Osteoporosis

Question 1

T score range in osteopenia?

Answer 1

-1 - -2.5

Question 2

T score for osteoporosis

Answer 2

> -2.5

Question 3

Name the 2 type of osteoporosis?

Answer 3

1. Postmenopausal

2. Senile

Question 4

What is the age for senile OP?

Answer 4

> 75

Question 5

What is secondary OP?

Answer 5

Steroid induced

Question 6

What is a T score?

Answer 6

BMD of young healthy patient of same sex and race

Question 7

What is a Z score

Answer 7

BMD of aged matched population of same sex and race

Question 8

Fragility fractures in order of occurrence?

Answer 8

1. Vertebral body
2. Hip
3. Wrist

Question 9

What risk assessment tool is used for OP?

Answer 9

FRAX score = risk of OP # in next 10 years

Question 10

Indications for treatment in OP? 3

Answer 10

1. Post menopausal female/ Male >50 with hip/vertebral fracture
2. T score of -1.5 - -2.5 with RFs
3. T score of >-2.5

Question 11

With a t score of -1.5 to -2.5 when would you consider therapy?

Answer 11

1. 10 year hip fracture risk >=3% (HIP 123)

2. FRAX >20%

Question 12

What is the Singh index?

Answer 12

Changes in the trabecular pattern of the proximal femur as index of OP

Question 13

What is ward triangle?

Answer 13

Weak point of femoral neck at junction of three trabecular groups

Question 14

What are 2 prophylactic agents used?

Answer 14

1. Vit D - 800-1000iu/day

2. Calcium - 1000-1200mg/day

Question 15

What are the groups of treatment options available for OP?

Answer 15

1. Bisphosphonates
2. Hormones
3. Immunoglobulins

Question 16

What are the 2 types of bisphosphonates?

Answer 16

Nitrogen and non nitrogen

Question 17

What is the mechanism of action of the bisphosphate group?

Answer 17

Incorporated into bone
Released when OC reabsorb bone
Inhibit OC - Apoptosis or Flatten ruffled border

Question 18

What is the mechanism of action of non-nitrogen bisphosphonates?

Answer 18

Induce premature OC apoptosis

Question 19

What is the mechanism of action of nitrogen bisphosphonates?

Answer 19

Inhibit Farnesyl Pyrophosphate synthase (Mevalonate pathway)

Question 20

Major side effects of BP therapy?

Answer 20

1. ON of the jaw
2. Atypical subtrochanteric femur fractures
3. GI symptoms

Question 21

Examples of NONnitrogen containing BP?

Answer 21

Clodronate
Tiludronate
Etidronate

CLOTILdE

Question 22

What are the hormone treatments available?

Answer 22

1. HRT
2. ERT - no uterus
3. Calcitonin
4. Raloxifene
5. Testosterone (not approved)
6. PTH - Terliparatide

Question 23

What is Raloxifene?

Answer 23

SERM - Selective oestrogen receptor modulator

Question 24

When may you not use telipratide?

Answer 24

Pagets disease = increased Osteosarc risk

Question 25

What are the 2 immunoglobulin therapies available?

Answer 25

Denosumab

Romosuzumab

Question 26

What does Denosumab do?

Answer 26

Monoclonal Ab against RANKL (Similar to osteoprotegrin)