Osteoperosis Flashcards
Two major changes of osteoporosis
Lower bone density and lower bone quality (micro architectural disruption)
What is the proportion of women who have an osteoporotic fracture?
1 out of 2
Symptoms of uncomplicated osteoporosis
None its silent
Most serious osteoporotic fracture
hip
Most common osteoporotic fracture
vertebral
Men or women have worse mortality after hip fracture
men
Two main causes of pathophysiology of osteoporosis
Low peak bone mass (started off at lower baseline) (modeling)
Bone loss later in life (remodeling)
What is the cause of primary osteoporosis
Aging, seen in postmenopausal women and aging men
Causes of secondary osteoporosis- genetic
Parental hip fracture or idiopathic hypercalciuria
Causes of secondary osteoporosis- lifestyle
Low Ca intake, Vit D issues, Alcohol >3 drinks/day, low BMI
Causes of secondary osteoporosis- endocrine
hypogonadism, hyperthyroidism, premature ovarian failure, hyperparathyroidism
Causes of secondary osteoporosis- GI
inflammatory bowel disease, celiac’s
Causes of secondary osteoporosis- Meds
Lots of glucocorticoids- more than 5mg/day for more than 3 months, PPIs, Anticonvulsants, aromatase inhibitors
Causes of secondary osteoporosis- Rheum
RA, end stage renal disease
Diagnostic tool for osteoporosis
DXA scan
Where do you want to DXA scan for osteoporosis
what about for primary hyperparathyroidism/fatties
Hip, Femoral neck, Lumbar Spine
forearm
Diagnostic score for old/young population and what’s are they compared to
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
DXA is only used for these two pops
postmenopausal women and men above 50
T score ranges
Normal
Low bone mass
Osteoporosis
Normal- -1 or less SDs below mean
Low Bone Mass- between 1-2.5 below mean
Osteo- 2.5 SDs or lower below mean
Patients who have had a history of ___ ___ are considered osteoporotic
History of fragility fractures
Screen all women over _ and men over _
65; 70
Screening ages for people with clinical risk factors for osteoporosis
Men
Women
Men- 50-69
Women- Postmenopausal women
Relationship between fracture risk and SD of T score below mean
every 1 SD of T-score below mean double the risk of fracture
Who do we treat according to
T score
History
FRAX test
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
Age criteria for treatment- men and women
Men above 50, postmenopausal women
Mnemonic for non-pharm treatment for osteoporosis
Calcium D vitamin Exercise Fall prevention Good nutrition Smoking
What’s the only drug that increases bone formation by osteoblasts
teriparatide
Preosteoblasts release __ which does what to osteoclasts
RANKL and it stimulates osteoclasts
Mature osteoblasts release __ which does what to RANKL
OPG blocks RANKL so increases bone formation
First line osteoporosis therapy
Bisphosphonates
Bisphosphonate mech of action
It blocks osteoclasts and kills them
Bisphosphonate short term common side effects (and the system it affects) and serious long term side effect
short term- flu like illness, GI issues
long term- Atypical fracture of femur and osteonecrosis of the jaw
Denosumab inhibits what, and is good for what patient pop because of its metabolism
Inhibits Rank ligand, isn’t excreted by the kidney so renal failure patient
Side effects of Denosumab
Hypocalcemia, skin issues, infection
Teriparatide pretty much acts as ___ hormone
parathyroid
Teriparatide has a window of bone anabolism before bone resorption occurs- must be given with what other drug
anti-resorptive agent
Teriparatide major side effect
osteosarcoma
Teriparatide contraindications
Paget’s disease, high alk phos,
hypercalcemia, h/o of skeletal malignancy,
radiation or mets
Raloxifene is what type of drug
selective estrogen receptor modulator
Raloxifene major contraindication
thromboembolism
