Osteoperosis

Question 1

Two major changes of osteoporosis

Answer 1

Lower bone density and lower bone quality (micro architectural disruption)

Question 2

What is the proportion of women who have an osteoporotic fracture?

Answer 2

1 out of 2

Question 3

Symptoms of uncomplicated osteoporosis

Answer 3

None its silent

Question 4

Most serious osteoporotic fracture

Answer 4

hip

Question 5

Most common osteoporotic fracture

Answer 5

vertebral

Question 6

Men or women have worse mortality after hip fracture

Answer 6

men

Question 7

Two main causes of pathophysiology of osteoporosis

Answer 7

Low peak bone mass (started off at lower baseline) (modeling)
Bone loss later in life (remodeling)

Question 8

What is the cause of primary osteoporosis

Answer 8

Aging, seen in postmenopausal women and aging men

Question 9

Causes of secondary osteoporosis- genetic

Answer 9

Parental hip fracture or idiopathic hypercalciuria

Question 10

Causes of secondary osteoporosis- lifestyle

Answer 10

Low Ca intake, Vit D issues, Alcohol >3 drinks/day, low BMI

Question 11

Causes of secondary osteoporosis- endocrine

Answer 11

hypogonadism, hyperthyroidism, premature ovarian failure, hyperparathyroidism

Question 12

Causes of secondary osteoporosis- GI

Answer 12

inflammatory bowel disease, celiac’s

Question 13

Causes of secondary osteoporosis- Meds

Answer 13

Lots of glucocorticoids- more than 5mg/day for more than 3 months, PPIs, Anticonvulsants, aromatase inhibitors

Question 14

Causes of secondary osteoporosis- Rheum

Answer 14

RA, end stage renal disease

Question 15

Diagnostic tool for osteoporosis

Answer 15

DXA scan

Question 16

Where do you want to DXA scan for osteoporosis

what about for primary hyperparathyroidism/fatties

Answer 16

Hip, Femoral neck, Lumbar Spine

forearm

Question 17

Diagnostic score for old/young population and what’s are they compared to

Answer 17

T-score for old- compared to young people to see how many SDs you are away from your peak bone mass
Z- score for young- age/race/gender matched

Question 18

DXA is only used for these two pops

Answer 18

postmenopausal women and men above 50

Question 19

T score ranges
Normal
Low bone mass
Osteoporosis

Answer 19

Normal- -1 or less SDs below mean
Low Bone Mass- between 1-2.5 below mean
Osteo- 2.5 SDs or lower below mean

Question 20

Patients who have had a history of ___ ___ are considered osteoporotic

Answer 20

History of fragility fractures

Question 21

Screen all women over _ and men over _

Answer 21

65; 70

Question 22

Screening ages for people with clinical risk factors for osteoporosis
Men
Women

Answer 22

Men- 50-69

Women- Postmenopausal women

Question 23

Relationship between fracture risk and SD of T score below mean

Answer 23

every 1 SD of T-score below mean double the risk of fracture

Question 24

Who do we treat according to
T score
History
FRAX test

Answer 24

T score more than 2.5 below mean
History of previous hip/spine fracture
FRAX score of 20% for any fracture or 3% for a hip fracture

Question 25

Age criteria for treatment- men and women

Answer 25

Men above 50, postmenopausal women

Question 26

Mnemonic for non-pharm treatment for osteoporosis

Answer 26

``` Calcium D vitamin Exercise Fall prevention Good nutrition Smoking ```

Question 27

What's the only drug that increases bone formation by osteoblasts

Answer 27

teriparatide

Question 28

Preosteoblasts release __ which does what to osteoclasts

Answer 28

RANKL and it stimulates osteoclasts

Question 29

Mature osteoblasts release __ which does what to RANKL

Answer 29

OPG blocks RANKL so increases bone formation

Question 30

First line osteoporosis therapy

Answer 30

Bisphosphonates

Question 31

Bisphosphonate mech of action

Answer 31

It blocks osteoclasts and kills them

Question 32

Bisphosphonate short term common side effects (and the system it affects) and serious long term side effect

Answer 32

short term- flu like illness, GI issues | long term- Atypical fracture of femur and osteonecrosis of the jaw

Question 33

Denosumab inhibits what, and is good for what patient pop because of its metabolism

Answer 33

Inhibits Rank ligand, isn't excreted by the kidney so renal failure patient

Question 34

Side effects of Denosumab

Answer 34

Hypocalcemia, skin issues, infection

Question 35

Teriparatide pretty much acts as ___ hormone

Answer 35

parathyroid

Question 36

Teriparatide has a window of bone anabolism before bone resorption occurs- must be given with what other drug

Answer 36

anti-resorptive agent

Question 37

Teriparatide major side effect

Answer 37

osteosarcoma

Question 38

Teriparatide contraindications

Answer 38

Paget’s disease, high alk phos, hypercalcemia, h/o of skeletal malignancy, radiation or mets

Question 39

Raloxifene is what type of drug

Answer 39

selective estrogen receptor modulator

Question 40

Raloxifene major contraindication

Answer 40

thromboembolism