Osteoporosis

Question 1

define osteoporosis

Answer 1

decrease in BMD due to more osteoclast activity compared to osteoblast which can increase bone fragility resulting in fragility fractures

primary: due to age or decrease in sex hormones
secondary: due to other conditions
- endocrine: hyperparathyroidism, hyperthyroidism, Cushing
- GI: malabsorption or anorexia
- kidney: chronic kidney disease
- drugs/medications: LT steroid use

Question 2

RF for osteoporosis

Answer 2

• female
• early menopause
• fracture after age 40
• nulliparity
• hx of secondary osteoporosis
• LT steroid use
• anorexia or low BMI
• smoking and alcohol
• possible signs of vertebral fractures

Question 3

what are 3 physical exam tests to do for evaluating possible vertebral fractures?

Answer 3

1. occiput-to-wall test >5cm
2. rib to pelvis =< 2 fingerbreadths apart in the midaxillary line
3. > 2 cm height decrease or historical >6cm height decrease

Question 4

how to evaluate the T and Z scores of a BMD scan aka DEXA scan?

Answer 4

T-score; used for primary osteoporosis
average to young bone age
- <-2.5 SD = osteoporosis
- -1 to -2.5 SD = osteopenia

z-score; commonly used for secondary osteoporosis
age matched numbers
- <-1.5 SD = osteoporosis
score is usually used in younger pts

Question 5

what does the screening process/recommendations look like for osteoporosis?

Answer 5

all males and females >=50Y they recommend
- vit D supplement
- diet high in Ca and protein
- weight bearing exercises at least 2 times per week + to help with balance (yoga and thai chi)

consider RF for osteoporosis ➔ fracture at age >40Y, >2 fractures in the past year etc.
- based on pt, consider either just using FRAX or also getting a BMD scan
- FRAX score to determine 10-Y fracture risk score

if high or medium risk (>15%) ➔ pharmacotherapy
if low risk (<15%) ➔ continue with lifestyle changes

reevaluate with repeat BMD scan depending on pt – may be 3Y or 5-10Y until next scan

Question 6

how might someone with osteoporosis present?

Answer 6

often asymptomatic until there is a fragility fracture of some sort
Major osteoporotic fractures: hip, vertebra, humerus, ribs and distal forearm

may have kyphosis
may have s/s of cervical fractures
may have shortness of breath from the decreased thoracic cavity
may have dull peristant back pain from the fractures

Question 7

what tx are available for osteoporosis?

Answer 7

lifestyle: vit D and calcium supplements, exercise, smoking cessation

pharma
- bisphosphonates: antiresorptive agent – inhibits osteoclasts
- denosumab (prolia): antiresorptive agent – RANKL inhibitor
- teriparatide (anabolic agent): PTH analogue