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Clin Med Lab 2 - Exam 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

pathology of osteoporosis (3)

A

reduction in bone mass

disruption of skeletal microarchitecture

fragility of skeleton

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2
Q

which component of bone is affected by osteoporosis

A

trabecular bone

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3
Q

2 mc causes of postmenopausal osteoporosis

A

estrogen deficiency

age

→ bone tissue is lost progressively

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4
Q

lifetime osteoporotic fracture risk for a woman at age 50

A

50%

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5
Q

lifetime osteoporotic risk for a man who reaches 50

A

20%

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6
Q

secondary osteoporosis is caused by

A

anything outside of age/hormones

being a woman

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7
Q

4 common causes of secondary osteoporosis

A

meds

vit D deficiency

etoh

chronic illness

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8
Q

2 common meds that cause osteporosis

A

steroids

antiepileptics

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9
Q

bone mass is determined by

A

genetics

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10
Q

rf for osteoporosis

A

white/asian

<127 lb or BMI <20

fh

personal hx fx

>2-3 etoh drinks/day

estrogen deficiency < 45 yo (induced surgical menopause)

testosterone deficiency

low Ca intake

vit D deficiency

sedentary lifestyle current tobacco use

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11
Q

what doe FRAX stand for

A

fracture risk assessment tool

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12
Q

what does FRAX calculate

A

pt’s 10 year probability for fx

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13
Q

what pt populations can FRAX be used for

A

postmenopausal women

men 40-90 yo

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14
Q

who is FRAX validated for

A

untreated pt’s

not currently undergoing tx for OP

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15
Q

what is included in the FRAX assessment

A

age

sex

weight

height

previous fx

parent fx’ed hip

current smoking

glucocorticoids

RA

secondary OP

etoh > 3/day

femoral head BMD

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16
Q

according to FRAX when do you treat OP

A

risk at or above 3%

OR

any other 10 year probability of major OP related factor

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17
Q

gold standard test for bone density

A

bone densitometry (DXA)

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18
Q

bones measured with bone densitometry

A

lumbar spine

hip

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19
Q

what is normal bone loss

A

~1%/year

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20
Q

who gets screened for OP

A

women 65 or older

younger but at risk for osteoporosis/malacia

pathologic fx

radiographic e.o diminished bone density (xray)

+/- men → no evidence

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21
Q

how do you decide the interval between DXA screening scans

A

T score

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22
Q

T score -1 to -1.5

A

screen every 5 years

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23
Q

T score -1.5 to -2.0

A

every 3-5 years

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24
Q

T score < -2.0

A

every 1-2 years

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25
Q

when would you use z score

A

premenopausal women

younger men/kids

people who do not meet standard screening criteria

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26
Q

how does the z score express bone density

A

standard deviation from age-matched, race-matched, and sex-matched means

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27
Q

memorize this

A
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28
Q

early symptoms of OP

A

typically asymptomatic/silent until fx

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29
Q

common first fx in OP

A

vertebral fx

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30
Q

sx of OP related vertebral fx (3)

A

height loss/kyphosis

+/- pain if acute

pain localized to midline spine, varying quality

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31
Q

can OP related vertebral fx occur in the absence of trauma

A

yes!

also minor trauma like speed bump, sudden lifting, coughing, bending

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32
Q

where does vertebral fx pain refer to (3)

A

flank

anterior abd

PSIS

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33
Q

what referred pain is rare for vertebral fx

A

legs

34
Q

if pain does radiate into legs w. vertebral fx, consider

A

neurologic status

35
Q

what do you think when you see, radiolucency, cortical thinning, occult fx

A

radiographic e.o OP

36
Q

what is the problem w. radiographs in OP

A

bone loss must be >30% to be detected

37
Q

lifestyle modification recs for OP

A

smoking cessation

limit etoh intake

regular weightbearing and muscle strengthening exercise

consume at least 1,200 mg Ca/day

adequate calorie intake

take measures in home to avoid falls

wear a brace

38
Q

strength training has to be at lease __ min

__ x/week to help prevent OP

A

30

3

39
Q

guidelines for pharm intervention in postmenopausal women 50 years or older

A

hx hip/vertebral fx

T-score -2.5 or less at femoral neck or spine (excluding secondary causes)

T-score btw -1 and -2.5 at the femoral neck or spine PLUS 10-year probability of hip fx 3% or higher OR 10-year probability of any major OP related fx 20% or higher

40
Q

is age plus hx of fx enough for pharm intervention

A

yes! → 50 yo or older PLUS any one guideline is enough for pharm intervention

41
Q

total Ca intake/day rec

A

1200 mg

42
Q

total vit D intake/day rec

A

800 IU

43
Q

s.e of Ca supplements

A

nephrolithiasis

dyspepsia

constipation

interfere w. iron and thyroid hormone absorption

+/- increased risk for CVD

44
Q

Ca interferes with the absorption of (2)

A

iron

thyroid hormone

45
Q

s.e of vit D supplements if excessive

A

hypercalcemia

hypercalciuria

nephrolithiasis

46
Q

chronically high levels of vit D may lead to

A

increased ca risk

mortality

falls

47
Q

vit D levels are measured w.

A

25 (OH) D

48
Q

first line tx for OP

A

bisphosphanates

49
Q

what med improves BMD AND decreases fx

A

bisphosphonates

50
Q

mc used bisphosphonate

A

Alendronate (Fosamax)

also

Risendronate (Actonel)

51
Q

suffix for bisphosphonates

A

-dronate

52
Q

what do you need to do before beginning bisphosphonates

A

correct hypocalcemia and vit D deficiency

53
Q

contraindications for bisphosphonates

A

esophageal d.o → including dysphagia

post bariatric surgery

unable to follow dosing guidelines

54
Q

bisphosphonates must be taken __

with __

A

first thing in the AM

8 oz water

55
Q

guidelines regarding eating/drinking/other meds with bisphosphonates

A

nothing for at east ½ hour after taking bisphosphonate

56
Q

guideline regarding position when taking bisphosphonate

A

remain upright (sit or stand) for 30 mins after administration

57
Q

what might happen if a pt does not follow position guidelines for bisphosphonates

A

may cause erosion of esophagus

58
Q

how often are bisphosphonates taken

A

once weekly

59
Q

what if a person can’t tolerate PO bisphosphonates

A

IV available

60
Q

indications for d.c’ing bisphosphonates

A

if taking alendronate OR risendronate (Actonel) x 5 years

OR if taking zoledronic acid (Reclast) x 3 years

PLUS

stable BMD and no prvious vertebral fx

61
Q

bisphosphonate rec for those at highest risk for fx

A

continue PO up to 10 years for PO

up to 6 years IV

62
Q

max duration for PO bisphosphonate tx

A
  1. years
63
Q

max duration for IV bisphosphonates tx

A

6 years

64
Q

risks of PO bisphophonates

A

upper GI irritation

osteonecrosis of jaw

renal toxicity → contraindicated in pt w. CrCl <30

65
Q

GI s.e related to bisphosphonates (3)

A

reflux

esophagitis

esophageal ulcers

66
Q

IV bisphosphonates can cause

A

acute-phase rxn → fever, myalgia, arthralgia

67
Q

besides bisphosphonates, another med used for OP tx

A

calcitonin

68
Q

how does calcitonin work (2)

A

increases bone density

may decrease vertebral fx risk

69
Q

is calcitonin first line tx for OP

A

no

70
Q

when might you use calcitonin

A

short-term pain relief in pt w. acute pain related to several vertebral fx

71
Q

s.e of calcitonin

A

rhinitis

increased malignancy risk

72
Q

oral analgesics indicated for OP tx

A

acetaminophen

NSAIDs

narcotics → only for severe pain control

73
Q

possible negative effect of NSAIDs in OP tx

A

may impair bone healing

74
Q

2 surgical options for vertebral fx

A

kyphoplasty

vertebroplasty

75
Q

when is vertebroplasty used

A

when little to no compression of vertebral body

76
Q

benefits of vertebroplasty

A

cheaper

no balloon involved → faster

less post op pain

77
Q

disadvantages of vertebroplasty

A

cement leakage

less effective vertebral heigh restoration → controversial

78
Q

benefits of kyphoplasty

A

less cement leakage

more effective restoration of vertebral body height → prevents kyphosis

79
Q

disadvantages of kyphoplasty

A

similar post op outcomes but much more expensive

requires overnight stay

more technically challenging → balloon tamponade + cement

80
Q

who might be a candidate for vertebral augmentation surgery

A

those unable to achieve pain control

81
Q

adverse events related to vertebral augmentation

A

cement PE

extravasation of cement

infxn

Clin Med Lab 2 - Exam 1 (7 decks)

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