Osteoporosis Flashcards
bone strength reflects 2 main features
- bone density
2. bone quality
Bone quantity depends on
1) acquisition of peak bone mass -
2) age-related bone loss - (ESTROGEN)
3) many diseases
4) drugs
What diseases can effect bone QUANtity
- hyperparathyroidism
- hyperthyroidism
- hypogonadism - anorexia, POF, Early menopause
- mal-absorption, malnutrition - celiac, IBD
- RA - TNF-driven disease
Why is it that TNF-driven disease can cause poor bone QUANtity
- increases osteoclastic activity
What type of drugs can effect bone QUANtity
- glucorticoids!!!!!
- Anti-estrogens (Brca)
- SSRIs
- PPIs
- anti-convulsants
- Heparin
Which part of the body has the highest incidence rate of fractures?
Vertebrae
What fractures are NOT included in fragility fracture definition
- Skull
- metatarsal/MC
- Ankle
What impact do breast feeding and pregnancy have on bone?
negative impact
Which BP medication is bone protective?
HCTZ
Which bone index is estrogen dependent
Bone quality - turnover of bone
which lab tests should be ordered
CBC with MCV
- creatinine/LFTs, ALP should be normal
- 25 OH Vitamin D
- Ca, PO4, Alb, Mg,
What influences age related bone loss
Estrogen/genetics/Fam Hx
Type of imaging required for OP
- Thoracolumbar spine xray
- DEXA
when should a DEXA be done
if over 65, if younger with a cause
who is the ref group for the T score
- normal healthy 25 year old
who is the ref group for the Z score
Own age group
In a healthy 40 yr old expect the T score and Z score to be
SIMILAR
When do you use the term osteoporosis
in people over 50
low bone mass defined as T-score
between -1.1 to -2.4
what is the ten year fracture risk based on?
- gender
- age
- bone density value
- previous fragility fracture
- prednisone
If you are <50 and you are below expected range for age vs above what is your z-score
< 2 vs > 2
Severe osteoporosis if T-score is
< -2.5 with fragility fracture
WHo gets pharmacologic intervention for osteoporosis
- High risk > 20% absolute fracture risk
recommended calcium and vitamin intake
1200mg/day
800-2000 units/day
Examples of anti-resorptive medications tat target osteoclasts
bisphosphonates
Denosumab
SERMs
Hormone therapy
Only anabolic therapy targets osteoblasts
Teripartide
Long term side effect of bisphosph
- osteonecrosis of jaw
- atypical femoral fracture
- early use cause esophageal irritation
2 main contraindications for BP use
Hypocalcemia
Low vitamin D levels
active upper gi DISEASE
- Renal dysfunction - all renally excreted
MOA of denosumab
RANKL inhibitor - inhibit osteoclast maturation
SERMs mechanism of action
agonist on bone, antagonist on breast and uterus!
Side effects of SERMs
- hot flashes
- DVT risk
2 most effective therapies (decrease VCF by 50%)
Denosumab
BPs