Osteoporosis

Question 1

how does osteoporosis occur?

Answer 1

rate of bone resorption becomes greater than rate of bone formation = net bone loss

Question 2

osteoporosis is most commonly a result of what? (3)

Answer 2

increased age
menopause
metabolic abnormalities

Question 3

what are 5 causes of secondary osteoporosis?

Answer 3

long-term glucocorticoid use
long-term thyroid replacement
anticonvulsant meds
smoking cigarettes
excessive alcohol use

Question 4

what are the 3 most common areas where patients with osteoporosis have fractures?

Answer 4

wrist
hip
vertebra

Question 5

at what age do wrist fractures most commonly occur?

Answer 5

50-60 years

Question 6

at what age do vertebral fractures most commonly occur?

Answer 6

60-70 years

Question 7

at what age do hip fractures most commonly occur?

Answer 7

70-80 years

Question 8

at what age does the body build less new bone to replace the loss of old bone?

Answer 8

after 35 years

Question 9

at what age should screening begin in women?

Answer 9

over 50 years old

Question 10

how is the diagnosis of osteoporosis most often made?

Answer 10

through low impact/spontaneous fractures

Question 11

what deformity is associated with fragility fractures of the vertebral bone?

Answer 11

kyphotic spine

Question 12

what is the most accurate imaging with the least radiation exposure, used to provide information about bone strength and risk of fracture?

Answer 12

DEXA scan

Question 13

DEXA scan score that compares bone density with that of a healthy young adult

Answer 13

T score

Question 14

DEXA scan score that compares bone density with that of other people your age

Answer 14

Z score

Question 15

what T score is normal?

Answer 15

above -1

Question 16

what T score is considered osteopenia?

Answer 16

between -1 and -2.5

Question 17

what T score is considered osteoporosis?

Answer 17

-2.5 or below

Question 18

a fracture where means osteoporosis regardless of T score? (2)

Answer 18

spinal/hip fracture

Question 19

when should women get a bone density test? (2)

Answer 19

age 65 or older
50-64 if + risk factors

Question 20

when should men get a bone density test? (2)

Answer 20

age 70 or older
50-69 if + risk factors

Question 21

what is the treatment of osteoporosis based on?

Answer 21

total fracture risk

Question 22

what is the key to bone density and strength?

Answer 22

calcium

Question 23

what is the 1st line therapy for osteoporosis?

Answer 23

bisphosphonates

decrease osteoclastic bone resorption and increase osteoclast apoptosis

Question 24

what is the length of bisphosphonate treatment?

Answer 24

3-5 years

drug holiday for 1 year

Question 25

which bisphosphonate is used for spine only?

Answer 25

ibandronate

Question 26

what are 2 rare side effects of bisphosphonates?

Answer 26

atypical femoral fractures (long-term use)
osteonecrosis of the jaw (frequent infusion)

Question 27

a patient presents with prodromal pain and localized periosteal or cortical thickening of the cortex that looks like “beaking”. Dx?

Answer 27

atypical femoral fracture d/t bisphosphonates

Question 28

what is a 2nd line treatment for osteoporosis that stimulates formation of new bone leading to increased BMD and decreases vertebral and nonvertebral fractures?

Answer 28

teriparatide (injection)

Question 29

what is a ADR of teriparatide?

Answer 29

osteosarcoma (over 2 year use)