Metabolic Bone Diseases

Question 1

Most common metabolic bone disease in the US

Answer 1

osteoporosis

Question 2

Released from parathyroid in response to low Ca+ level and activate kidney, bones, GI system

Answer 2

PTH

Question 3

Released from thyroid in response to elevated serum Ca

Answer 3

calcitonin

Question 4

Biggest medication category linked to osteoporosis as a side effect

Answer 4

steroids

Question 5

Standard test for the evaluation of bone mineral density

Answer 5

DEXA scan

Question 6

What age should everyone receive a DEXA scan regardless of risk factors?

Answer 6

women > 65 and men > 70

Question 7

Bone mineral density compared to what is normally expected in a young healthy adult (at their peak BMD) based on gender

Answer 7

T-score

Question 8

What T-scare indicates osteroporosis?

Answer 8

less than -2.5

Question 9

Used in the following populations compared to other ppl of matched ages/sex/race: Premenopausal women, Men younger then 50 years, Children

Answer 9

z-score

Question 10

What z-score is considered “below the expected range for age?”

Answer 10

-2.0

Question 11

Effective at predicting femoral neck, hip and spine fractures. Lower cost than DXA. Portable. No exposure to radiation

Answer 11

Quantitative calcaneal ultrasonography

Question 12

What imaging should women btw 65-69 and men btw 75-79 receive if their T-score is -1.5?

Answer 12

vertebral imaging

Question 13

Symptoms of osteoporosis

Answer 13

gradual loss of height and Dowager’s hump

Question 14

Nonpharmacologic treatment of osteoporosis

Answer 14

calcium, vit D, excercise

Question 15

Which calcium supplement is better when patient is using H2 blockers/PPIs?

Answer 15

calcium citrate

Question 16

Which calcium supplement is less like to cause kidney stones?

Answer 16

calcium citrate

Question 17

Drug of choice for osteoporosis or Paget’s after failure of conservative treatment

Answer 17

bisphosphonates

Question 18

Name the bisphosphonates

Answer 18

alendronate (Fosamax), Risedronate (Actonel), Zoledronic acid (Reclast), Ibandronate (Boniva)

Question 19

Inhibit bone resorption by decreasing the number and function of osteoclasts

Answer 19

bisphosphonates

Question 20

What do you need to correct before starting treatment with bisphosphonates?

Answer 20

calcium and vitamin D

Question 21

CI to oral bisphosphonates

Answer 21

Barretts, upper GI dz, esophagitis, GFR < 35

Question 22

Atypical fractures associated with bisphosphonates

Answer 22

subtrochanteric and lateral femur fx

Question 23

Horrifying side effect of bisphosphonates

Answer 23

osteonecrosis of jaw

Question 24

How long might you continue therapy for a patient who is high risk (T-score <3.5)?

Answer 24

10 yrs

Question 25

Indicated for the reduction in risk of invasive breast cancer in postmenopausal women with osteoporosis

Answer 25

Estrogen agonist/antagonist (SERMs)

Question 26

Name the SERM mentioned in Jen’s lecture

Answer 26

Raloxifene (Evista)

Question 27

approved for the treatment of osteoporosis in women ≥5 years post menopause. Has not been shown to reduce nonvertebral fractures

Answer 27

calcitonin (miaclcin or fortical)

Question 28

What allergy is a CI to calcitonin treatment?

Answer 28

salmon

Question 29

Only if failed other non-estrogen treatment options. 5 yrs of therapy. Started with 10 yrs of menopause

Answer 29

Hormone replacement therapy (HRT)- Prempro

Question 30

For severe osteoporosis when other treatments have failed. stimulates bone formation also approved for use in men

Answer 30

Parathyroid hormone: Teriparatide (Forteo)

Question 31

Area most commonly involved with Pagets disease

Answer 31

axial skeleton

Question 32

Increased rate of bone remodeling. Overgrowth of bone at single or multiple sites. Impaired integrity of affected bone. Onset after 55

Answer 32

paget’s (Osteitis deformans)

Question 33

Cancer associated with Paget’s

Answer 33

osteosarcoma

Question 34

Increased lab result with Pagets

Answer 34

alkaline phosphatase

Question 35

Test of choice for Pagets. Show increased bone remodeling and blood flow

Answer 35

bone scan

Question 36

Decreased mineralization of newly formed bone. Bone is soft but no loss of bone matrix

Answer 36

osteomalacia

Question 37

Two main causes of osteomalacia

Answer 37

hypocalcemia and hypophosphatemia

Question 38

Common symptoms of osteomalacia

Answer 38

bone pain, muscle weakness, bone tenderness, fracture

Question 39

Most common imaging finding of osteomalacia

Answer 39

reduced bone density with thinning of the cortex

Question 40

Cortical infarctions
wide transverse lucencies traversing bone usually at right angles to the involved cortex. Associated most frequently with osteomalaciaand rickets

Answer 40

Looser’s fractures

Question 41

Where are fractures most commonly located in osteomalacia?

Answer 41

distal radius and proximal femur

Question 42

Major contributor to renal osteodystrophy

Answer 42

secondary hyperparathyroidism

Question 43

high turnover secondary to hyperparathyroidism

Answer 43

osteitis fibrosis

Question 44

low turnover, most common CKD related bone disease, due to suppression of the parathyroid glands

Answer 44

adynamic bone disease

Question 45

low turnover with abn mineralization, not that common in CKD

Answer 45

osteomalacia

Question 46

either high or low turnover and abnormal mineralization

Answer 46

mixed osteodystrophy