonal antibody

Question 26

UW table. non-modifiable risk factors.

Answer 26

Female, advanced age, postmenopausal, low body weight.
Others: white/asian, malabsorption, inflammatory diseases (RA), hypeCORTISOLIM, hyperthyroid/parathryoid.

Question 27

UW table. modifiable risk factors.

Answer 27

smoking, alcohol, sedentary lifestyle
medications - GLUCOCORTICOIDS, anticonvulsants
vitD/Ca deficiency, estrogen deficiency (premature menopause, hysterectomy)

Question 28

UW. Screening.
for who?

Answer 28

One time DEXA for all women >= 65 y/o.
or
Female <65 who have equivalent risk of osteoporotic fracture (risk determined by FRAX tool)