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Keystone: Exam 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Dual energy X-ray absorptiometry measures which areas?

A

o Spine L1-L4

o Hip: femoral head + total head

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2
Q

Standard deviation difference between patient’s BMD and mean BMD of 30 y/o healthy adults of same sex and race

A

T-Score

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3
Q

Standard deviation difference between patient’s BMD and mean BMD of age-matched (age/sex/race) reference population

A

Z-Score

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4
Q

-1 → -2.5 T-score =

A

Osteopenia

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5
Q

Name the feature:

Clinical diagnosis of osteoporosis independently of BMD

A

Low trauma fracture = fracture occurring w/ a fall from standing height

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6
Q 
Which of the following is NOT a risk factor of osteoprosis?
A. Prior fragility fracture
B. Parental history of hip fracture 
C. Glucocorticoid therapy
D. Obesity
E. Excessive alcohol intake 
F. Rheumatoid arthritis
A

D.

Smoking is also a risk factor

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7
Q 
Which of the following is TRUE about the patients that should be tested for osteoporosis?
A. Women > 50 
B. Men > 65
C. Postmenopausal women 
D. Men 60-75
A

C.

A. Women >65
B. Men > 70
D. Men 50-70 if at major risk

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8
Q

Name the test(s) to evaluate the following causes of secondary osteoporosis:
Renal disease

A

Creatinine

Electrolytes

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9
Q

Name the test(s) to evaluate the following causes of secondary osteoporosis:
Vitamin D deficiency

A

25 hydroxyvitamin D

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10
Q

Name the test(s) to evaluate the following causes of secondary osteoporosis:
Hyperparathyroidism

A

Calcium
Phosophorus
Albumin
PTH

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11
Q

Name the test(s) to evaluate the following causes of secondary osteoporosis:
Idiopathic hypercalciuria

A

24 hour urine calcium

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12
Q

Name the test(s) to evaluate the following causes of secondary osteoporosis:
Hyperthyroidism

A

TSH

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13
Q

Name the test(s) to evaluate the following causes of secondary osteoporosis:
Multiple myeloma

A

CBC

SPEP/UPEP

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14
Q

Name the test(s) to evaluate the following causes of secondary osteoporosis:
Cushing’s syndrome

A

24 hr UFC

1 mg dexamethasone suppression or salivary cortisol

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15
Q 
Which of the following bisphosphonates is/are not taken IV?
A. Ibandronate
B. Zoldronic acid
C. Pamidronate
D. Alendronate
A

D

*Pamidronate is NOT used for osteoporosis. Used for severe hypocalcemia

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16
Q

Target level of 25OH vitamin D in osteoporosis patients

A

30

17
Q

Atypical subtronchanteric fractures are seen as a side effect of:

A

Bisphosphonates

o Drug inhibits osteoclast → loss of ability to repair bone

18
Q 
Name the class of drug:
Raloxifene
A

Antiresorptive:

SERM = Selective Estrogen Receptor Modulators

19
Q

Action of drug:

Raloxifene

A

Binds to estrogen receptor

Estrogen agonist in bone –> inhibit osteoclasts
Estrogen antagonist in breast tissue –> reduces risk of breast cancer

20
Q

T/F: Raloxifene is the most potent antiresorptive.

A

False: less potent than bisphosphates and denosumab

21
Q 
Name the class of drugs:
Impair osteoclast function, decrease differentiation, increase apoptosis
A

Bisphosphonates

22
Q 
Which of the following bisphosphonates is/are not taken PO?
A. Alendronate
B. Zoledronic acid
C. Resedronate
D. Ibandronate
A

B

23
Q 
Which of the following is NOT a side effect of bisphosphonates?
A. Esophagitis
B. Flu-like symptoms
C. Hypercalcemia
D. Bone and muscle pain
A

C. Hypocalcemia

A. Esophagitis w/ oral: avoid in upper GI disease or Barret’s esphogus
B. w/ IV
D. rare but w/ oral or IV

24
Q

Typical approach to bisphosphonate treatment

A

Stop drug every 4-5 years for 4-5 years to give bones a chance to repair microfractures

25
Q

Osteonecrosis of jaw seen as a side effect of:

A

Bisphosphonates
Decreased jaw bone turnover (microcracks) + antiangiogenic effects of BP (necrotic bone) (decreased blood flow) + microbes tracking into bone

26
Q

Name the drug:

Binds to RANKL before it can bind to RANK (on osteoclast) and activate osteoclast

A

Denosumab

27
Q

Denosumab administration

A

SubQ injection q 6 months

28
Q 
Which of the following is NOT a possible side affect of Denosumab?
A. Hypocalcemia
B. Infection
C. Renal failure
D. Subtronchanteric fractures
E. Osteonecrosis of jaw
A

C. No renal restriction

29
Q

Name the drug:
Anabolic agent
Induces differentiation and maturation of osteoblast precursors

A

Teriparatide = Human recombinant PTH1-34

30
Q

Which of the following is NOT a feature of Teriparatide?
A. Daily SC injection
B. Cheap
C. FDA mandated 2 year treatment limit
D. Contraindicated for pts at higher risk of osteosarcoma

A

B. Very expensive

31
Q

Which of the following is NOT a contraindication for Teriparatide?
A. Pts at high risk of osteosarcoma
B. Pts w/ cancer within the last 3 years
C. Pts w/ elevated PTH

A

B. Last 5 years

Keystone: Exam 1 (12 decks)

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