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Ortho > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Risk factors for osteoporosis

A

age, gender (F>M), race, low body weight (>127), smoking (control), FH, excessive alcohol consumption, previous factor, chronic steroid use, RA, secondary osteoporosis

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2
Q

ACCESS leads to osteoporosis

A

alcohol use, corticosteroids,, calcium low, estrogen low, smoking, sedentary lifestyle

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3
Q

causes of Primary Osteoporosis

A 
Hormone deficiency
Estrogen
Testosterone (in men)
Risk factors
Sedentary lifestyle
Smoking
Age
Body size
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4
Q

causes of secondary Osteoporosis

A 
Hormone excess
Cushing’s Syndrome
Thyrotoxicosis
Hyperparathyroidism
Alcoholism
Celiac Disease (malabsorption)
Medications
Chronic steroid use
Anticonvulsants
Depo-provera
SSRI’s
Rosiglitazone
PPI’s
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5
Q

pathophysiology

A

imbalance between bone resorption (exceeds) and bone formation
osteoclast activity exceeds osteoblast activity

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6
Q

Signs and Sxs

A 
Asymptomatic until fracture occurs
Loss of height
-1.5 inches or more since young adult
-.5 inches in one year
Kyphosis - Dowager’s hump
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7
Q

Diagnostic Studies (general)

A

Serum Vitamin D 25 (OH)
31-100 ng/ml (normal)
< 31 ng/ml = Vit D insufficiency
< 20 ng/ml= Vit D deficiency

TSH
CMP
CBC (anemia)

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8
Q

what levels of vit D increases peoples risk of fracture

A

Levels < 31 ng/ml - risk of fracture

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9
Q

normal vit D levels

A

40-60

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10
Q

people w/ vit D def are at an increase risk in developing what?

A

Autoimmune diseases
MS
Type I diabetes
Also associated w/ HTN and Cardiovascular disease

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11
Q

factors contributing to vit D def

A 
Advancing age
Inadequate sun exposure
Insufficient dietary intake of vit D
Dark skin complexion
Malabsorption disorders, liver diseases and kidney disease
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12
Q

gold standard for diagnosing osteopenia and osteoporosis

A

Dual-energy x-ray absorptiometry(DXA scan) aka Bone Density Test

Repeat every 2-3 years
non-invasive

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13
Q

T- score

A

Bone density of pt compared to bone density of young normal mean (depends on age) expressed as SD
Usually use for Older pts
compare score to normal mean

USUALLY GO BY T

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14
Q

Z- score

A

Bone density in premenopausal women, children and younger men
used in younger pts
compare to age and sex

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15
Q

normal T score

A

> -1

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16
Q

T score for osteopenia (low bone mass)

A

between -1 and -2.5

17
Q

T score for osteoporosis

A

< -2.5

18
Q

when to first order a DXA scan?

A

first at age 65… unless risk factors:

19
Q

risk factors where you would order a DXA scan sooner than 65?

A
  1. Late menarche and/or early menopause
  2. Low BMI < 21 or wt <127 lbs
  3. Smoker
  4. Hx of low trauma fracture of hip, wrist, spine, possibly ankle
  5. Hx of hip fx in parent
  6. FH of osteopenia/osteoporosis
  7. Pts on chronic steroids or other meds known to contribute to bone loss
20
Q

what is the most common site for osteoporosis related-fractures?

A

vertebrae, hip, distal radius

21
Q

key for management of osteoporosis

A

prevention and early detection

22
Q

preventative management

A

*1. Meeting daily calcium and vitamin D requirements throughout entire lifetime (500-600 mg BID if 51 years old for calcium, oral vit D3 800-2,000)
*2. Weight-bearing activities
(walking, upper body dumbbells and lower body leg weights, senior programs aerobics/water aerobics)
3. Smoking cessation
4. Limit alcohol intake
5. Limit excessive caffeine intake
6. fall prevention

23
Q

medications for tx

A
  1. Bisphosphonates - Inhibits osteoclast
    Fosamax (alendronate), Actonel or Atelvia (risedronate), Boniva (ibandronate)
    Reclast (zoledronic acid) IV
  2. Teriparatide (Forteo)
    Daily SQ injection for 2 years,
    PTH analog - stimulates production new bone matrix
  3. Raloxifene (Evista) - SERM
    60mg po QDaily
    Dual purpose: prevent bone loss and prevent risk of invasive breast cancer
  4. Denosumab (Prolia)-
    Monoclonal ab that inhibits osteoclast activity
24
Q

Bisphosphonates

A
  1. Must be taken with full glass of water (tap, no mineral or well) first thing in the morning.
  2. *No eating, drinking, or taking other medications for 30 minutes
  3. Must remain upright for 30 minutes to decrease risk of GI side effects and help w/ absorption
  4. *Do not take calcium along with bisphosphonate
  5. Non-compliance can be an issue
25
Q

SE of Bisphosphonates

A
  1. GI
    Dyspepsia, GERD, esophagitis, esophageal ulcers
    *DO NOT give to pts with hx of any of the above!
    Most common SE are nausea and heartburn after taking pill
  2. MSK
    Arthralgias
    *Osteonecrosis of the Jaw (ONJ)
    –> RARE. Reported cases were in cancer patients receiving IV med (zoledronic acid IV for MM)
  3. increase risk of atypical femur fracture (causes cortical thickening of femoral shaft, could have a fracture through area and not see it)
26
Q

Raloxifen

A

SERM

Contraindications -DVT or PE history or stroke

Side effects -Hot flashes, flu-like sxs, joint pain, HA

Acts like estrogen on bones to reduce bone loss

decreases risk of invasive breast cancer

27
Q

Teriparatide

A

SQ daily injection for 2 years
need to be put on bisphos after 2 yrs

Only medication for osteoporosis that will actually build bone (works on osteoblasts)

Contraindication- Hx radiation therapy

SE -Irritation at injection site, joint pain, dizziness, nausea, (osteosarcoma in rats studies)

*New bone doesn’t get mineralized unless you have normal vitamin D levels

28
Q

Denosumab

A

SQ injection abdomen, arm, or thigh Q6 mos.

MOA-
RANK ligand (RANKL) inhibitor
Prevents bone resorption

Side effects
Back pain, hypercholesterolemia, pain in arms or legs, muscle pain, osteonecrosis of jaw (ONJ)

29
Q

wide compression fracture …

A

do not put on fosmax
give teriparatide
do a kyphoplasty

30
Q

who should be treated medically for osteoporosis

A

Pts on chronic steroids

T score < 2.5, low bone mass

Pts w/ prior fractures

Transplants, COPD, RA, IBD

GERD pts on PPI’s

DM pts on rosiglitazone (Avandia)

Pts with celiac dz

Ortho (5 decks)

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