Orthopaedics & Rheumatology_ Osteoporosis Flashcards
What percentage of postmenopausal women will have an osteoporosis-related fracture?
- Approximately 50%
What are the risk factors for fractures independent of bone mineral density (BMD)?
- 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
What is the preferred diagnostic modality for osteoporosis?
- Bone mass density scan (DEXA) of the hip and lumbar spine
How is the T score calculated?
- T score = (BMD [patient] − mean BMD [of a young adult population])/Standard deviation (of a young adult population)
What is a normal T score?
0 to -1
T score for osteopenia
-1 to -2.5
T score that defines osteoporosis
< -2.5
Who should be screened for osteoporosis?
- 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.
How frequently should women be screened for osteoprosis?
- every 2 years
Men with what conditions should get a bone mass density test?
- Low-trauma fractures
- radiographic osteopenia
- hypogonadism
- irritable bowel disease
- glucocorticoid therapy
- primary hyperparathyroidism
- loss of more than 1.5 inch in height
What are the treaments of osteoporosis ?
- Bisphosphonates, selective estrogen receptor modulators (raloxifene)
- supplemental calcium and vitamin D
- weight-bearing exercise (at least 30 minutes three times per week)
- smoking cessation
How much supplemental calcium for patients with osteoporosis?
1000 milligrams per day.
How much supplemental vitamin D for patients with Osteoporosis?
800 IU per day.
What serum 25 hydroxyvitamin D concentration is defined as Vitamin D insufficiency?
20-30 ng/mL
Vitamin deficiency
< 20 ng/mL
What factors influence cutaneous production of vitamin D?
- 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.
Approximately how much sun exposure is needed to maintain an adequate amount of cutaneous vitamin D production?
- 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).
What is the treatment for vitamin D insufficiency?
- 800 to 1000,IU of oral vitamin D (ergocalciferol) or D3 (cholecalciferol) per day.
What is the treatment for vitamin D deficiency?
- 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).
How do bisphosphonates work?
- Bisphosphonates inhibit osteoclastic bone resorption.
How should bisphosphonates be taken?
- 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).
What is the risk of osteonecorsisnecrosis of the Jaw with oral bisphosphonates use?
- 1 in 100,000 patients years
IS hormone replacement therapy the first line therapy for osteoporosis?
- No, it is reserved for patients who have menopausal symptoms, or cannot tolerate bisphosphonates.
Do bisphosphonates decrease fracture risk in patients with osetopenia?
- no bisphosphonates have been shown to increase bone mineral density in patients with osteopenia though this has not consistently led to fracture risk reduction.
What is the treatment of osteopenia?
- 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.
