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Clin Med-Endocrine > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

The world health organization classifies osteoporosis as what

A

a bone density that falls 2.5 STD dev below the mean for a young healthy adults of the same sex (t-score -2.5)

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2
Q

women of what time frame of their menstrual cycle and what bone density score put them at risk for what?

A

postmenopausal who fall between -1.0 and -2.5 also have low bone density and are at risk of developing osteoporosis

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3
Q

what are the values for a person to have osteopienia

A

between -2.5to 1.0

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4
Q

what is the correlation between mortality with osteoporosis

A

very high due to the complications of treatment of fractures

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5
Q

when are fractures of the radius most common

A

before the age of 50 and plateau by 60 w/ only a modest age related increase

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6
Q

what is the incidence rate for hip fractures

A

doubles every 5 years after 70years old

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7
Q

What types of fracture complications are their with osteoporosis

A

wrist fractures
hip fractures
vertebral fractures

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8
Q

what are the complications that come with hip fractures

A

high incidences of DVT and PE (20-50%)

mortality rate between 5-20% during the 1st year after surgery

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9
Q

what are the complications that arise with vertebral fractures

A

relatively asymptomatic
associated with long term morbidity and slight increase in mortality rates due to pulmonary disease
can cause loss of height and kyphosis and secondary pain and back discomfort’
thoracic fractures can be associated with restrictive lung disease

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10
Q

what is a colles fracture

A

a fracture of the distal radius when a person attempts to break a fall using hands and arms

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11
Q

what is primary type 1 osteoporosis

A

postmenopausal causing rapid bone loss w/in 6 years of menopause, mainly trabecular bone (spongy bone)

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12
Q

what is primary type 2 osteoporosis

A

senile (men and women > 75 yrs of age) slow progression, both cortical and trabecular bone

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13
Q

what is secondary types of osteoporosis

A 
sex hormone deficiency (hypogonadism, prolactinoma, orchiectomy (removal of testes) for prostate cancer)
hormone excess (hyperthroidism, hyperparathyroidism, corticosteroids)
Increased bone resorption/formation ration: immoblilization, space flight, long term heparin, cancer
multifactorial(renal failure, anorexia athletic amenorrhea, ETOH use
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14
Q

what are risk factor for osteoporosis (non modifiable)

A 
woman (postmenopausal)
white race
advanced age
personal history of fractures as adult
history of fractures in a first degree relative
dementia
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15
Q

what are risk factors that are modifiable

A 
Low body weight
current cigarette smoking
ETOH abuse
Low Calcium intake
Vitamin D deficiency
lack of physical activity
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16
Q

what are chronic disease states that put people at risk for osteoporosis

A

rheumatologic and autoimmune
hypogonadal states, anorexia, DM, Cushings syndrome, hyperthyroidism
Celiac, gastric bypass, chrohn’s, malabsorption
Multipe Myeloma, Lymphoma, leukemia
Epilepsy, Muscular sclerosis, Dementia, parkinsons, poor eye sight

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17
Q

what medications will put you at risk

A

most common is glucocorticoids

anticonvulsants, immunosuppressants, aromatase inhibitors, heparin lithium, hormone therapies, PPI, ICS in elderly

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18
Q

What is the pathophysiology for normal bone growth?

A

skeleton increases in size by linear growth and by apposition of new bone tissue on the outer surface of the cortex which is known as modeling. the modeling allows the long bones to adapt and shape to the stress placed on them
Puberty require increased sex hormone production which is required for maturation

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19
Q

What happens to bone mass in adulthood

A

bone mass remain constant after peak bone mass is achieve in adulthood- equal balance

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20
Q

what are the two primary functions of bone remodeling?

A

repair microdamage with in skeleton to maintain strength

to supply calcium from the skeleton to maintain normal serum calcium

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21
Q

what regulated bone remodeling

A

estrogen, androgen, vitamin D, PTH,

22
Q

what happens to bone remodeling at ages 30-40

A

resorption exceeds formation
due to menopause
or increase osteoclast activity or decrease osteoblast activity

23
Q

what are the signs and symptoms of osteoporosis

A

usually painless unless the patient sustains a fracture
height loss
increased kyphosis of thoracic spine with a secondary protuberant abdomen
bone pain or deformities from fractures

24
Q

how is osteoporosis diagnosed

A

made clinically in the setting of a fragility fracture regardless of T-score

25
Q

how is osteoporosis diagnosed in men and women

A

post menopausal women and men greater than 50years old with no fragility fracture diagnosed by bone density testing

26
Q

What labs are ordered to rule out secondary causes of osteoporosis?

A 
CBC
Calcium if elevated hyperPTH low Vit D def or GI malabsorption
phosphorus level
Cratinine
TSH
27
Q

what is the gold standard in diagnosis a person with osteoporosis?

A

DEXA scan

28
Q

what does a DEXA scan measure?

A

measure bone density w/minimal radiation exposure

focuses mainly on the spine and hip

29
Q

how are DEXA scan values reported

A

T-scores

it compares the values of the individual results to those of a healthy 30 year old of the same race and

30
Q

what is a t-score of less than -2.5 in the lumbar, spine, femoral neck or total hip

A

this is classified at osteoporosis

31
Q

what is the t-score less than -1.0 but greater than -2.5 is considered

A

osteopenia

32
Q

what are the approved testing guidelines for osteoporosis

A

for postmenopausal women and men>50years old

measure height annually

33
Q

What are the requirements for a dexa scan

A 
all women>65yr
all men>70
post menopausal women7.5mg of prednisone or duration of tx>3months
primary hyperPTH
monitoring osteoporosis meds
34
Q

what is the treatment for hop fractures

A

require open reduction and internal fixation with rehab and pain mgmt

35
Q

what is the treatment for vertebral fx

A

acute pain mgmt if symptomatic

vertoplast/kypoplasty

36
Q

what is the treatment for wrist fractures

A

may or may not require pinning, ORIF or manual reduction, acute pain mgmt

37
Q

what is the treatment for osteoporosis by reducing underlying modifiable risk factors

A 
d/c meds
smoking cessation
alcohol abuse treatment
environmental safety in the home( eliminate throw rugs, move wires, remove tripping hzds)
treat vision impairment
specialized care for pts with dementia
38
Q

what was can you treat osteoporosis?

A

improve nutrition
calcium supplements
Vitamin D
weight bearing exercise ( do not increase bone mass but prevents bones loss)

39
Q

how is exercise a good treatment for osteoporosis

A

prevents bone loss, but does not increase bone mass
improves coordination, strength, and balance
needs to be at least 3x/week

40
Q

what are the normal values for calcium levels

A

8.5-10.5

41
Q

what is 1st line treatment for osteoporosis what are additional treatments

A 
bisphosphonates
SEMS selective estrogen receptor modulators
calcitonin
PHT
Testosterone
42
Q

what is the MOA of bisphophonates

A

inhibit osteoclast-induced bone resorption
increases bone density and reduce incidence of both vertebral and nonvertebral fx
prevents corticosteroid osteoporosis

43
Q

when should oral agents for osteoporosis be taken

A

in the am w/ 8oz of water and 40 min prior to consuming anything else, need to remain upright to prevent esophagitis

44
Q

what are side effects of bisphosphonates

A

osteonecrosis of jaw, esophagitis, esophageal cancer

45
Q

how long is the treatment for bisphophonates?

A

1/2 life is 10 yrs there fore it is now recommended to d/c after 5 years of tx

46
Q

how does estrogen work to fight osteoporosis

A

reduces bone turnover, prevents bone loss and causes small increases in bone mass of the spine, hip, and total body

47
Q

what are some long term side effects of estrogen therapy

A

increased risk of CV events, breast cancer, storkes, endometrial hyperplassia, DVT, PE

48
Q

how do serms work to prevent osteoporosis

A

used in postmenopausal women

prevents bone loss and reduces bone turn over

49
Q

how does PTH work for people with osteoporosis

A

works on osteoblasts

favors bone formation over resorption, produces increase in bone tissue and restores the micoarchitecture

50
Q

what is an example of PTH medication

A

teriparatide
given sub q daily for 2 years
not as effective as with pts who used bisphosphonates
best as mono therapy

51
Q

when is testosterone use for treatment

A

in hypogonadal men

Clin Med-Endocrine (8 decks)

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