Osteoporosis

Question 1

What is metabolic bone disease

Answer 1

Any bone disorder resulting from chemical aberrations

Question 2

What are two examples of metabolic bone disease

Answer 2

Osteopenia
osteoporosis

Question 3

What determines the difference between osteopenia and osteoporosis

Answer 3

Severity of the bone disease

Question 4

What are the two different types of osteopenia & osteoporosis

Answer 4

Primary: post menopausal (most common)

Secondary: presence/ treatment of other disease

Question 5

Why are women at greater risk for developing osteopenia or osteoporosis

Answer 5

Hormones… estrogen plays a big role with bone density

Question 6

What other hormone disorders can lead to osteopenia / osteoporosis

Answer 6

Cushing
Thyroid disorder
Hyperparathyroidism
DM

Question 7

When is peak bone mass achieved

Answer 7

Around age 30

Question 8

Is osteoporosis / osteopenia a qualitative or quantitative disorder

Answer 8

Quantitative… the mechanism to make bone is working fine, just not making enough

Question 9

What does impaired bone mineralization lead to

Answer 9

osteomalacia

Question 10

What presentations may be seen with osteoporosis / osteopenia

Answer 10

Height loss
Kyphosis
*Compression fractures lead to both

Question 11

What is a fragility fracture

Answer 11

Any fracture that results from low energy

Question 12

What are the results from a DEXA scan

Answer 12

T score
Z score

Question 13

When is a T score used

Answer 13

Most patients

Question 14

When is a Z score used

Answer 14

pre-menopausal women
young males

Question 15

What T score indicated osteoporosis

Answer 15

< -2.5

Question 16

What T score indicates osteopenia

Answer 16

-1- -2.5

Question 17

If a patient has a T score less that -2.5 and has a fracture, what does this mean

Answer 17

severe osteoporosis

Question 18

How often does a patient need to follow up with a T score of -1 to -1.5

Answer 18

every 5 years

Question 19

How often does a patient need a follow up with a T score of -1.5 to -2

Answer 19

Every 3-5 years

Question 20

How often does a patient need to follow up with a T score under -2

Answer 20

Every 1-2 years

Question 21

What is the best measurement of a vitamin D deficiency and why

Answer 21

25-hydroxyvitamin D
(25(OH)D)

Measures active vitamin D

Question 22

What is the first line treatment for osteoporosis

Answer 22

Risk reduction and prevention

Question 23

Which patients are given pharmacological treatment for osteoporosis

Answer 23

T score less than -2.5

Osteopenic patients with a 10yr hip fracture risk of 3+%

Osteopenic patients with a 10yr major hip fx risk of 10+%

Any patient with a fragility fracture

Question 24

What are the pharmacological treatment options for osteoporosis

Answer 24

Vitamin D + calcium
Bisphosphonates
Denosumab
Teriperatide
SERMs
Calcitonin

Question 25

Why is Vitamin D + calcium given as an osteoporosis treatment

Answer 25

Adequate levels of both are required for optimal health and medication efficacy... give to ALL patients

Question 26

How much calcium can be absorbed at a time

Answer 26

500mg

Question 27

Why does calcium carbonate need to be taken with food and without any H2 receptors

Answer 27

Requires acid for absorption

Question 28

What is the first line pharmacological option for osteoporosis

Answer 28

Bisphosphonates

Question 29

What is the MOA for bisphosphonates

Answer 29

Inhibit bone resorption via osteoclasts

Question 30

What are some bisphosphonates that can be used

Answer 30

Alendronate Risedronate Zolendronate Ibandronate

Question 31

When is alendronate used

Answer 31

For non-vertebral fx

Question 32

When is ibandronate used

Answer 32

Prevention / treatment of post-menopausal osteoporosis

Question 33

Which patients will be given zolendronate

Answer 33

Those who can't tolerate PO medication

Question 34

What are some side effects of bisphosphonates

Answer 34

Erosive pharyngitis (oral) Osteonecrosis of the jaw (IV) Fever/chills/flushing (IV) Myalgias (IV)

Question 35

How should bisphosphonates be administered

Answer 35

Taken in the am with 8oz of water and 40min before food Remain upright

Question 36

Who do you need to be cautious with in regards to bisphosphonates

Answer 36

CrCl<35 Elderly, diabetics, CKD

Question 37

What is the MOA of denosumab

Answer 37

Inhibits osteoclast maturation (RANK L) inhibitor Reduces vertebral fx > hip fx

Question 38

Which patients is denosumab indicated in

Answer 38

High risk fx with breast CA, prostate CA, hormone deprivation tx

Question 39

What are the side effects of denosumab

Answer 39

Hypocalcemia Hypercholesterolemia Eczema/dermatitis Pancreatitis Osteonecrosis of the jaw

Question 40

What is Teriperatide and what is the MOA

Answer 40

PTH analog Decreases osteoblast apoptosis and promotes production of new bone matrix

Question 41

When is Teriperitide indicated

Answer 41

Treatment for osteoporosis and atypical fractures

Question 42

How long can teriperatide be given

Answer 42

2 years only

Question 43

What is the BBW of teriperatide

Answer 43

Increased risk of osteosarcoma

Question 44

Which patients should NOT be given teriperatide

Answer 44

Pagets Skeletally immature h/o sarcoma significant radiation

Question 45

How do SERMs work

Answer 45

Bind estrogen receptor (protective effects) Will reduce vertebral fx only

Question 46

What is the indication for SERMs

Answer 46

Prevention, not treatment Post-menopausal women

Question 47

What are example of SERMs

Answer 47

Tamoxifen Raloxifene

Question 48

When is tamoxifen indicated

Answer 48

After breast cancer treatment

Question 49

What are the side effects of SERMs

Answer 49

hot flashes thromboembolism reduced LDL reduced breast CA risk

Question 50

What is the MOA of calcitonin

Answer 50

Decrease bone resorption *inhilation

Question 51

What is the indication for calcitonin

Answer 51

Primarily for pain associated with vertebral compression fractures