Osteoporosis

Question 1

most common bone disease in the US

Answer 1

osteoporosis

Question 2

Charactistics of Osteoporosis

Answer 2

low bone mass, deterioration of bone tissue and disrupted bone architecture, compromised strength, increased risk of fracture

Question 3

Etiology of osteoporosis

Answer 3

low peak bone mass, increased bone loss, falls

Question 4

Inadequate peak bone mass due to

Answer 4

Physical activity, Endocrine activity, Nutrtion (calcium, vitamn D during bone growth), Genetics (PEN-G)

Question 5

Why lose bone loss?

Answer 5

Age, menopause and hypogonadism, lcinical risk factors, high bone turnover

Question 6

Pathology osteoporosis

Answer 6

loss of trabecular plates and thinning of trabeculae causing fragility and increase in fracture

Question 7

History and its relationship to falls

Answer 7

mild falls can cause a big loss or damage to bones if they are weak, lifting something very heavy and then feeling some sharp back pain may indicate vertebral fracture

Question 8

What lifestyle choices can affect this?

Answer 8

smoking, alcohol, inadequate diet (low calcium, low Vid, TOO much vitamin A, too much salt), inadequate physical activity or mobilization

Question 9

what general types of states can increase possibility of osteoporosis

Answer 9

low estrogen (menopause, tamoxifen, hypogonadism, klinefelter, anorexia), Cushing or Cushing like disease, too much thyroid hormone, diabetes, adrenal insufficiency, hypER parathyroidism, GI disorders or other absorptive problems like PPIs

Question 10

Physical findings in osteoporosis?

Answer 10

usually none, if fracture occurs first, then fracture (hip, wrist, and vertebral spine), asymptomatc or symptomatic fracture of dorsal spine can lead to increasing kyphosis

Question 11

DEXA

Answer 11

dual-xray absorbiometry is the main screen and diagnositic study to measure bone density

Question 12

Vertebral imaging can be done when

Answer 12

in the absence of bone density diagnosis and given frequnecy of asymx vertebral fractures, xray of spine recommended

Question 13

If already determined to have low bone density, what labs should you consider?

Answer 13

CBC, Calc Phosph, Creatinine, Alk PHos, 25-hydroxyvitamin D, TSH, Calcium and creatinine in urine (24 hour urine), Urinary cortisol, Celiac disease, Estradiol, ESR, SPEP, biochem markers of boen turne over

Question 14

What does alk phosph have to do with anything?

Answer 14

its a marker of bone resorption or bone turnover

Question 15

When should you consider Celiac disease

Answer 15

low urinary calcium, low vitD

Question 16

biochemical markers for bone turnover

Answer 16

C telopeptide, Urinary N telopeptide, alkaline phosphatase, osteocalcin, aminoterminal propeptide of type 1 procollagen (P1NP)

Question 17

In the dexa scan, what is a z score?

Answer 17

Bone density when compared to those of a similar age, sex, and ethnicity matched reference population

Question 18

T score?

Answer 18

young adult (age 20-40) reference population of the same sex

Question 19

Normal BMD

Answer 19

T score > 1SD below YA mean (> -1)

Question 20

Osteopenia

Answer 20

-2.5 < -1SD of YA mean

Question 21

Osteoporosis

Answer 21

BMD T score < 2.5SD below YA mean (-2.5)

Question 22

Who should be tested with DEXA?

Answer 22

women>65, men > 70 ; younger postmenopausal women with clinical risk factors for fracture, adults > 50 with fracture, adults with conditions like RA or use corticosteroids,

Question 23

A diagnosis of osteoporosis can be made even if they don’t have bone mineral density diagnosis- who should you xray?

Answer 23

Woman > 70, Men >80; women 65-69 or men 75-79 if BMD Tscore < -1.5, postmenopausal women 50-65 and men 50-69 with risk fractures

Question 24

What risk fractures are we talking about in regards to the population of postmenopausal women 50-64 and men 50-69?

Answer 24

low trauma fracture, historical loss of height of > 1.5 inches, prospective loss of height of 0.8 inches, recent or ongoing corticosteroid treatment

Question 25

DDx with what

Answer 25

Osteomalacia, Neoplasm

Question 26

osteomalacia caused by

Answer 26

vit d deficiency, hposphate def, acidosis, drugs (fluoride, bisphonoate, chronic renal failure via aluminum), hypophosphatasia

Question 27

Neoplasm that is metastatic to bone

Answer 27

can cause compression fracture, things like MM and leukemia can do this

Question 28

Treatment

Answer 28

Bisphosphonates, Calcitonin, Estrogen Replacement Therapy, Estrogen Antagonist, RANKL Inhibitor

Question 29

bisphosphonates

Answer 29

alendronate and all other - dronates; inhibit osteoclast activity

Question 30

bisphosponate side effects

Answer 30

renal issues, GI irritation, cross reaction with drugs/ food

Question 31

Calcitonin

Answer 31

from salmon, decrease pain of vertebral fracture but not super effective- intranasally or subq injections

Question 32

Calcitonin names

Answer 32

Miacalcin, Fortical `

Question 33

Estrogen replacement therapy

Answer 33

decrease hip and pine fractures by 35%, but cause possible increase in MI, PE, breast cancer, DVT

Question 34

RANKL inhibitors

Answer 34

denosomab aka prolia

Question 35

RANKL does what?

Answer 35

causes hypocalcemia, renal defects are avoided, subQ injection reduces vertebral fractures by 68%

Question 36

what concerns should you have with RANKL inhibitors?

Answer 36

osteonecrosis of the jaw and atypical hip fractures.

Question 37

Amount of calcium and Vitamin D

Answer 37

1000(m), 1200(w) ; 800-1000 vitD

Question 38

treat who?

Answer 38

postmenopausal women and men age > 50 with the following should be considered for treatment. - hip or vertebral fracture, T score < or = -2.5 of the femoral neck total hip or lumbar spine; low bone mass -2.5 < T score < -1 of femoral neck or lumbar spine and a 10 year FRAX > or - 3% for hip or major osteoporosis related fracture > or - 20%

Question 39

consider what for osteoporosis first

Answer 39

bisphosphonate alendronate first, if problems with GERD/ dyspepsia treat with IV bisphosphonate or estrogen therapy or denosumab, If renal insufficiency, treat with deonsumab or estrogen antagonist

Question 40

Vertebral fractures cancause what?

Answer 40

loss of heigh, restrictive lung disease, alter abdominal anatopy leading to constipation, abdominal pain, bloating,and early satiety.

Question 41

how many patients with hp fractures require long term nursing care?

Answer 41

20%; only 40% regain full prefracture functioning