Osteoporosis Flashcards
List 9 risk factors for Osteoporosis
Age >65 Fragility fracture after 40 Parents with hip fracture Underweight Poor mineral absorption from poor diet or gastric surgeries >3 drinks per day Smoking Steroid use Rheumitological condition Female Post menopausal, early meopause, late menarche
How to diagnose osteoporosis
BMD
If moderate risk (10-20) then get thoracic lumbar x-ray
What blood wokr would you get after diagnosing osteoporosis
HB TSH Ionized ca Alk phos - pagets Phosphate Creat Vit D - 25 OH SPEP (if vertebral fracture) for MM
How much calcium and vit D should people be taking
1000 IU daily of vit D
1200 mg calcium from all sources
List Five things to do for someone with osteoporosis that aren’t prescriptions
Advise calcium Advise Vit D Advise Wt. bearing exercises Advise OT home assessment for falls risk Advise physio or kinesiology for balance exercises Hip Guards
List three categories of drugs and a drug in those categories for treatment of osteoporosis. Lise a major side effect for each
Bisphosphonates (alendronate)
- Esophogeal ulcer
- Atypical fractures
- Jaw osteonecrosis
Selective Estrogen Receptor Modulator (Raloxifene)
-PE/DVT
Parathyroid hormone analog (teriparatide)
- Hypercalciuria or hypercalcemia
- Angioedema
Monoclonal Antibody (denosumab)
- Joint pain
- Jaw osteonecrosis
HRT (Premarin)
-DVT
What is the osteoporosis and osteopenia diagnosic criteria
Osteoporosis
Physical exam for osteoporsis
Height Rib to pelvis distance (2 cm) Kyphosis Weight Get up and go test
When do you do a BMD in someone under 50
Fragility fracture Prolonged steroid use Aromatase inhibitors Premature menopause (<45) Malabsorption syndrome
What is the OST
Weight -Age
<10 should do BMD
When to do BMD in >50
>65 Fragility fracture after 40 Prolong glucocorticoids Aromatase inhibitors Anticovulsants Parental Hip fracture Malabsorption Vertebral fracture Smoker EtOH >3 per day Low body weight Rheumatoid
List seven secondary cuases of osteoporosis
DM Hypoparathyroidism Alcoholism Anorexia Liver dx Celiac Crohns Medications (PPI, Steroids, Aromatase injibitors, Anti epileptics, Lithium, chemo HIV CKD RA
Specifically what exercise should you recommend to patients to prevent
Strength twice per week
Balance 20 minutes per day
Aerobics 30 min 5 times per day
Posture 10 min per day
How long should someone be on Bisphosphonates
Reassess after 3-5 years
If still high risk can continue for additional five years
If low or mod risk consider 3-5 year drug holiday and then reassess
Can put them back on it for 5 more years
No studies past 10 years
DON”T GIVE DRUG HOLIDAY FOR DENOSUMAB. If you are stopping it put them on bisphosphonate
What to give men with osteoporosis
Alendronate
Risendronate
Zolendronic acid
