Osteoporosis

Question 1

What is a fragility fracture? What age with osteoporosis are we worried?

Answer 1

a fracture that wouldnt damage a normal bone
>40 years with osteoporosis

Question 2

Where do fragility fractures happen?

Answer 2

hip, vertebra, humerus and forearm

Question 3

Which gender gets more osteoporosis? Which get more fractures?

Answer 3

1. Women
2. Men

Question 4

What are the two types of bone and distinguish between them?

Answer 4

Cortical- most, dense outer shell
Cancellous (trabecular)- 20%, porous, internal

Question 5

What are the 3 types of bone cells?

Answer 5

Osteoblast- build bone
Osteoclast- resorb bone
Osteocyte= mineralize

Question 6

What is the role of PTH and calcitonin?

Answer 6

PTH- resorb Ca and phosphate
Calcitonin- excrete it

Question 7

Where is calcitonin made?

Answer 7

parafollicular cells in thyroid

Question 8

What happens to bone cells as we age?

Answer 8

cytes die and the mineralization gets weaker

Question 9

When does bone mass peak?

Answer 9

age 30

Question 10

What is the most common fracture?

Answer 10

vertebral

Question 11

What risk factors put you at risk of Osteoporosis?

Answer 11

White/Asian
Calcium intake
menopause
sex
Small
Underweight

Question 12

True or false Obese patients are more at risk of osteoporosis than underweight?

Answer 12

False- weight bearing= good

Question 13

How long does it take to fully remodel the skeleton?

Answer 13

10 years

Question 14

What medical conditions can cause osteoporosis?

Answer 14

Hyper parathyroid
Hyper thyroid
Cushings
menopause
chronic inflammatory diseases-RA

Question 15

What drugs are we concerned about causing osteoporosis?

Answer 15

Anticoags
Antidepressants- lower blast activity
antiepileptics

Question 16

Which anticoag is worse for osteoporosis?

Answer 16

heparin

Question 17

How does PPIs effect osteoporosis?

Answer 17

lower Ca absorption

Question 18

When is a corticosteroid causing bone issues?

Answer 18

> 3months of 7.5 mg/day

Question 19

What are symptoms of osteoporosis?

Answer 19

asymptomatic until fracture

Question 20

How can you diagnose Osteoporosis?

Answer 20

Vertebral compression fracture, hip fracture, or >1 fragility fracture over 50 years

Question 21

WHht BMD score says osteoporosis vs osteopenia?

Answer 21

OP- <-2.5
osteopenia- -1 to - 2.5

Question 22

Who should be screened?

Answer 22

> 50 years

Question 23

What is significant weight loss?

Answer 23

> 10 % since age 25

Question 24

What height loss both historic and recent is indicative?

Answer 24

H->6 cm
R- >2 cm

Question 25

What is bad rib to pelvis distance?

Answer 25

< 2 fingers

Question 26

When is DXA not reliable for diagnosis?

Answer 26

< 50 years

Question 27

When do you use T score and Z score with DXA?

Answer 27

T- >50 Z<50

Question 28

When should you do a BMD testing?

Answer 28

>50 IF previous fracture or >2 risk factors >65 if 1 risk factor >70

Question 29

What is incorporated in a CAROC?

Answer 29

age, sex and t score at femoral neck

Question 30

For CAROC, which gender sees a sharp increase in risk with age?

Answer 30

women

Question 31

What are the caveats for fracture risk tools?

Answer 31

Cant monitor therapy risk for Treatment NAIVE no for <50

Question 32

How often should you repeat BMD for each fracture risk?

Answer 32

>15= 3 years 10-15= 5 years <10= 10 years

Question 33

What lifestyle modifications can we do?

Answer 33

exercise, smoke cessation reduce alcohol

Question 34

How does exercise help? How much exercise?

Answer 34

stims blasts > 2x weekly

Question 35

What are functional exercises?

Answer 35

improve daily tasks

Question 36

Is impact exercise good?

Answer 36

Yes if SAFE

Question 37

True or false: quitting smoking allows BMD to return

Answer 37

True

Question 38

What is calcium intake amounts for the years?

Answer 38

Men 50-70= 1000 mg Men >70 = 1200 mg Women >50= 1200mg

Question 39

What are the calcium supplements and their percentages?

Answer 39

Carbonate= 40 Citrate= 21 Lactate= 13 gluconate= 9

Question 40

What is the issue with bone meal as a supplement?

Answer 40

contaminants

Question 41

When would we use citrate?

Answer 41

if on PPI or super old

Question 42

When is safety an issue with calcium?

Answer 42

> 2000 mg/ day

Question 43

How can we estimate calcium intake?

Answer 43

Give 300 mg to each source then another 300 if dairy

Question 44

How much to supplement vitamin D?

Answer 44

everyone 400 IU

Question 45

Which version of vitamin D is preferred?

Answer 45

D3-cholcalciferol

Question 46

What food is high in vitamin D?

Answer 46

fatty fish, eggs, fortified food

Question 47

When would we monitor Vitamin D? What values indicate, toxicity, deficiency, and adequate?

Answer 47

if need HIGH doses toxic >125 Adequate >50 Low= <30

Question 48

What is first line for osteoporosis?

Answer 48

bisphosphanates

Question 49

How does bisphosphonates work?

Answer 49

halts decline by stoping clasts and killing them

Question 50

What are the bisphosphonates?

Answer 50

'dronates' zoledronic acid- IV

Question 51

When can we get EDS for the bisphosphonates?

Answer 51

risk greater than 20% or due to to fragility fracture or CS

Question 52

When is zoledronic acid covered?

Answer 52

unable to take oral 2 of: >75 fracture or score <-2.5

Question 53

What is the dosing for dronates?

Answer 53

daily, weekly or monthly

Question 54

How often is zoledronic acid?

Answer 54

yearly

Question 55

How should you take the dronates?

Answer 55

NOT NEAR OTHER MEDS 30 min before food and upright for 30 min

Question 56

When do we see benefit with dronates?

Answer 56

years

Question 57

S/e of dronates?

Answer 57

Gi, osteonecrosis of jaw, femur fracture

Question 58

How can we fix Gi/ esophagus side effects of dronates?

Answer 58

upright for 30 min

Question 59

Who generally gets osteonecrosis of jaw?

Answer 59

cancer, immunosuppressed, high doses, smokers

Question 60

If a patient wants to become pregnant but is on a dronate what do they do?

Answer 60

need to be off it for 1 year because lasting effects

Question 61

How long do patients go on dronates for?

Answer 61

3-6 years

Question 62

How does denosumab work?

Answer 62

stops RANKL and stops clasts activation

Question 63

When is denosumab covered?

Answer 63

if fail on bisphosphonates

Question 64

When do you see benefit and how long are you on denosumab?

Answer 64

1 month indefinite

Question 65

True or false: Denosumab benefits lasts after d/c

Answer 65

False

Question 66

At what renal is denosumab not indicated?

Answer 66

<30

Question 67

S/e of denosumab?

Answer 67

well tolerate but same as dronates REBOUND FRACTURES THO

Question 68

How do we limit rebound fractures with denosumab?

Answer 68

if stopping put on dronate for 6 months

Question 69

How does raloxifene work? Who is it for?

Answer 69

a SERM to decrease bone resorb 3rd line for prevention for postmenopausal

Question 70

What is duration of raloxifene?

Answer 70

lifelong

Question 71

S/E of raloxifene?

Answer 71

flushing, flu like, edema, VTE, stroke

Question 72

What drug interaction with raloxifene are we worried about?

Answer 72

Levothyroxine

Question 73

What is the efficacy for raloxifene?

Answer 73

Not as good useless for pre menopausal

Question 74

What role is there for HRT? What happens after d/c?

Answer 74

with persistant menopausal symptoms loss accelerates

Question 75

S/E of HRT?

Answer 75

VTE risk and stoke, cancer

Question 76

Efficacy of teriparatide? What is role?

Answer 76

VERY potent only for highest risk

Question 77

MOA of teriparatide?

Answer 77

stims osteoblast

Question 78

WHat drug options are SC?

Answer 78

Teriparatide romosozumab

Question 79

What options are IV?

Answer 79

Zaledronic acid

Question 80

S/E of teriparatide?

Answer 80

hypercalcemia, renal stones, Gi, hypotension

Question 81

Efficacy of romosozumab and role ?

Answer 81

more potent highest risk

Question 82

MOA of romosozumab?

Answer 82

Mab against sclerostin= stops the inhibitory agent that stops bone formation

Question 83

An issue with the potent agents is that after d/c you lose the benefits. How can we fix this?

Answer 83

add dronate to maintain

Question 84

What are the benefits of combo therpay?

Answer 84

better for BMD no impact on fractures

Question 85

What combos is actually bad for you?

Answer 85

estrogen and dronates= atypical fracture increase

Question 86

What is considered treatment failure?

Answer 86

decreasing BMD or fractures despite adherence and adequate therapy for 1 year

Question 87

How often should you follow up with people on therapy for osteoporosis?

Answer 87

every 3 years

Question 88

If a patient has a fracture while on dronates what is the play?

Answer 88

nothing only small delay in healing

Question 89

If a patient has a fracture and is not on dronate what is the play?

Answer 89

start 2-12 weeks post fracture

Question 90

WHat do you do if a patient has an atypical femur fracture while on dronates?

Answer 90

d/c