Osteoporosis Flashcards
how does osteoporosis occur?
rate of bone resorption becomes greater than rate of bone formation = net bone loss
osteoporosis is most commonly a result of what? (3)
increased age
menopause
metabolic abnormalities
what are 5 causes of secondary osteoporosis?
long-term glucocorticoid use
long-term thyroid replacement
anticonvulsant meds
smoking cigarettes
excessive alcohol use
what are the 3 most common areas where patients with osteoporosis have fractures?
wrist
hip
vertebra
at what age do wrist fractures most commonly occur?
50-60 years
at what age do vertebral fractures most commonly occur?
60-70 years
at what age do hip fractures most commonly occur?
70-80 years
at what age does the body build less new bone to replace the loss of old bone?
after 35 years
at what age should screening begin in women?
over 50 years old
how is the diagnosis of osteoporosis most often made?
through low impact/spontaneous fractures
what deformity is associated with fragility fractures of the vertebral bone?
kyphotic spine
what is the most accurate imaging with the least radiation exposure, used to provide information about bone strength and risk of fracture?
DEXA scan
DEXA scan score that compares bone density with that of a healthy young adult
T score
DEXA scan score that compares bone density with that of other people your age
Z score
what T score is normal?
above -1
what T score is considered osteopenia?
between -1 and -2.5
what T score is considered osteoporosis?
-2.5 or below
a fracture where means osteoporosis regardless of T score? (2)
spinal/hip fracture
when should women get a bone density test? (2)
age 65 or older
50-64 if + risk factors
when should men get a bone density test? (2)
age 70 or older
50-69 if + risk factors
what is the treatment of osteoporosis based on?
total fracture risk
what is the key to bone density and strength?
calcium
what is the 1st line therapy for osteoporosis?
bisphosphonates
decrease osteoclastic bone resorption and increase osteoclast apoptosis
what is the length of bisphosphonate treatment?
3-5 years
drug holiday for 1 year
which bisphosphonate is used for spine only?
ibandronate
what are 2 rare side effects of bisphosphonates?
atypical femoral fractures (long-term use)
osteonecrosis of the jaw (frequent infusion)
a patient presents with prodromal pain and localized periosteal or cortical thickening of the cortex that looks like “beaking”. Dx?
atypical femoral fracture d/t bisphosphonates
what is a 2nd line treatment for osteoporosis that stimulates formation of new bone leading to increased BMD and decreases vertebral and nonvertebral fractures?
teriparatide (injection)
what is a ADR of teriparatide?
osteosarcoma (over 2 year use)
