Orthopaedics & Rheumatology_ Osteoporosis

Question 1

What percentage of postmenopausal women will have an osteoporosis-related fracture?

Answer 1

• Approximately 50%

Question 2

What are the risk factors for fractures independent of bone mineral density (BMD)?

Answer 2

• Advanced age
• previous fracture
• long-term glucocorticoid therapy
• body weight less than 127 pounds
• first degree relative with hip fracture
• cigarette smoking
• excessive alcohol intake

Question 3

What is the preferred diagnostic modality for osteoporosis?

Answer 3

• Bone mass density scan (DEXA) of the hip and lumbar spine

Question 4

How is the T score calculated?

Answer 4

• T score = (BMD [patient] − mean BMD [of a young adult population])/Standard deviation (of a young adult population)

Question 5

What is a normal T score?

Answer 5

0 to -1

Question 6

T score for osteopenia

Answer 6

-1 to -2.5

Question 7

T score that defines osteoporosis

Answer 7

< -2.5

Question 8

Who should be screened for osteoporosis?

Answer 8

• Women aged 65 years and older
• or younger women whose fracture risk is equal to or greater than that of a 65 year old white woman with no other risk factors.

Question 9

How frequently should women be screened for osteoprosis?

Answer 9

• every 2 years

Question 10

Men with what conditions should get a bone mass density test?

Answer 10

• Low-trauma fractures
• radiographic osteopenia
• hypogonadism
• irritable bowel disease
• glucocorticoid therapy
• primary hyperparathyroidism
• loss of more than 1.5 inch in height

Question 11

What are the treaments of osteoporosis ?

Answer 11

• Bisphosphonates, selective estrogen receptor modulators (raloxifene)
• supplemental calcium and vitamin D
• weight-bearing exercise (at least 30 minutes three times per week)
• smoking cessation

Question 12

How much supplemental calcium for patients with osteoporosis?

Answer 12

1000 milligrams per day.

Question 13

How much supplemental vitamin D for patients with Osteoporosis?

Answer 13

800 IU per day.

Question 14

What serum 25 hydroxyvitamin D concentration is defined as Vitamin D insufficiency?

Answer 14

20-30 ng/mL

Question 15

Vitamin deficiency

Answer 15

< 20 ng/mL

Question 16

What factors influence cutaneous production of vitamin D?

Answer 16

• Age: production declines with advancing age,
• latitude
• cloud cover: complete cloud cover reduces UV energy by 50%
• shade: Shade and pollution decreases UV energy by 60%
• UV energy does not penetrate glass
• sunscreens - sun protection factors greater than 8 block vitamin D producing UV rays.
• Skin melanin content darker pigmentation is associated with less vitamin D production.

Question 17

Approximately how much sun exposure is needed to maintain an adequate amount of cutaneous vitamin D production?

Answer 17

• five to 30 minutes between 10am and 3pm, twice per week to the face, legs, or back without sunscreen. (Varies by time of year in latitude).

Question 18

What is the treatment for vitamin D insufficiency?

Answer 18

• 800 to 1000,IU of oral vitamin D (ergocalciferol) or D3 (cholecalciferol) per day.

Question 19

What is the treatment for vitamin D deficiency?

Answer 19

• 50,000 IU of oral vitamin D2 or D3, once per week for six to eight weeks.
• Then 800 to 1000 IU of Vitamin D2 or D3 daily (through the optimal dose and frequency are still being researched).

Question 20

How do bisphosphonates work?

Answer 20

• Bisphosphonates inhibit osteoclastic bone resorption.

Question 21

How should bisphosphonates be taken?

Answer 21

• on an empty stomach
• first thing in the morning
• with at least eight ounces of water
• nothing else by mouth for at least 30 minutes after ingestion
• remain upright for at least 30 minutes after ingestion (to minimize esophageal side effects).

Question 22

What is the risk of osteonecorsisnecrosis of the Jaw with oral bisphosphonates use?

Answer 22

• 1 in 100,000 patients years

Question 23

IS hormone replacement therapy the first line therapy for osteoporosis?

Answer 23

• No, it is reserved for patients who have menopausal symptoms, or cannot tolerate bisphosphonates.

Question 24

Do bisphosphonates decrease fracture risk in patients with osetopenia?

Answer 24

• no bisphosphonates have been shown to increase bone mineral density in patients with osteopenia though this has not consistently led to fracture risk reduction.

Question 25

What is the treatment of osteopenia?

Answer 25

• calcium and vitamin D
• weight bearing exercise
• smoking cessation
• bisphosphonates and selective estrogen receptor modulators are approved for the prevention of osteoporosis and can be considered in patients with increased fracture risk.