Osteoporosis

Question 1

bone strength reflects 2 main features

Answer 1

1. bone density

2. bone quality

Question 2

Bone quantity depends on

Answer 2

1) acquisition of peak bone mass -
2) age-related bone loss - (ESTROGEN)
3) many diseases
4) drugs

Question 3

What diseases can effect bone QUANtity

Answer 3

• hyperparathyroidism
• hyperthyroidism
• hypogonadism - anorexia, POF, Early menopause
• mal-absorption, malnutrition - celiac, IBD
• RA - TNF-driven disease

Question 4

Why is it that TNF-driven disease can cause poor bone QUANtity

Answer 4

• increases osteoclastic activity

Question 5

What type of drugs can effect bone QUANtity

Answer 5

• glucorticoids!!!!!
• Anti-estrogens (Brca)
• SSRIs
• PPIs
• anti-convulsants
• Heparin

Question 6

Which part of the body has the highest incidence rate of fractures?

Answer 6

Vertebrae

Question 7

What fractures are NOT included in fragility fracture definition

Answer 7

• Skull
• metatarsal/MC
• Ankle

Question 8

What impact do breast feeding and pregnancy have on bone?

Answer 8

negative impact

Question 9

Which BP medication is bone protective?

Answer 9

HCTZ

Question 10

Which bone index is estrogen dependent

Answer 10

Bone quality - turnover of bone

Question 11

which lab tests should be ordered

Answer 11

CBC with MCV

• creatinine/LFTs, ALP should be normal
• 25 OH Vitamin D
• Ca, PO4, Alb, Mg,

Question 12

What influences age related bone loss

Answer 12

Estrogen/genetics/Fam Hx

Question 13

Type of imaging required for OP

Answer 13

• Thoracolumbar spine xray

- DEXA

Question 14

when should a DEXA be done

Answer 14

if over 65, if younger with a cause

Question 15

who is the ref group for the T score

Answer 15

• normal healthy 25 year old

Question 16

who is the ref group for the Z score

Answer 16

Own age group

Question 17

In a healthy 40 yr old expect the T score and Z score to be

Answer 17

SIMILAR

Question 18

When do you use the term osteoporosis

Answer 18

in people over 50

Question 19

low bone mass defined as T-score

Answer 19

between -1.1 to -2.4

Question 20

what is the ten year fracture risk based on?

Answer 20

• gender
• age
• bone density value
• previous fragility fracture
• prednisone

Question 21

If you are <50 and you are below expected range for age vs above what is your z-score

Answer 21

< 2 vs > 2

Question 22

Severe osteoporosis if T-score is

Answer 22

< -2.5 with fragility fracture

Question 23

WHo gets pharmacologic intervention for osteoporosis

Answer 23

• High risk > 20% absolute fracture risk

Question 24

recommended calcium and vitamin intake

Answer 24

1200mg/day

800-2000 units/day

Question 25

Examples of anti-resorptive medications tat target osteoclasts

Answer 25

bisphosphonates
Denosumab
SERMs
Hormone therapy

Question 26

Only anabolic therapy targets osteoblasts

Answer 26

Teripartide

Question 27

Long term side effect of bisphosph

Answer 27

• osteonecrosis of jaw
• atypical femoral fracture
• early use cause esophageal irritation

Question 28

2 main contraindications for BP use

Answer 28

Hypocalcemia
Low vitamin D levels
active upper gi DISEASE
- Renal dysfunction - all renally excreted

Question 29

MOA of denosumab

Answer 29

RANKL inhibitor - inhibit osteoclast maturation

Question 30

SERMs mechanism of action

Answer 30

agonist on bone, antagonist on breast and uterus!

Question 31

Side effects of SERMs

Answer 31

• hot flashes

- DVT risk

Question 32

2 most effective therapies (decrease VCF by 50%)

Answer 32

Denosumab

BPs