Osteoporosis

Question 1

Age parameters for bone mineral density testing

Answer 1

• W > 65
  
  • Post-menopausal W < 65 W/RFs for fracture and poor Calcium intake
• M > 70 or < 70 if w/RFs

Question 2

Dual-energy x-ray absorptiometry (DEXA)

T-score and Z-score definition

Answer 2

• Provides T-scores for peri-postmenopausal W + M > 50
• T-score = standard deviation between a patient’s BMD and that of a young adult reference population (BETTER)
  
  • Defines criteria for osteoporosis and low bone mass
• Z-score = comparison of person’s BMD to an age matched population
  
  • -2 or lower is considered below expected range for age

Question 3

Diagnostic Criteria of T-score for peri/postmenopausal W + M > 50

Answer 3

**Normal: anything -1 < is normal

**Low bone mass: -2.4 to -1: osteopenia

**Osteoporosis: < -2.5

Severe: < -2.5 with fragility fx (not seen in practice mostly)

Question 4

Fragility fracture and most common sites

Answer 4

• Occurring spontaneously or from minor trauma
• Fall from standing height or less
• Result from mechanical forces that would not ordinarily result in fracture
• Spine (vertebral compression fracture), Hip, wrist
• Putting cement in vertebra to make spinal column bigger → create fragility fracture in other areas of vertebra

Question 5

DEXA scan testing

Sites (3), Dx, false elevation..

Answer 5

• Need TWO sites to make Dx
• Lumbar spine (L1-L4) AND Hips (BL = 1 site)
  
  • Hips: use femoral neck and total hip values
• If cannot use spine and hips:
  
  • 3rd site is forearm (⅓ up distal radius)
• Scan can read really high if pt has compression fracture
• Dx if ONE SITE has T score in range (osteopenia or osteoporosis)
• Femoral neck R + L and Total R + L (HIPS)

Question 6

Recommended site for hyperparathyroidism DEXA testing

Answer 6

Forearm (⅓rd up distal radius)

Question 7

FRAX risk calculator

Answer 7

• If hip fracture risk in next 10 years > 3% OR
  
  • Primarily look at this → more likely to get hip fracture
• Total fracture risk in next 10 years > 20%

THEN → Treat as if osteoporosis

If pt has osteopenia → then calculate this

Question 8

Labs to check to evaluate osteoporosis

Answer 8

• CBC, CMP, Calcium, Phosphorous
• 25-hydroxyvitamin D
• Ensure adequate calcium/vitmain D intake

Question 9

Osteoporosis treatment plan

Answer 9

• Start Tx - 1st line tx bisphosphonate
• Need to supplement Vit D first before bisphosphonate otherwise bisphosphonate will not work as well
• Borderline → Get Ca + Vit D levels up where they need to be → repeat in year
• Ensure adequate Ca + Vit D intake
  
  • Ca: 1200mg/daily (half in diet, half via supplementation)
    
    • Too much → cardiac issues/pee it out
  • Vit D: 800u/daily - more through sunlight exposure