Osteoporosis

Question 1

What are the risk factors for osteoporosis?

Answer 1

• White or Asian race
• Advanced age
• Previous fracture
• Long-term PO steroids
• Low body weight (<127 lbs)
• Cigarette smoking
• Excess alcohol intake

Question 2

When should women be screened for osteoporosis and what screening tools should be used?

Answer 2

At 40+ years:
- Height annually (risk with loss of height)

At 50+ years/Postmenopausal women:
- DXA scan
- Detailed history and exam
- FRAX assessment

Question 3

What DXA scan results indicate a diagnosis of osteopenia? Osteoporosis?

Answer 3

DXA: Dual-Energy X-ray Absorptiometry

• T-Score: 1.0 to -2.5 = Osteopenia
  (treat if + for risk factors)
• T-Score: < -2.5 = Osteoporosis (treat all)

Question 4

What is important when diagnosing osteoporosis from history/exam findings?

Answer 4

• Postmenopausal women > 50 years old
• Check for height loss
• History of fractures
• History of fragility fractures (fractures with
  minimally-traumatic fall), regardless of age

Question 5

How does the FRAX Calculator assist with diagnosis of osteoporosis?

Answer 5

• Determines if treatment is necessary
• Easy, step-by-step process
• 10-year estimate of fracture risk:
  - Hip fracture risk > 3% in 10 years
  - All fracture risk > 30% in 10 years

Question 6

Per the 2020 osteoporosis treatment guidelines, what is the recommended first-line treatment?

Answer 6

First-line = Bisphosphonates:
- Alendronate
- Risedronate
- Zolendronic acid

***NO Ibandronate/Boniva due to lack of data on hip fracture reduction!!!

Question 7

Per the 2020 osteoporosis treatment guidelines, what are the alternative and cautioned treatments?

Answer 7

Alternative:
- Denosumab:
- risk of rapid bone loss if stopped
- must start another med ASAP if stopped

Cautioned:
- NO Menopausal Hormone Therapy for osteoporosis since risks outweigh the benefits

Question 8

Per the 2020 osteoporosis treatment guidelines, what factors are important when treating women over the age of 65?

Answer 8

If at high fracture risk, consider:
- patient preference
- fracture/risk profile
- benefits
- harms
- price of meds

Question 9

Per the 2020 osteoporosis treatment guidelines, how should male patients be managed?

Question 10

What non-pharmaceutical management should be recommended for patients with osteoporosis?

Answer 10

• Reduce risk of falls
• Exercise:
  - weight-bearing
  - resistance training
  - balance training (yoga, tai chi)
• Avoid:
  - oral corticosteroids
  (oral more so than inhaled)
  - anticonvulsants
• Stop:
  - cigarettes
  - alcohol

Question 11

What OTC medications should be ordered for patients with osteoporosis?

Answer 11

• Calcium:
  
  • if >50 years = 1200mg daily
  • food = preferable source
  • if GERD = calcium citrate
• Vitamin D (use D3):
  
  • especially if ≥50 years
  • 1000 - 2000 IU daily
  • 100 IU per 8oz milk