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724: Medical Lectures > Osteoporosis > Flashcards

Osteoporosis Flashcards

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USMLE® Step 1 flashcards
1
Q

What can be defined as a skeletal disorder characterized by a loss of bone osteoid that reduces bone integrity, resulting in an increased risk of fractures?

A

osteoporosis

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2
Q

In the US osteoporosis causes how many fractures annually?

A

2 million

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3
Q

White women have a __% lifetime risk of sustaining one or more osteoporotic fractures

A

40

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4
Q

What are the 5 most common causes of osteoporosis?

A
  • aging
  • high-dose corticosteroid administration
  • alcoholism
  • smoking
  • sex hormone deficiency
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5
Q

What is the most common cause of osteoporosis in men?

A

antiandrogen therapy for prostate conacer

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6
Q

What is caused by a major mutation in the gene coding for type I collagen (bone constitute)?

A

osteogenesis imperfecta

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7
Q

When does osteoporosis become symptomatic?

A

following fracture

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8
Q

Are serum calcium, phosphate, and PTH normal, decreased, or increased?

A

normal

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9
Q

Are vitamin levels D normal, decreased, or increased?

A

decreased

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10
Q

Serum 25-hydroxyvitamin D levels < __g/mL are considered frank vitamin D deficiency

A

20

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11
Q

A T-score greater than or equal to __ is considered normal

A

-1.0

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12
Q

A T-score between __ - __ is considered osteopenia (low bone density)

A

-1.0 to -2.5

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13
Q

A T-score less than __ is considered osteoporosis

A

-2.5

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14
Q

Fracture risks increase __-fold for each standard deviation drop in bone mineral density

A

two

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15
Q

DXA should be obtained every _ years for T scores -1.0 to -1.5

A

5

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16
Q

DXA should be obtained every _ years for T scores -1.5 to -2.0

A

3-5

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17
Q

DXA should be obtained every _ years for T scores less than -2.0

A

1-2

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18
Q

The “_ score” is a statistical term that is used for expressing an individual’s bone density as standard deviation from age-matched, race-matched, and sex-matched means

A

Z

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19
Q

What are 2 differential diagnoses of osteoporosis?

A
  • osteomalacia

- bone marrow neoplasm

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20
Q

Diet should be high in what 4 things when treating osteoporosis?

A
  • protein
  • total calories
  • calcium
  • vitamin D
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21
Q

What are the 7 specific treatment measures?

A

1) vitamin D and calcium
2) biphosphonates
3) sex hormones
4) selective estrogen receptor modulators
5) teriparatide
6) calcitonin
7) denosumab

22
Q

True or False

Sun exposure and vitamin D supplementation are useful in preventing and treating osteoporosis

A

False

23
Q

Vitamin D supplementation reduces the incidence of vertebral fractures by __%

A

37

24
Q

Calcium supplementation does not reduce the risk of fracture in those with dietary calcium intake over ____ mg daily

A

1000

25
Q

Calcium supplementation may be linked to an increase in what?

A

myocardial infarction

26
Q

How do biphosphonates help treat osteoporosis?

A

They increase bone density significantly and reduce the incidence of both vertebral and nonvertebral fractures

27
Q

Biphosphonates are effective in preventing what?

A

corticosteroid-induced osteoporosis

28
Q

To ensure intestinal absorption when should oral bisphosphonates by taken?

A

in the morning with at least 8 oz of water 40 minutes before consuming anything else

29
Q

What are 3 oral bisphosphonates?

A
  • alendronate
  • risedronate
  • ibandronate
30
Q

What are 2 IV bisphosphonates?

A
  • zoledronic acid

- pamidronate

31
Q

Bisphosphonate therapy can cause several side effects that are collectively known as what?

A

the acute-phase response

32
Q

What are the symptoms of the acute-phase response?

A
  • fever, chills, or flushing
  • musculoskeletal pain
  • nausea, vomiting, or diarrhea
  • fatigue or dyspnea
  • edema
  • headache or dizziness
  • eye inflammation
33
Q

The acute-phase response typically develops after treatment with what?

A

their first infusion of zoledronic acid

34
Q

Bisphosphonate use for more than 5 years is associated with what?

A

An increased risk in subtrochanteric or femoral shaft fractures

35
Q

Patients taking oral bisphosphonates have an increased risk of developing what?

A

esophageal cancer

36
Q

Bisphosphonates can e discontinued after a _ year course of therapy. Why?

A

5

Because they have a half life of 10 years in bone

37
Q

What is essential in preventing osteoporosis in postmenopausal women?

A

estrogen replacement therapy (ERT)

38
Q

What can help prevent osteoporosis in hypogonadal men?

A

testosterone administration

39
Q

What can be used in place of estrogen for prevention of osteoporosis?

A

Raloxifene (a selective estrogen receptor modulator)

40
Q

What is the advantage of taking raloxifene over estrogen supplements?

A

Reduced risk of breast cancer

41
Q

However, raloxifene can increase the risk for what?

A

thromboembolism

42
Q

Teriparatide is an analog of what hormone?

A

parathyroid hormone

43
Q

What does teriparatide do?

A

It stimulates the production of new collagenous bone matrix that must be mineralized

44
Q

Teriparatide dramatically increases the bone density in all bones except for which one?

A

the distal radius

45
Q

What patients are contraindicated for teriparatide use?

A
  • patients with hypercalcemia **

- those with an increased risk of osteosarcoma (Paget’s disease, open epiphyses, past history)

46
Q

What should be considered following a course of teriparatide and why?

A

A course of bisphosphonates in order to retain the improved bone density

47
Q

Both nasal and parenteral _____ have analgesic effects on bone pain from fractures and have shown to reduce the risk factor of vertebral fractures

A

calcitonin

48
Q

______ is a monoclonal antibody that inhibits the proliferation and maturation of preosteoclasts into mature osteoclast bone-resorbing cells

A

Denosumab

49
Q

How does denosumab function?

A

It binds to the osteoclast receptor activator of nuclear factor-kappa B ligand (RANKL)

50
Q

Denosumab should not used in patients with ___calcemia

A

hypo

724: Medical Lectures (42 decks)

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