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MOHD Keystone Exam 1 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Skeletal disease defined by compromised bone strength, increased risk of fracture

A

Osteoporosis

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2
Q

Increased bone resorption and decreased bone formation causes

A

Osteoporosis

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3
Q

These are the four phases of bone activity

A

Quiescent phase
Resorption phase
Formation phase
Quiescent phase after remodeling

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4
Q

Measures areal bone mineral density in gm/cm2, compares patient’s BMD to normative data

A

Duel-energy X-ray absorptiometry (DXA)

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5
Q

BMD score 0 to -1

A

normal

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6
Q

SERM medication, binds estrogen receptor

A

Raloxifene

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7
Q

Alendronate
Risendronate
Ibandronate
Zoledronic Acid

A

Bisphosphonates

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8
Q

BMD score of -2.5

A

osteoporosis

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9
Q

Hormones for osteoporosis

A

Calcitonin, Estrogen

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10
Q

Standard deviation difference between patient’s BMD and mean BMD of age-matched reference population

A

Z-score

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11
Q

Agonist, antagonist properties depending on target organ

A

Raloxifene

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12
Q

BMD score -1 to -2.5

A

low bone density for age (“osteopenia”)

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13
Q

Associated with estrogen use

A

breast cancer, cardiovascular

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14
Q

Raloxifene is an estrogen ______ in bone

A

agonist

  • -> inhibits osteoclasts
  • -> improves BMD
  • -> decreases fracture risk
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15
Q

May be used for Paget’s disease of the bone

A

Calcitonin

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16
Q

Standard deviation difference between patient’s BMD and mean BMD of young adult

A

T-score

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17
Q

Anabolic osteoporosis medication

A

teriparatide

18
Q

Raloxifene is an estrogen ________ in breast tissue

A

antagonist

–> reduces risk of breast cancer

19
Q

disrupts protein prenylation –> cytoskeletal abnormalities in osteoclast –> detachment from bone –> reduced bone resorption

A

Bisphosphonates

20
Q

Induces differentiation and maturation of osteoblast precursors, increases preexisting osteoblast function, reduces osteoblast apoptosis: increases BMD and decreases fractures

A

teriparatide

21
Q

Risk factors for fracture

A

Prior fragility fracture,
parental history of hip fracture, glucocorticoid therapy, excess OH intake (>3/day), rheumatoid arthritis, cigarette smoking

22
Q

Menopause, Advanced Age, Familial predisposition

A

Primary causes of bone loss

23
Q

Side effects of Raloxifene

A

DVT, hot flashes

24
Q

Possible secondary causes of bone loss:

A 
Medications (excess glucocorticoids)
Renal disease
Vitamin D, calcium deficiency
Hyperparathyroidism
Idiopathic hypercalciuria (renal wasting)
Hyperthyroidism
Premature menopause/hypogonadism
Multiple myeloma
Cushing's syndrome
Malabsorption (IBD, celiac) or malnutrition (anorexia)
Smoking/excess OH
Inflammatory diseases (RA)
25
Q

Impair osteoclast function, decrease differentiation, increase apoptosis –> increase BMD, decrease fracture

A

Bisphosphonates

26
Q

Non-pharm treatment for osteoporosis

A

Used for all patients
Calcium (12-1500/day)
Vitamin D (800/day)

27
Q

Action of bisphosphonates

A

Inhibit farnesyl pyrophosphate synthase enzyme in mevalonate pathway (cholesterol biosynthetic pathway)

28
Q

Who to treat for osteoporosis

A

T score less than -2.5
Low trauma fracture
T score of -1 to -2.5 if other risk

29
Q

Side effects include: esophagitis, flu-like symptoms, bone/muscle pain, hypocalcemia, atypical subtrochanteric fractures, osteonecrosis

A

Bisphosphonates

30
Q

Biologic receptor activator of nuclear factor kappa-B ligand

A

Denosumab

31
Q

Increases BMD, decreases fractures

A

Denosumab

32
Q

Side effects include hypocalcemia, infections, concerns about neoplastic effects/subtrochanteric fractures/ONJ

A

Denosumab

33
Q

Use this for post-menopausal women, men over 50

A

T-score (compare to young population)

34
Q

Used for children, premenopausal women, men under 50

A

Z-score (compare to peers)

35
Q

Antiresorptive drugs

A

SERMs, Bisphosphonates, Biologic, Hormones

36
Q

Antiresorptives work by

A

Inhibiting osteoclasts, reestablish balance between osteoclasts/osteoblasts, stop bone loss (do not gain bone density)

37
Q

Neutral effect on cardiovascular system, endometrium

A

Raloxifene

38
Q

Avoid these if patient has upper GI disease, Barret’s esophagus

A

Bisphosphonate oral drugs

39
Q

May have some effect on acute pain control

A

Calcitonin

40
Q

Where is the DXA scan measuring bone density?

A

hip, lumbar spine

MOHD Keystone Exam 1 (14 decks)

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