osteoporosis Flashcards
what diseases are osteoporosis risks:
autoimmune disorders (i.e. RA)
multiple myeloma
DM
hyperparathyroidism
hyperthyroidism
Cushin’s
Celiac, IBD
breast and prostate CA
eating disorders
some medicines that cause bone loss:
anti-seizure medications
diabetes meds (SLGT2 inhibitor)
steroids (glucocorticoids -cortisone, prednisone)
breast CA aromatase inhibitors
indications for osteoporosis treatment:
low Z scores
very low T scores
not responding to prescriptions
multiple fractures
age for peak bone mass?
30-35
pattern of bone loss in glucocorticoid taking patients:
rapid bone loss in first 6 months and then gradual loss thereafter
what are the 5 risk groups for osteoporosis?
1a) clinical hip Fx (femoral head or intertrochanteric region)
1b) vertebral fracture
2) t score -2.5 or worse
3) low bone mass and fracture of wrist, pelvis, or prox. humerus
4) WHO FRAX threshold met
5) glucocorticoid induced osteoporosis
DEXA scan diagnostic criteria:
normal: -1 or greater
osteopenia: between -1 and -2.5
osteoporosis: -2.5 or less
severe osteoporosis: -2.5 or less and fragility fracture
what is the NORA?
national osteoporosis risk assessment
study where post-menopausal women have their BMD measures and assess self-reported fractures over the next year
types of DEXA scans:
lumbar spine (either L1-L4 or L2-L4)
hip
wrist
choose the weakest site (lowest/most negative T score) for analysis
what does DEXA measure?
bone mineral density (BMD) in g/cm2
what is the DEXA T score?
compares the patient’s BMD with the young normal mean BMD and expresses the difference as a standard deviation score
what is a DEXA Z score?
compares the patient’s BMD to an age-matched mean and expresses the difference as a standard deviation score
most clinically relevant when considering secondary osteoporosis in younger patients
a score of <-1.5 warrants a secondary osteoporosis workup
what is a low Z score typically indicative of?
secondary osteoporosis
HOWEVER, this is not validated through clinical trials and there is a high suspicion of secondary causes in all patients, not just in those with a low Z score.
biochemical markers for bone turnover:
BONE RESPORTION
serum CTX - breakdown of collagen
BONE FORMATION
serum P1NP - for patients being treated w/ teriparatide
secondary osteoporosis risk factors:
type 1 DM, premature menopause, hyperthyroidism, malnutrition, liver disease, osteogenesis imperfecta
what is WHO frax?
questionnaire that assesses osteoporosis risk (factors: gender, age, previous fracture, parental fracture, smoking etc.)
when is FRAX used?
when the patient previously fell into an intermediate or moderate risk zone and when other factors (i.e. glucocorticoid use, fragility fracture) weren’t present to drive treatment
NOT used when the patient has sustained a hip fracture, vertebral fractures, or has a qualifying T score
what are the 2 FRAX fracture risks calculated?
chance of major fracture (hip, wrist, humerus, or pelvis) in 10 years
chance of hip fracture risk in 10 years
what FRAX scores is treatment recommended for?
major fracture risk >20%
hip risk >3%
