osteoporosis

Question 1

what are fragility fractures

Answer 1

low impact or low trauma fractures that according to the WHO are caused by injury that would be insufficient to fracture normal bone.

Question 2

major risk factors for osteoporosis

Answer 2

“SHATTERED”
Steroid use >5mg of prednisolone
Hyperthyroidism, hyperparathyroidism, hypercalciuria
Alcohol and tobacco use
Thin (BMI<18.5)
Testosterone low
Eearly menopause
Renal or liver failure
Erosive/inflammatory bone disease (myeloma, RA)
Dietary low Ca/malabsorption/DM1

Question 3

definition of osteoporisis

Answer 3

a silent skeletal disorder characterized by compromised bone strenth predisposing to an increased risk of fracture

Question 4

bone strength reflects the integration of two main features:

Answer 4

bone density and bone quality

Question 5

DEXA bone densitometry: WHO osteoporosis critera

Answer 5

BMD=bone mineral density
T-score: number of standard deviation the BMD is from the youthful average

t-Score > 0 BMD is better than the reference

T-Score 0 to -1 BMD is normal

T-score between -1 and -2.5 osteopenia

T score -2.5 and below: osteoporosis

Question 6

role of estrogen deficiency in bone loss:

Answer 6

When a woman goes through menopause, her ovaries stop producing estrogen, leading to a decline in estrogen levels in the body. This decline in estrogen can lead to an increase in bone resorption, or the breakdown of bone tissue, which can result in a loss of bone density. This increased bone loss can make postmenopausal women more susceptible to osteoporosis, a condition characterized by weak and fragile bones. Estrogen replacement therapy is often used to help mitigate this bone loss by supplementing the body’s declining estrogen levels.

Question 7

approach to fracture prevention in people at risk

Answer 7

1. address lifestlye (diet, calcium , protein vitamin D intake, exercise, fall prevention, smoking, moderation of alcohol)
2. address secondary osteoporosis - diseases and drugs
3. consider drug treatment : antiresorptive or anabolic drugs

Question 8

who should undergo bone mineral density testing

Answer 8

all women 65 y and older
all postmenopausal women
risk factors
secondary osteoporosis

Question 9

some investigations for osteoporosis:

Answer 9

CBC
serum calcium
total alkaline phosphatase
serum creatinine
protein electrophoresis
TSH

Question 10

AACE and the Endocrine Society recommend serun 25(OH)D what value to define vitamin D sufficency

Answer 10

> =30ng/ml

Question 11

what pharmacological agents can be used for treatement of osteoporosis

Answer 11

biphosphonates
romosozumab
SERMS
calcitonin nasal spray
hormone therapy
parathyroid hormone

Question 12

non pharmacological options for osteoporosis

Answer 12

Calcium intake 1500 mg /day > 50 years
Vitamin D 800 IU (20mcg) / day > 50 years
Good intake of dietary protein
Reduction in caffeine intake
Reduction in sodium intake
Regular physical activity; aerobic and weight bearing >30 minutes at least 3X per week

Question 13

1st line therapy for the prevention and treatment of osteoporosis

Answer 13

biphosphonates

Question 14

important characteristics of biphosphonates

Answer 14

• inhibit bone resporption
• poorly absorbed, given on empty stomach with water
• renal excretion

Question 15

ICD-10 osteoporosis unspecified

Answer 15

M81.0

Question 16

NICE suggests DEXA to…

Answer 16

patients who had previous low-trauma fracture, or for women 65y old and older with one or more risk factors for osteoporosis, or younger if two or more.

The benefits of universal screening remain unproven.

Prior to giving long-term prednisolone

Men or Women with osteopoenia if low-trauma, nonvertebral fracture

Bone and bone-remoddeling disorders