Osteoporosis

Question 1

Gender and Bone Mass: Stats

Answer 1

-women experience greater bone loss in early postmenopausal years (continues at a gradual rate)
-women have lower peak density (these factors combine so women reach “fracture threshold” earlier than men)
-men lose about a 1/3 less bone mass compared to women over a life time
-in women, at around age 30: bone reabsorbed by osteoclasts > bone formed by osteoblasts

Question 2

Osteoporosis: Definition

Answer 2

bone mineral density that is 2.5 standard deviations below peak bone mass

Question 3

How do you measure bone mineral density?

Answer 3

DEXA scan
Results reported in a T-score

Question 4

Classification for Normal Bone Mineral Density

Answer 4

normal
T-score is -1 or greater

Question 5

Classification for Osteopenia

Answer 5

low bone mass (“poor bone”)
T-score is between -1 and -2.5

Question 6

Classification for Osteoporosis

Answer 6

literally means “porous bone”
T-score is ≤ -2.5

Question 7

Classification for Severe Osteoporosis

Answer 7

osteoporosis WITH a history of a fragility fracture
T-score is ≤ -2.5

Question 8

Osteopenia: Definition

Answer 8

thinning of the trabecular matrix of the bone before osteoporosis
T-score between -1 and -2.5

Question 9

Osteoporosis: Definition

Answer 9

“porous bone”
characterized by: low bone density and structural deterioration of the bone
-usually bones in the
hips, vertebrae, and
wrists (trabecular
bones)
osteoporosis is used when ACTUAL BREAKS in trabecular matrix have occurred
common, serious disease

Question 10

Osteoporosis: Characteristics (4)

Answer 10

-low bone mass
-micro-architectural deterioration
-increase in bone fragility
-susceptibility to fracture high

Question 11

Osteoporosis: Major Risk Factors (9)

Answer 11

-aging
-female (esp. postmenopausal)
-Caucasian
-history of fracture as adult
-family history
-body weight < 127lbs
-smoking
-alcohol use
-long-term corticosteroid therapy & immunosuppressive drugs

Question 12

Osteoporosis: Minor Risk Factors (7)

Answer 12

-thin, small frame
-lack of weight bearing exercises
-lack of Ca and/or Vitamin D
-eating disorders
-gastric bypass surgery
-lack of estrogen/testosterone
-excessive caffeine consumption

Question 13

Osteoclasts have the function to _____________

Answer 13

disrupt the old bone tissue

Question 14

A hyperactivity of osteoclasts is one of the causes of __________

Answer 14

of the onset of osteoporosis

Question 15

Osteoblasts have the function to ____________

Answer 15

produce new bone tissue

Question 16

A proper balance between osteoclasts and osteoblasts is the basis for _______________

Answer 16

a normal bone density

Question 17

Osteoporosis: Pathogenesis

Answer 17

increased bone reabsorption (osteoclast activity increased); decrease bone formations (osteoblast activity decreased);
-problem can be: failure to make new bone (osteoblasts); too much bone reabsorption (osteoclasts); or both

Question 18

Osteoporosis: Early CM

Answer 18

NONE

Question 19

Osteoporosis: Late CM (4)

Answer 19

fractures
pain
loss of height
stooped posture (Kyphosis)

Question 20

Osteoporosis: Complication

Answer 20

Hip fracture
-osteoporotic hip fractures linked to increased risk of mortality (2.8-4x GREATER RISK of death)
-more common in those greater than 65
-more common in women
-most common location: proximal third of the femur

Question 21

Hip Fracture: Clinical Presentation (5)

Answer 21

-sudden onset of hip pain before OR after a FALL
-inability to walk
-severe groin pain
-tenderness
-affected leg is externally rotated and shortened

Question 22

Osteoporosis: Pharmacotherapy: Goal, Prevention, & Treatment

Answer 22

Goal: reduce fractures
Primary prevention:
-Ca (diet and
supplement- 1200 to
2000mg/day)
-Vitamin D (diet and
supplement- 800 to
1000 IU/day)
Treatment:
-promote bone
formation
-decrease bone
reabsorption (MOST
common)

Question 23

Osteoporosis: Classes of Pharm (3)

Answer 23

biphosphonates
selective estrogen receptor modulators
hormone therapy: Calcitonin

Question 24

Aldendronate (Fosamax): Indication, Class, and MOA

Answer 24

-osteoporosis
-reduces fractures by 50
-biphosphonate
-binds permanently to surfaces of bones to inhibit osteoclast activity

Question 25

Aldendronate (Fosamax): AE and Teaching Points

Answer 25

AE: GI common (N/V/D), esophageal ulcers
Teaching:
-DON’T lie down for 30 minutes after taking for risk of ulcers
-Take with water
-DO NOT take with food, other drinks, Ca or Vitamins for 2 hours (VERY low bioavailability

Question 26

Raloxifene (Evista): Indication, Class, MOA

Answer 26

osteoporosis: used as prevention and treatment
-reduces risk of spinal
fractures by 50%
-selective estrogen receptor modulator (SERMs)
-mimics estrogen by increasing bone density, inhibits bone reabsorption

Question 27

Raloxifene (Evista): AE and Teaching Points

Answer 27

AE: hot flashes, leg cramping
BLACK BOX warning: stroke risk
Teaching:
-MUST TAKE adequate Ca and Vitamin D replacement TO WORK
-discontinue at least 72 hours before planned procedures
-any prolonged
immobilization periods
-high risk of blood
clotting
-DO NOT smoke or drink alcohol
-DO NOT use if pregnant

Question 28

Calcitonin-Salmon (Miacalcin)

Answer 28

osteoporosis: treatment only, can help with pain
-reduces spinal fractures
by 30% (must take for at
least 5 years to see long
term benefit)
MOA: inhibits bone removal by osteoclasts

slows done bone loss and increases spinal bone density
typically given intranasal, can cause nasal irritation