Osteoporosis Flashcards
Dual energy X-ray absorptiometry measures which areas?
o Spine L1-L4
o Hip: femoral head + total head
Standard deviation difference between patient’s BMD and mean BMD of 30 y/o healthy adults of same sex and race
T-Score
Standard deviation difference between patient’s BMD and mean BMD of age-matched (age/sex/race) reference population
Z-Score
-1 → -2.5 T-score =
Osteopenia
Name the feature:
Clinical diagnosis of osteoporosis independently of BMD
Low trauma fracture = fracture occurring w/ a fall from standing height
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
D.
Smoking is also a risk factor
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
C.
A. Women >65
B. Men > 70
D. Men 50-70 if at major risk
Name the test(s) to evaluate the following causes of secondary osteoporosis:
Renal disease
Creatinine
Electrolytes
Name the test(s) to evaluate the following causes of secondary osteoporosis:
Vitamin D deficiency
25 hydroxyvitamin D
Name the test(s) to evaluate the following causes of secondary osteoporosis:
Hyperparathyroidism
Calcium
Phosophorus
Albumin
PTH
Name the test(s) to evaluate the following causes of secondary osteoporosis:
Idiopathic hypercalciuria
24 hour urine calcium
Name the test(s) to evaluate the following causes of secondary osteoporosis:
Hyperthyroidism
TSH
Name the test(s) to evaluate the following causes of secondary osteoporosis:
Multiple myeloma
CBC
SPEP/UPEP
Name the test(s) to evaluate the following causes of secondary osteoporosis:
Cushing’s syndrome
24 hr UFC
1 mg dexamethasone suppression or salivary cortisol
Which of the following bisphosphonates is/are not taken IV? A. Ibandronate B. Zoldronic acid C. Pamidronate D. Alendronate
D
*Pamidronate is NOT used for osteoporosis. Used for severe hypocalcemia
Target level of 25OH vitamin D in osteoporosis patients
30
Atypical subtronchanteric fractures are seen as a side effect of:
Bisphosphonates
o Drug inhibits osteoclast → loss of ability to repair bone
Name the class of drug: Raloxifene
Antiresorptive:
SERM = Selective Estrogen Receptor Modulators
Action of drug:
Raloxifene
Binds to estrogen receptor
Estrogen agonist in bone –> inhibit osteoclasts
Estrogen antagonist in breast tissue –> reduces risk of breast cancer
T/F: Raloxifene is the most potent antiresorptive.
False: less potent than bisphosphates and denosumab
Name the class of drugs: Impair osteoclast function, decrease differentiation, increase apoptosis
Bisphosphonates
Which of the following bisphosphonates is/are not taken PO? A. Alendronate B. Zoledronic acid C. Resedronate D. Ibandronate
B
Which of the following is NOT a side effect of bisphosphonates? A. Esophagitis B. Flu-like symptoms C. Hypercalcemia D. Bone and muscle pain
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
Typical approach to bisphosphonate treatment
Stop drug every 4-5 years for 4-5 years to give bones a chance to repair microfractures
Osteonecrosis of jaw seen as a side effect of:
Bisphosphonates
Decreased jaw bone turnover (microcracks) + antiangiogenic effects of BP (necrotic bone) (decreased blood flow) + microbes tracking into bone
Name the drug:
Binds to RANKL before it can bind to RANK (on osteoclast) and activate osteoclast
Denosumab
Denosumab administration
SubQ injection q 6 months
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
C. No renal restriction
Name the drug:
Anabolic agent
Induces differentiation and maturation of osteoblast precursors
Teriparatide = Human recombinant PTH1-34
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
B. Very expensive
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
B. Last 5 years