Osteoporosis Flashcards
What is the definition of osteoporosis?
- reduction in the strength of bone that leads to increased risk of fractures
- decreased bone density
Define osteoporotic
- T score of -2.5
Define osteopenic
- postmenopausal women with T score between -1.0 & -2.5
What is the most common bone disease?
- osteoporosis
Why are the morbidity & indirect mortality rates so high with osteoporosis?
- complications of the tx of fxs
Fractures of _____ _____ increase in frequency before age _____ and plateau by age _____ w/only a modest _____ after.
- distal radius
- 50
- 60
- increase
What is the incidence rate for hip fractures after age 70?
- doubles q 5y
What are the complications of osteoporosis?
FRACTURES
- wrist
- hip
- vertebral
What are the types of osteoporosis?
- primary
- secondary
What are the types of primary osteoporosis?
- type I
- type II
What is type I primary osteoporosis?
- postmenopausal
- rapid bone loss w/in 6y of menopause, mainly trabecular bone
What is type II primary osteoporosis?
- senile (men & women >75 y/o)
- slow progression
- both cortical & trabecular bone
What are the types of secondary osteoporosis?
- sex hormone deficiency
- hormone excess
- increased bone resorption/formation ratio
- multifactorial
What are the types of risk factors for osteoporosis?
- non-modifiable
- potentially modifiable
- chronic disease
- medications
What are the non-modifiable risk factors for osteoporosis?
- postmenopausal
- white race
- advanced age
- personal hx of fx of adult
- hx of fx in 1st degree relative
- dementia
What are the potentially modifiable risk factors of osteoporosis?
- low body wt
- current cigarette smoking
- ETOH abuse
- low Ca intake
- Vit D deficiency
- inadequate physical activity/immobility
What is the MC medication risk factor for osteoporosis?
- glucocorticoids
What is the function of bone remodeling?
- repair micro damage w/in skeleton to maintain skeletal strength
- supply Ca from skeleton to maintain normal serum Ca levels
What is bone remodeling regulated by?
- estrogen
- androgens
- vit D
- PTH
- growth factors
What are the S&S of osteoporosis?
- asymptomatic unless pt fxs
- gradual height loss
- increased kyphosis of t-spine
- pain
How is osteoporosis diagnosed?
- clinically
AND - DEXA scan
How do labs help in the dx of osteoporosis?
- r/o secondary causes
What imaging is done for dx of osteoporosis?
- DEXA
What do the DEXA results mean?
- T score > -2.5 = osteoporosis
- T score b/t -1.0 & -2.5 = osteopenia
What is the non-pharm tx for osteoporosis?
- tx underlying fx
- reduce underlying modifiable risk factors
- improve nutrition (Ca & vit D suppl)
- wt bearing ex.
What is the pharm tx for osteoporosis?
- bisphosphonates
- SERMs (selective estrogen receptor modulators) (not as effective as bisphos)
- estrogen
- calcitonin (rarely used)
- PTH
- testosterone
What is the MOA of bisphosphonates?
- inhibit osteoclast-induced bone resorption
increases bone density
What are the side effects of bisphosphonates?
- osteonecrosis of the jaw
- esophagitis
- esophageal CA
What is the tx length of bisphosphonates & why?
- 5 years
- 1/2 life = 10 years
What is the use of SERMs?
- prevention of osteoporosis in postmenopausal women
- reduces vertebral fx risk only
What is the use of estrogen for osteoporosis?
- not recommended as 1st line tx
- prevention
What is the use of calcitonin for osteoporosis?
- reduces # of new vertebral fx only
- not used in prevention
What is the MOA of PTH for osteoporosis?
- stimulates osteoblasts
- increases bone formation
What is PTH approved for in tx of osteoporosis?
- both men & women
When is T used for osteoporosis tx?
- hypogonadal men to prevent osteoporosis
