Osteoporosis Flashcards
Disease of low bone strength, characterized by inadequate bone mass and quality leading to deterioration.
White Women > 50 years old → increased risk if not on Estrogen Replacement
Osteoporosis
Most Common Location of Fractures due to Osteoporosis
Vertebrae
Hip
Pelvis
Wrist
Osteoporosis Risk Factors
Age
Sex
Sex Hormone Deficiency
Alcoholism
Smoking
Long Term PPI Use
What Blood Tests are used for Osteoporosis Diagnosis
CBC
CMP
PTH (Parathyroid Hormone)
Serum 25-hydroxyvitamin D
What Blood Tests are used for Osteoporosis Medication Adherence and Efficacy?
CTX → Bone Resorption
P1NP → Bone Formation
Who should receive a Bone Mineral Density Test?
All Women ≥ 65
All Men ≥ 70
What is the best Test for Osteoporosis?
DEXA
Normal DEXA-T Score
≥ -1.0
Osteopenia DEXA-T Score
-1.0 to -2.5
Osteoporosis DEXA-T Score
≤ -2.5
Severe Osteoporosis DEXA-T Score
≤ -2.5 + Fracture
How often should a person with a DEXA Score of -1.0 to -1.5 receive a scan?
5 Years
How often should a person with a DEXA Score of < -2.0 receive a scan?
1 - 2 Years
How often should a person with a DEXA Score of -1.5 to -2.0 receive a scan?
3 - 5 Years
Tool used to predict a 10-year risk of hip or other major osteoporosis fracture
FRAX
(Fracture Risk Assessment Tool)
When is treatment for Osteoporosis recommended?
T Score < -2.5 who already had a fracture
or
T Score of -1.0 to -2.5 with a high risk of fracture
What is essential for intestinal absorption of Calcium?
Vitamin D
Osteoporosis Medication that Inhibits Osteoclast-induced bone resorption
Biphosphonates
- Alendronate
- Risedronate
- Ibandronate
Side Effects:
- Esophageal Dysfunction
- Osteonecrosis of Jaw
- Chalkstick Fracture of Femoral Shaft
Osteoporosis Medication that is used to prevent Osteoporosis but doesn’t help once it is established.
Reduces Vertebral Fracture but not Hip Fractures
Selective Estrogen Receptor Modulators (SERMs)
- Raloxifene
- Tamoxifen (causes bone loss if premenopausal)
- Bazedoxifene
Side Effects:
- do not give if history of PE or DVT
Osteoporosis Monoclonal Antibodies that inhibit the proliferation and maturation of Osteoclasts
Denosumab (Prolia)
- can be given to pts. with impaired renal function and those receiving sex hormone therapy for breast or prostate cancer.
Side Effects:
- hypocalcemia
- hyperlipidemia
- increased risk of infection
Effects wane quickly after 6 months.
- no drug holidays
- cannot be discontinued with a substitute
- fetal teratogenicity
Osteoporosis Medication:
Gives modest anti-osteoporis benefit; used as a last resort. Increases overall risk of malignancy, especially Liver Cancer.
Used primarily for analgesic effect for acute osteoporotic vertebral compression fracture.
Calcitonin
Osteoporosis Medication:
Marked enhancement of bone mass (risk of Osteosarcoma)
Stimulates new production of collagenous bone matrix.
Do not use in patients with hypercalcemia.
Anabolic Agents
- Teriparatide
- Abaloparatide
Osteoporosis Medication:
Monoclonal antibody that increases new bone formation and decreases bone resorption.
Given subcutaneously monthly.
May increase risk of Cardiovascular Events.
Mixed Agent
- Romosozumab
