Osteoporosis

Question 1

What is the definition of osteopenia?

Answer 1

Post menopausal women and men older than 50 with a DEXA/BMD testing of T score -1 to -2.5.

Question 2

How can osteoporosis be defined by using BMD testing?

Answer 2

Without secondary causes, it can be diagnosed when femur neck, total hip or composite lumbar vertebrae parentheses to or more vertebrae) he has a T score that is -2.5 or less.

Question 3

What if hip or spine cannot be accurately measured?

Answer 3

DEXA of the distal third of the radius can be used

Question 4

What is the clinical diagnosis of osteoporosis?

Answer 4

Based on the presence of fragility fractures, especially in the hip or vertebral compression fracture

Question 5

How can osteoporosis diagnosis happen for pre-menopausal women and men under 50?

Answer 5

By fragility fracture and low bone mass on DEXA, define by Z score less than -2

Question 6

What can be used to screen for osteoporosis other than central DEXA?

Answer 6

Quantitative, calcaneal ultrasonosonography or peripheral DEXA, however abnormal results require confirmation by central DEXA

Question 7

What is the benefit of using quantitative CT which provides an equivalent DEXA T score? What are the drawbacks?

Answer 7

It’s not hindered by degenerative changes in the lumbar spine, and is highly sensitive for vertebral compression fractures; cost and radiation exposure are much greater

Question 8

What organization recommend pharmacologic treatment for osteoporosis?

Answer 8

The US national osteoporosis foundation

Question 9

Foundation recommends pharmacologic treatment for which patients?

Answer 9

Osteoporosis related hip or spine fracture
BMD T score of -2.5 or less.
BMD T-score between -1 and -2.5 and a 10 year risk for hip fracture of 3% or greater, Or risk for major osteoporosis related fracture of 20% or greater as estimated by FRAX

Question 10

When pharmacotherapy be used for prevention of BMD?

Answer 10

Post menopausal women at risk of osteoporosis and
Prevent or treat glucocorticoid-induced osteoporosis

Question 11

What Oral Bisphosphonates are the first line treatments for osteoporosis in postmenopausal and men older than 50?

Answer 11

Alendronate and Risesronate

Question 12

What osteoporosis prevention can be given to GIO patients?

Answer 12

Risesronate, Zoledronic acid IV, Denosumab

Question 13

What are the indications of giving intervenous Zoledronic acid? What is the frequency?

Answer 13

If the patient has upper G.I. symptoms, or any difficulty taking oral Bisphosphonates; once annually

Question 14

zoledronic acid given every 18 months for six years can reduce what risk and women?

Answer 14

Vertebral, and non-vertebral fracture in women with osteopenia

Question 15

What are the contraindications for using bisphosphonates?

Answer 15

GFR less than 35… and should not be given until vitamin D deficiency and hypocalcemia are treated, if present

Question 16

What are the rare adverse effects of anti-resorptive agents?

Answer 16

Osteonecrosis of the jaw and atypical femur fracture

Question 17

What are the pattern of anti-resorptive agent side effects?

Answer 17

 Osteonecrosis of the jaw can happen at any point in therapy. A typical femur fracture appears to increase with duration of therapy.

Question 18

How can you prevent the adverse effects of anti-resorptive agents?

Answer 18

Drug holiday after three years if I V, and after five years if oral

Question 19

What should be supplemented in Osseo porosis patients?

Answer 19

National Academy of medicine recommends calcium intake of 1000 to 1200 mg per day ideally from dietary sources
Vitamin D supplement of 1000 IU per day is appropriate for osteoporosis care

Question 20

Describe Denosumab?

Answer 20

Receptor activator of nuclear factor, KB Ligon inhibitors. Monoclonal antibody that inhibits osteoclast activation. Inhibits bone resortption, increases bone density, reduces the incidence of osteoporotic fractures

Question 21

When is Dunas in a preferred in patient?

Answer 21

Patients with stage 4 chronic kidney disease, and those who are intolerant or incompletely responding to bisphosphonate therapy

Question 22

What are the adverse effects of Denosumab?

Answer 22

Hypocalcemia, especially in older patients with vitamin D, deficiency, or CKD.
Increase rate of cellulitis and bronchitis .
Medication related osteonecrosis, and a typical femur fracture

Question 23

Anabolic agents such as teriparatide, stimulate bone formation by mimicking what hormone? What are these agents used for?

Answer 23

Recombinant human PTH; high risk for fracture postmenopausal, and GIO patients.
Also, for men with primary or hypergonadism related osteoporosis, who are high risk .

Question 24

What is the route of administration for anabolic agents? What is the duration limit for this treatment?

Answer 24

 Daily subtitaneous injections; two years

Question 25

What should be done to prevent loss of newly formed bone after anabolic treatment

Answer 25

Sequential therapy of anti-resorptive agents one month after completing the anabiotic treatment course

Question 26

What are the nonpharmacologic management for osteoporotic patients?

Answer 26

Weight, bearing, resistance, and balance exercising