Osteoporosis

Question 1

Content: 3 ways to define osteoporosis.

Answer 1

1. Microarchitectural deterioration of bone tissue leading to decreased bone mass
2. Bone fragility
3. Susceptibility to fracture

Question 2

Q: Osteoporosis is a problem of _________ peak bone _____ and _____________ bone _____.

Answer 2

decreased, mass, increased, loss

Question 3

Q: How many million individuals in the US are affected by osteoporosis?

Answer 3

10 million

Question 4

Q: When does bone mass peak?

Answer 4

Between 20-25 yo

Question 5

Q: When does bone mass begin to decline?

Answer 5

Around 50 yo

Question 6

Q: What imaging is often used to identify osteoporosis?

Answer 6

DEXA

Question 7

Q: What is BMD?

Answer 7

Body mass density - comes from a DEXA test

Question 8

Defn: T-score

Answer 8

number of standard deviations from the young adult mean density

Question 9

Defn: Z-score

Answer 9

number of standard deviations from age matched mean density

Question 10

Q: What T-score indicates osteoporosis?

Answer 10

< -2.5

Question 11

Q: What T-score indicated osteopenia?

Answer 11

-1 to -2.5

Question 12

T/F: For every standard deviation below the norm, the risk of fractures triples.

Answer 12

False: doubles

Question 13

Q: When does the z-score apply for osteoporosis?

Answer 13

pre-menopausal females and males < 50

Question 14

Q: What is FRAX?

Answer 14

Fracture Risk Assessment Tool

Question 15

Q: What does FRAX calculate?

Answer 15

10 year fracture risk, for things like hip fracture and osteoporosis fractures

Question 16

T/F: FRAX is the treatment decision making tool in previously treated pts.

Answer 16

False, untreated

Question 17

Content: Primary Osteoporosis (2)

Answer 17

1. unrelated to chronic illness
2. Related to aging and decreased gonadal function

Question 18

Content: Secondary osteoporosis (2)

Answer 18

1. Secondary to chronic illnesses/meds that cause accelerated bone loss
2. Ex. glucocorticoid use, hyperthyroidism

Question 19

Content: Risk factors for Osteoporosis (10 - general idea)

Answer 19

1. Genetics
2. Low Ca intake
3. Low vitamin D stores
4. Tobacco and alcohol us
5. Prior history of fracture
6. Medications
7. Malabsorpation
8. Excessive urinary calcium
9. Overactive thyroid gland
10. Other medical conditions

Question 20

Content: Secondary Evaluation of Osteoporosis (7)

Answer 20

1. Comprehensive metabolic panel
2. CBC
3. 24 hour urine for Ca, creatinine, Na
4. 25-Hydroxy Vit D
5. TSH
6. SPEP/UPEP if anemic
7. PTH

Question 21

Q: How do you assess fall risk?

Answer 21

TUG - Timed get up and go

Question 22

Content: TUG (5)

Answer 22

1. Stand from a seated position
2. Walk ~10 ft
3. Turn around
4. Return to seated position in chair
5. Normal time < 10 seconds

Question 23

Content: Life choices and bone health (5)

Answer 23

1. Adequate Ca intake (~1200 mg/day)
2. Optimal Vit D levels
3. WB exercise
4. Avoid tobacco use
5. Avoid excessive alcohol use

Question 24

Q: How much Ca is in 8 oz of milk?

Answer 24

300 mg

Question 25

Q: What calcium supplements are available?

Answer 25

1. Calcium carbonate 2. Calcium citrate

Question 26

Content: Calcium carbonate (2)

Answer 26

1. Needs stomach acid for absorption 2. Taken with meals

Question 27

Content: Calcium citrate

Answer 27

Can be taken with or without food

Question 28

Content: Calcium supplements (2)

Answer 28

1. Limit to ~500 mg in a dose 2. May cause constipation

Question 29

Content: Vitamin D supplementation (5)

Answer 29

1. Vit D2 - ergocalciferol 2. Vit D3 - cholecalciferol 3. supplementation guided by 250HD value 4. Can be taken with or without food 5. Safe upper limite = 2,000IU

Question 30

Diagram: Vit D formation

Answer 30

Question 31

Q: What is the recommendation for exercise to prevent osteoporosis?

Answer 31

30 min, most days of running, walking, or elliptical + muscle stregnthening and balance exercises

Question 32

T/F: WB activities decrease BMD.

Answer 32

False

Question 33

T/F: High impact WB exercise increased BMD by 1-2% at the spine and hip.

Answer 33

True

Question 34

Q: What type of training increased spine BMD?

Answer 34

Resistance

Question 35

Q: What type of training increased hip BMD?

Answer 35

high impact

Question 36

T/F: Menstraul cycle effects gains in BMD.

Answer 36

True

Question 37

Q: Who will be referred to PT for osteoporosis type treatment?

Answer 37

Those at increased risk or fall, unstable gait, weakness

Question 38

Q: What are pharmacologica treatment options for low bone mass? (4)

Answer 38

1. Bisphosphonate 2. Teriparatide 3. Denosumab 4. Selective Estrogen Receptor Modulators

Question 39

Content: Types of Bisphosphonates (4)

Answer 39

1. Alendronate -wkly 2. Risedronate - wkly/moly 3. Ibandronate - moly/IV every 3 mo 4. Zolendronic Acid - IV annually

Question 40

Diagram: Mechanism of Action of Bisphosphonates - Osteoclasts are targets

Answer 40

Question 41

Content: Side Effects of Bisphosphonates (6)

Answer 41

1. Upper GI irritation 2. Osteonecrosis of the jaw 3. Severe musculoskeletal pain 4. HypoCa 5. Scleritis 6. Atypical femur fractures

Question 42

Content: Teriparatide (2)

Answer 42

1. Anabolic (bone building agent) 2. Daily injection

Question 43

Content: Denosumab (3)

Answer 43

1. Inhibits osteoclast function 2. Decreases bone resorption 3. Consider in pts. with kidney dysfunction

Question 44

Q: What medications put you at high risk for osteoporosis? (3)

Answer 44

1. Steroids 2. Aromatase inhibitors 3. Androgen deprivation therapy

Question 45

Q: For bone health how often should bone density be evaluated?

Answer 45

On treatment = every 1-2 years Not on treatment = every 2 years