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MSK clin Med > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is metabolic bone disease

A

Any bone disorder resulting from chemical aberrations

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2
Q

What are two examples of metabolic bone disease

A

Osteopenia
osteoporosis

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3
Q

What determines the difference between osteopenia and osteoporosis

A

Severity of the bone disease

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4
Q

What are the two different types of osteopenia & osteoporosis

A

Primary: post menopausal (most common)

Secondary: presence/ treatment of other disease

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5
Q

Why are women at greater risk for developing osteopenia or osteoporosis

A

Hormones… estrogen plays a big role with bone density

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6
Q

What other hormone disorders can lead to osteopenia / osteoporosis

A

Cushing
Thyroid disorder
Hyperparathyroidism
DM

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7
Q

When is peak bone mass achieved

A

Around age 30

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8
Q

Is osteoporosis / osteopenia a qualitative or quantitative disorder

A

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

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9
Q

What does impaired bone mineralization lead to

A

osteomalacia

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10
Q

What presentations may be seen with osteoporosis / osteopenia

A

Height loss
Kyphosis
*Compression fractures lead to both

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11
Q

What is a fragility fracture

A

Any fracture that results from low energy

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12
Q

What are the results from a DEXA scan

A

T score
Z score

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13
Q

When is a T score used

A

Most patients

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14
Q

When is a Z score used

A

pre-menopausal women
young males

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15
Q

What T score indicated osteoporosis

A

< -2.5

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16
Q

What T score indicates osteopenia

A

-1- -2.5

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17
Q

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

A

severe osteoporosis

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18
Q

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

A

every 5 years

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19
Q

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

A

Every 3-5 years

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20
Q

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

A

Every 1-2 years

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21
Q

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

A

25-hydroxyvitamin D
(25(OH)D)

Measures active vitamin D

22
Q

What is the first line treatment for osteoporosis

A

Risk reduction and prevention

23
Q

Which patients are given pharmacological treatment for osteoporosis

A

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

24
Q

What are the pharmacological treatment options for osteoporosis

A

Vitamin D + calcium
Bisphosphonates
Denosumab
Teriperatide
SERMs
Calcitonin

25
Q

Why is Vitamin D + calcium given as an osteoporosis treatment

A

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

26
Q

How much calcium can be absorbed at a time

A

500mg

27
Q

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

A

Requires acid for absorption

28
Q

What is the first line pharmacological option for osteoporosis

A

Bisphosphonates

29
Q

What is the MOA for bisphosphonates

A

Inhibit bone resorption via osteoclasts

30
Q

What are some bisphosphonates that can be used

A

Alendronate
Risedronate
Zolendronate
Ibandronate

31
Q

When is alendronate used

A

For non-vertebral fx

32
Q

When is ibandronate used

A

Prevention / treatment of post-menopausal osteoporosis

33
Q

Which patients will be given zolendronate

A

Those who can’t tolerate PO medication

34
Q

What are some side effects of bisphosphonates

A

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

35
Q

How should bisphosphonates be administered

A

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

Remain upright

36
Q

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

A

CrCl<35
Elderly, diabetics, CKD

37
Q

What is the MOA of denosumab

A

Inhibits osteoclast maturation (RANK L) inhibitor

Reduces vertebral fx > hip fx

38
Q

Which patients is denosumab indicated in

A

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

39
Q

What are the side effects of denosumab

A

Hypocalcemia
Hypercholesterolemia
Eczema/dermatitis
Pancreatitis
Osteonecrosis of the jaw

40
Q

What is Teriperatide and what is the MOA

A

PTH analog

Decreases osteoblast apoptosis and promotes production of new bone matrix

41
Q

When is Teriperitide indicated

A

Treatment for osteoporosis and atypical fractures

42
Q

How long can teriperatide be given

A

2 years only

43
Q

What is the BBW of teriperatide

A

Increased risk of osteosarcoma

44
Q

Which patients should NOT be given teriperatide

A

Pagets
Skeletally immature
h/o sarcoma
significant radiation

45
Q

How do SERMs work

A

Bind estrogen receptor (protective effects)

Will reduce vertebral fx only

46
Q

What is the indication for SERMs

A

Prevention, not treatment

Post-menopausal women

47
Q

What are example of SERMs

A

Tamoxifen
Raloxifene

48
Q

When is tamoxifen indicated

A

After breast cancer treatment

49
Q

What are the side effects of SERMs

A

hot flashes
thromboembolism
reduced LDL
reduced breast CA risk

50
Q

What is the MOA of calcitonin

A

Decrease bone resorption

*inhilation

51
Q

What is the indication for calcitonin

A

Primarily for pain associated with vertebral compression fractures

MSK clin Med (12 decks)

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