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54 MSK > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Significant causes for decrease in bone mass

A
  1. Age
  2. Menopause
  3. Alcohol consumption
  4. Smoking
  5. Medication use
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2
Q

What drugs can cause osteoporosis?

A
  1. Glucocorticoids
  2. Immunosuppressants
  3. Anti-seizure medications
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3
Q

Clinical presentation of osteoporosis

A
  • Asymptomatic
  • Undiagnosed until presented with fragility fracture
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4
Q

Common sites of fragility fracture

A
  1. Spine (vertebral compression: height loss, kyphosis)
  2. Hip (neck of femur, intertronchanteric)
  3. Wrist
  4. Humerus
  5. Pelvis
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5
Q

Goals of treatment

A
  1. Prevent fracture
  2. Improve QoL
  3. Reduce economic burden
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6
Q

Who are considered for BMD screening?

A
  1. Post-menopausal women
  2. Men >65 years old
    Especially if risk factors are present
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7
Q

What tool can be used to detect women’s osteoporosis risk?

A

OSTA = age in years - weight in kg

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8
Q

In OSTA, what is considered high risk?

A

> 20 → consider DXA

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9
Q

In OSTA, what is considered medium risk?

A

0-20 → consider DXA if any other risk factors present

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10
Q

How is osteoporosis diagnosed?

A
  1. History of fragility fracture
    OR
  2. BMD measurement using DXA
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11
Q

What does BMD T-score compare against?

A

Young adult reference population

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12
Q

What dose BMD Z-score compare against?

A

Expected BMD for patient’s age and sex

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13
Q

What is the significance of BMD Z-score ≥ -2?

A

Coexisting problems (e.g. alcoholism, GC therapy) that can contribute to osteoporosis

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14
Q

What BMD score represents osteoporosis?

A

T-score ≤ -2.5 SD

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15
Q

What BMD score represents osteopenia?

A

T-score -1 to -2.5 SD

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16
Q

What BMD score represents normal bone density?

A

T-score ≥ -1 SD

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17
Q

Risk factors for BMD screening

A
  1. Family history of osteoporosis or fragility fracture
  2. Previous fragility fracture
  3. Ageing
  4. Low body weight
  5. Height loss (>2cm within 3 years)
  6. Early menopause
  7. Medications
  8. Smoking
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18
Q

Clinical risk factors for FRAX

A
  1. Age
  2. Sex
  3. Weight
  4. Height
  5. Previous fracture
  6. Parent fractured hip
  7. Current smoking
  8. Glucocorticoids (current or >3 months PO Prednisolone >5mg OD)
  9. RA
  10. Secondary osteoporosis
  11. Alcohol 3 or more units/day
  12. BMD
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19
Q

What drug class is Alendronate

A

Bisphophonates

20
Q

What drug class is Zoledronic acid

A

Bisphophonates (IV)

21
Q

What drug class is Raloxifene

22
Q

What drug class is Denosumab

23
Q

What drug class is Risedronate

A

Bisphophonates

24
Q

What drug class is Teriparatide

A

Recombinant PTH (SQ)

25
What drug class is Romosozumab
Sclerostin Inhibitor (SC)
26
Contraindications of bisphophonate
1. CrCl <35ml/min 2. Hypocalcemia 3. Oesophagel or gastric abnormality 4. Unable to sit upright for >30min 5. Aspiration risk
27
Dosing of Alendronate
70mg every week
28
Treatment duration for low risk fracture for bisphosphonates
PO: 5 years IV: 3 years
29
Dosing of Riserdronate
35mg every week
30
SE/Safety of bisphosphonates
ONJ Atypical femoral fracture
31
Which other drug classes have same SE/safety concern as bisphosphonates?
Romosozumab Denosumab
32
Dosing of Romosozumab (SC)
Once a month for 1 year
33
Dosing of Denosumab
Every 6 months
34
CI of Teriparatide
1. CrCl <30ml//min 2. Paget's disease/history of bone radiation 3. Hypercalcemia
35
SE of Teriparatide
Postural hypotension
36
Treatment duration of Teriparatide
<2 years
37
CI of Denosumab
Hypocalcemia
38
CI of Raloxifene
1. CrCl<30ml/min 2. History/current VTE 3. Hepatic/renal impairment
39
What labs should be done prior to starting pharmacological treatment?
1. Serum calcium 2. Serum 25(OH) VItamin D (20-30ng/ml < 50 -100ng/ml)
40
Treatment monitoring
1. SCr 2. Serum calcium 3. Serum 24(OH) vitamin D
41
Fracture prevention
1. Exercise (weight bearing - 30min daily, muscle strengthening & balance 2-3x weekly) 2. Smoking cessation 3. Limit caffeine intake 4. Limit alcohol intake 5. Reduce risk for falls 6. Ensure adequate calcium intake 7. Maintain Vitamin D status (800IU/day cholecalciferol for those at risk of Vit D insufficiency)
42
MOA of bisphosphonates
Slow bone loss by increasing osteoclast cell death
43
MOA of sclerotin inhibitor
Removes sclerotin inhibition of the canonical Wet signalling pathway that regulates bone growth
44
MOA of PTH therapies
Stimulate new bone formation and increase bone strength
45
MOA of RANKL inhibitor
Prevents development of osteoclasts

54 MSK (6 decks)

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