Osteoporosis Flashcards
Definition of Osteoporosis
R>F
Bone Resorption > Bone Formation
When is osteoporosis most prevalent in menopause
5-10 years after
Fall from standing height with fracture
Osteoporotic Fracture
Is osteoporosis curable?
NO
3 hot spots for fracture bone (HSW)
Hip, Spine, Wrist
High risk Factors (5)
1) Age >50
2) Females
3) Low Estrogen
4) Glucocorticoid Use
5)Prior osteoporotic fx
Primary cause osteoporosis
1) Normal aging
2)postmenopausal
What does having back pain have a increased risk of what fracture
Compression fracture
Dowager Hump
Kyphosis Thoracic Spine
Height loss
Mobility
Palpate joints and spine (spinous and paraspinous area)
What fracture is increased with Dowager Hump
Compression fractures
Exophthalmos, lid lag, goiter, tremor, weight
loss, pretibial myxedema
Hyperthyroidism
Dorsal fat, HTN, abdominal striae, central
obesity
Cushings
Primary Osteoporosis Labs
Normal vs Deficient
NORMAL: Calcium and Phosphorous
Deficient: D Vitamin
Secondary Osteoporosis
Serum Ca, PTH, TSH (those on hormone), 24-hour urine calcium, alkaline phosphokinase, testosterone in men
Urinary N-Telopeptides, serum C-Telopeptides
Bone Resorption Markers
Bone Density Test for who
Womanaged65orolder
* Managed70orolder
* Break a bone after age 50
* Woman of menopausal age with risk factors
* Postmenopausalwomanunderage65withriskfactors
* Managed50-69withriskfactors
* Adults with condition (RA) or taking a medications associated with bone loss.
Osteoporosis DEXA BMD Criteria (WHO)
Bone Mineral Density (BMD)
DEXA T-score < - 2.5
NOS T score Spine or Hip
T score < -2.5
NOS T score Vertebral, Proximal Humerus, Pelvic Fracture
T score -1 and -2.5
T score
normally expected in a healthy young adult of the same sex
Z score
someone of the same age, sex, weight, and ethnic origin
Osteopenia T score
-1 to -2.5
Osteoporosis T Score
> -2.5
FRAX Tool
Probability having a fracture in next 10 years using BMD
Vertebral Fracture Assessment
Lateral spine x ray & BMD
Bone scan, CT, MRI, Bone biopsy
NOF Vertebral Imaging Recommends
Current height compared to peak height during young adulthood
Calcium intake how much mg >50 y/o
600-700 mg daily
Vitamin D intake how much mg >50 y/o
800-1000 mg PO daily
Bisphosphonate
Alendronate (Fosamax)
Risedronate (Actonel)
Zoledronic (Reclast)
Ibandronate (Boniva) –> Women only
Monoclonal antibody - dc bone resorption
Denosumab (Prolix)
SC q 6 months
How to take Bisphosphonates
Take on empty stomach 30 minutes before food/drink and don’t eat 30 minutes after
Swallow with full glass of water 6-8 oz
Don’t lie down for 30 minutes
Bisphosphonate c/I GFR
GFR <30-35
Bisphosphonate long term use
Osteonecrosis of jaw , Atypical femur fracture
>5 years of treatment or high dose IV bis
How long can you take Bisphosphonate Oral and IV (Zolendronic acid)
10 years oral
6 years IV Zoledronic acid
When can you give calcitonin supplementation
> 5 years postmenopausal (nasal and injectable)
What increases BMD in early postmenopausal females
Miacalcin
If you don’t have hysterectomy, what do you need
Progestin to protect uterine lining
Estrogen Agonist
Raloxifene (Evista)
Prevent and tx osteoporosis
Bone Anabolic Agents
For postmenopause and males high risk
Abaloparatide (Tymlos)
Terparatide (Forteo) –> use for 2 years
Bone Anabolic Romosozumab who to avoid in
Avoid in MI or CVA in last year. s/e cardiac events
What happen when you stop Rank Ligand Inhibitors Denosumab (Prolix)
Rapid bone loss occur and result in more fractures SC q 6 months
Follow up osteoporosis
Annual checkup
Labs and DEXA
-height loss,
– new back pain,
– postural change or suspicious finding on chest x-ray,
following the last (or first) vertebral imaging test
– patients being considered for a temporary cessation of
drug therapy to make sure no new vertebral fractures
Get vertebral imaging
