Osteoporosis Flashcards
What is the definition of osteopenia?
Post menopausal women and men older than 50 with a DEXA/BMD testing of T score -1 to -2.5.
How can osteoporosis be defined by using BMD testing?
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.
What if hip or spine cannot be accurately measured?
DEXA of the distal third of the radius can be used
What is the clinical diagnosis of osteoporosis?
Based on the presence of fragility fractures, especially in the hip or vertebral compression fracture
How can osteoporosis diagnosis happen for pre-menopausal women and men under 50?
By fragility fracture and low bone mass on DEXA, define by Z score less than -2
What can be used to screen for osteoporosis other than central DEXA?
Quantitative, calcaneal ultrasonosonography or peripheral DEXA, however abnormal results require confirmation by central DEXA
What is the benefit of using quantitative CT which provides an equivalent DEXA T score? What are the drawbacks?
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
What organization recommend pharmacologic treatment for osteoporosis?
The US national osteoporosis foundation
Foundation recommends pharmacologic treatment for which patients?
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
When pharmacotherapy be used for prevention of BMD?
Post menopausal women at risk of osteoporosis and
Prevent or treat glucocorticoid-induced osteoporosis
What Oral Bisphosphonates are the first line treatments for osteoporosis in postmenopausal and men older than 50?
Alendronate and Risesronate
What osteoporosis prevention can be given to GIO patients?
Risesronate, Zoledronic acid IV, Denosumab
What are the indications of giving intervenous Zoledronic acid? What is the frequency?
If the patient has upper G.I. symptoms, or any difficulty taking oral Bisphosphonates; once annually
zoledronic acid given every 18 months for six years can reduce what risk and women?
Vertebral, and non-vertebral fracture in women with osteopenia
What are the contraindications for using bisphosphonates?
GFR less than 35… and should not be given until vitamin D deficiency and hypocalcemia are treated, if present
What are the rare adverse effects of anti-resorptive agents?
Osteonecrosis of the jaw and atypical femur fracture
What are the pattern of anti-resorptive agent side effects?
 Osteonecrosis of the jaw can happen at any point in therapy. A typical femur fracture appears to increase with duration of therapy.
How can you prevent the adverse effects of anti-resorptive agents?
Drug holiday after three years if I V, and after five years if oral
What should be supplemented in Osseo porosis patients?
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
Describe Denosumab?
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
When is Dunas in a preferred in patient?
Patients with stage 4 chronic kidney disease, and those who are intolerant or incompletely responding to bisphosphonate therapy
What are the adverse effects of Denosumab?
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
Anabolic agents such as teriparatide, stimulate bone formation by mimicking what hormone? What are these agents used for?
Recombinant human PTH; high risk for fracture postmenopausal, and GIO patients.
Also, for men with primary or hypergonadism related osteoporosis, who are high risk .
What is the route of administration for anabolic agents? What is the duration limit for this treatment?
 Daily subtitaneous injections; two years
