osteoporosis

Question 1

what diseases are osteoporosis risks:

Answer 1

autoimmune disorders (i.e. RA)
multiple myeloma
DM
hyperparathyroidism
hyperthyroidism
Cushin’s
Celiac, IBD
breast and prostate CA
eating disorders

Question 2

some medicines that cause bone loss:

Answer 2

anti-seizure medications
diabetes meds (SLGT2 inhibitor)
steroids (glucocorticoids -cortisone, prednisone)
breast CA aromatase inhibitors

Question 3

indications for osteoporosis treatment:

Answer 3

low Z scores
very low T scores
not responding to prescriptions
multiple fractures

Question 4

age for peak bone mass?

Answer 4

30-35

Question 5

pattern of bone loss in glucocorticoid taking patients:

Answer 5

rapid bone loss in first 6 months and then gradual loss thereafter

Question 6

what are the 5 risk groups for osteoporosis?

Answer 6

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

Question 7

DEXA scan diagnostic criteria:

Answer 7

normal: -1 or greater
osteopenia: between -1 and -2.5
osteoporosis: -2.5 or less
severe osteoporosis: -2.5 or less and fragility fracture

Question 8

what is the NORA?

Answer 8

national osteoporosis risk assessment

study where post-menopausal women have their BMD measures and assess self-reported fractures over the next year

Question 9

types of DEXA scans:

Answer 9

lumbar spine (either L1-L4 or L2-L4)
hip
wrist

choose the weakest site (lowest/most negative T score) for analysis

Question 10

what does DEXA measure?

Answer 10

bone mineral density (BMD) in g/cm2

Question 11

what is the DEXA T score?

Answer 11

compares the patient’s BMD with the young normal mean BMD and expresses the difference as a standard deviation score

Question 12

what is a DEXA Z score?

Answer 12

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

Question 13

what is a low Z score typically indicative of?

Answer 13

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.

Question 14

biochemical markers for bone turnover:

Answer 14

BONE RESPORTION
serum CTX - breakdown of collagen

BONE FORMATION
serum P1NP - for patients being treated w/ teriparatide

Question 15

secondary osteoporosis risk factors:

Answer 15

type 1 DM, premature menopause, hyperthyroidism, malnutrition, liver disease, osteogenesis imperfecta

Question 16

what is WHO frax?

Answer 16

questionnaire that assesses osteoporosis risk (factors: gender, age, previous fracture, parental fracture, smoking etc.)

Question 17

when is FRAX used?

Answer 17

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

Question 18

what are the 2 FRAX fracture risks calculated?

Answer 18

chance of major fracture (hip, wrist, humerus, or pelvis) in 10 years

chance of hip fracture risk in 10 years

Question 19

what FRAX scores is treatment recommended for?

Answer 19

major fracture risk >20%
hip risk >3%