Osteoporosis

Question 1

Bone strength reflects integration of

Answer 1

1. bone density (mineral packed within the bone)
2. bone quality (structure, mineralization)

DQ

Question 2

Diminished bone mass can result from

Answer 2

1. failure to reach an optimal peak bone mass by early adulthood
2. once you’ve gotten there, you have either increased bone resorption or decreased bone formation

Question 3

Non-modifiable risk factors for osteoporosis

Answer 3

1. female gender
2. advanced age
3. Caucasian/Asian race
4. FH of osteoporosis
5. personal history of fracture
6. previous hyperthyroidism
7. early menopause (before 45)
8. Maybe something like RA

The FACt is I’m Fucking Pissed at HER

Question 4

Three main factors contributing to osteoporosis:

Answer 4

1. Gender (women with lower peak bone mass, hit menopause, or pregnancy and lactation with transient bone loss)
2. Ethnicity: men and non-white women with higher peak bone mass than whites
3. Genetics

GEG

Question 5

Some modifiable risk factors?

Answer 5

1. tobacco
2. sedentary
3. caffeine use (excessive)
4. low Ca and vit D intake
5. Too much alcohol
6. Hormone deficiency like testosterone or estrogen
7. Low BMI (anorexia nervosa)
8. Glucocorticoids

Question 6

Aging bone loss is ____ than menopausal

Answer 6

slower

Question 7

Some drugs that lead to osteoporosis; mechanisms of how many of these drugs work:

Answer 7

1. glucocorticoids
2. chemo
3. anticonvulsants (inhibit vit D metabolism)
4. SSRI’s
5. medroxyprogesterone
6. Proton pump inhibitors
7. excess thyroid hormone;
   estrogen antagonism or work at Ca absorption and vit D level

SEMPre CAGney

Question 8

On history and physical, look for; Consider further lab tests only if

Answer 8

risk factors and signs of occult vertebral fractures; signs of a secondary cause of osteoporosis

Question 9

For someone with vertebral fractures, what would be in the history?

Answer 9

1. back pain: acute or chronic
2. loss of height (>1.5 inches)
3. Restrictive lung disease symptoms (exertional dyspnea, decreased exercise tolerance)
4. Early satiety (reduced abdo cavity)
5. Depression, anxiety, fear

Question 10

On physical consider:

Answer 10

1. height and body weight
2. spinal tenderness/deformities (Dowager’s hump)
3. protuberant abdo
4. secondary osteoporosis signs
5. fall risk

Question 11

Risk factors for fractures:

Answer 11

1. history of falling
2. poor physical condition
3. neuro disorders
4. impaired vision and hearing
5. sedatives and anti-hypertensives
6. environmental hazards

Question 12

Screening criteria:

Answer 12

1. women over 65; men over 70
2. those with fracture over 50
3. 50-69 with clinical risk factors
4. RA or glucocorticoids

Question 13

Gold standard for screening for osteoporosis is

Answer 13

DEXA (dual-energy X-ray absorptiometry)

Question 14

Three sites for DEXA:

Answer 14

spine, hip (total and femoral neck) and forearm (non-dominant included)

Question 15

T-score for normal, osteopenia, osteoporosis:

Answer 15

Over -1.0, b/w -2.5 and 1.0, less than -2.5

Question 16

T-score related to ____ and ____; it compares

Answer 16

bone strength, fracture risk; pt’s BMD with young-normal mean BMD and expresses difference as SD score (T-score!!!)

Question 17

Fracture risk doubles with

Answer 17

every SD decrease in BMD

Question 18

X-ray of bone

Answer 18

cannot reliably measure bone density, but CAN ID spinal fractures (explain back pain, height loss, or kyphosis)

Question 19

Morbidity after vertebral fractures:

Answer 19

1. back pain
2. height loss
3. deformity (kyphosis, protuberant abdomen)
4. reduced pulmonary function
5. diminished quality of life (lose self-esteem, depression, distorted body image, loss of INDEPENDENCE)

Question 20

Prevention of osteoporosis:

Answer 20

1. adequate intake of Ca, vit D
2. weight-bearing and muscle-strengthening exercise (especially walking)
3. avoid falls
4. avoid tobacco/excess EtOH use

Question 21

First line of treatment of osteoporosis is; major one is

Answer 21

bisphosphonates (increased bone density and reduced fracture risk; inhibits action of osteoclasts!!);
alendronate!!!

Question 22

More common SE’s of bisphosphonates; more rare ones?

Answer 22

1. Hypocalcemia
2. Hypophosphatemia
3. Musculoskeletal pain
4. GI (abdo pain, acid reflux, eso ulcer, gastritis);
5. osteonecrosis of the jaw
6. atypical femoral fractures
7. visual disturbances