Osteoporosis

Question 1

Definition of Osteoporosis
R>F

Answer 1

Bone Resorption > Bone Formation

Question 2

When is osteoporosis most prevalent in menopause

Answer 2

5-10 years after

Question 3

Fall from standing height with fracture

Answer 3

Osteoporotic Fracture

Question 4

Is osteoporosis curable?

Answer 4

NO

Question 5

3 hot spots for fracture bone (HSW)

Answer 5

Hip, Spine, Wrist

Question 6

High risk Factors (5)

Answer 6

1) Age >50
2) Females
3) Low Estrogen
4) Glucocorticoid Use
5)Prior osteoporotic fx

Question 7

Primary cause osteoporosis

Answer 7

1) Normal aging
2)postmenopausal

Question 8

What does having back pain have a increased risk of what fracture

Answer 8

Compression fracture

Question 9

Dowager Hump

Answer 9

Kyphosis Thoracic Spine
Height loss
Mobility
Palpate joints and spine (spinous and paraspinous area)

Question 10

What fracture is increased with Dowager Hump

Answer 10

Compression fractures

Question 11

Exophthalmos, lid lag, goiter, tremor, weight
loss, pretibial myxedema

Answer 11

Hyperthyroidism

Question 12

Dorsal fat, HTN, abdominal striae, central
obesity

Answer 12

Cushings

Question 13

Primary Osteoporosis Labs
Normal vs Deficient

Answer 13

NORMAL: Calcium and Phosphorous

Deficient: D Vitamin

Question 14

Secondary Osteoporosis

Answer 14

Serum Ca, PTH, TSH (those on hormone), 24-hour urine calcium, alkaline phosphokinase, testosterone in men

Question 16

Urinary N-Telopeptides, serum C-Telopeptides

Answer 16

Bone Resorption Markers

Question 18

Bone Density Test for who

Answer 18

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.

Question 19

Osteoporosis DEXA BMD Criteria (WHO)

Answer 19

Bone Mineral Density (BMD)

DEXA T-score < - 2.5

Question 20

NOS T score Spine or Hip

Answer 20

T score < -2.5

Question 21

NOS T score Vertebral, Proximal Humerus, Pelvic Fracture

Answer 21

T score -1 and -2.5

Question 22

T score

Answer 22

normally expected in a healthy young adult of the same sex

Question 23

Z score

Answer 23

someone of the same age, sex, weight, and ethnic origin

Question 24

Osteopenia T score

Answer 24

-1 to -2.5

Question 25

Osteoporosis T Score

Answer 25

> -2.5

Question 26

FRAX Tool

Answer 26

Probability having a fracture in next 10 years using BMD

Question 27

Vertebral Fracture Assessment

Answer 27

Lateral spine x ray & BMD Bone scan, CT, MRI, Bone biopsy

Question 28

NOF Vertebral Imaging Recommends

Answer 28

Current height compared to peak height during young adulthood

Question 29

Calcium intake how much mg >50 y/o

Answer 29

600-700 mg daily

Question 30

Vitamin D intake how much mg >50 y/o

Answer 30

800-1000 mg PO daily

Question 31

Bisphosphonate

Answer 31

Alendronate (Fosamax) Risedronate (Actonel) Zoledronic (Reclast) Ibandronate (Boniva) --> Women only

Question 32

Monoclonal antibody - dc bone resorption

Answer 32

Denosumab (Prolix) SC q 6 months

Question 33

How to take Bisphosphonates

Answer 33

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

Question 34

Bisphosphonate c/I GFR

Answer 34

GFR <30-35

Question 34

Bisphosphonate long term use

Answer 34

Osteonecrosis of jaw , Atypical femur fracture >5 years of treatment or high dose IV bis

Question 35

How long can you take Bisphosphonate Oral and IV (Zolendronic acid)

Answer 35

10 years oral 6 years IV Zoledronic acid

Question 36

When can you give calcitonin supplementation

Answer 36

>5 years postmenopausal (nasal and injectable)

Question 37

What increases BMD in early postmenopausal females

Answer 37

Miacalcin

Question 38

If you don't have hysterectomy, what do you need

Answer 38

Progestin to protect uterine lining

Question 39

Estrogen Agonist

Answer 39

Raloxifene (Evista) Prevent and tx osteoporosis

Question 40

Bone Anabolic Agents

Answer 40

For postmenopause and males high risk Abaloparatide (Tymlos) Terparatide (Forteo) --> use for 2 years

Question 41

Bone Anabolic Romosozumab who to avoid in

Answer 41

Avoid in MI or CVA in last year. s/e cardiac events

Question 42

What happen when you stop Rank Ligand Inhibitors Denosumab (Prolix)

Answer 42

Rapid bone loss occur and result in more fractures SC q 6 months

Question 43

Follow up osteoporosis

Answer 43

Annual checkup Labs and DEXA

Question 44

-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

Answer 44

Get vertebral imaging