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Clinical Medicine Ortho > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

progressive decrease in bone mass that results in increased bone fragility and a higher fracture risk

-loss of bone mass and bone strength

bone mineral density > 2

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2
Q

What is osteopenia?

A

low bone density with bone mineral density (BMD) between -1 and -2.5

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3
Q

What is primary osteoporosis?

A

-idiopathic (80% of women and 60% of men with osteoporosis

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4
Q

What is stage 1 primary osteoporosis?

A
  • occurs in post-menopausal women
  • accelerated trabecular bone loss
  • vertebral body and distal forearm fracture
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5
Q

what is stage 2 primary osteoporosis?

A
  • both men & women >70;
  • trabecular and cortical bone loss;
  • fractures of proximal humerus, proximal tibia, femoral neck, and pelvis
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6
Q

What is secondary osteoporosis?

A
  • common feature of another disease process

- inheritable disease of connective tissue or drug side effect -(Affects 20% of women and 40% of men)

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7
Q

What are some risk factors of osteoporosis?

A
  • 5x increase each decade after 40
  • family hx of hip fracture
  • Ethnicity: whites > asians & hispanics > blacks > polynesians
  • poor nutrition (calcium deficiency)
  • physical inactivity
  • meds (chronic corticosteroid use, anticonvulsants, anticoagulants)
  • tobacco, alcohol
  • high caffeine intake
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8
Q

What are some chronic disease states that can increase a patients risk of osteoporosis?

A
  • estrogen deficiency
  • androgen deficiency
  • hyperparathyroidism
  • IBS
  • diabetes
  • hypercortisolism
  • cirrhosis
  • malabsorption
  • gastrectomy
  • multiple myeloma
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9
Q

what is the most important influence on bone density?

A

hereditary

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10
Q

when does bone mass peak?

A

beginning of third decade

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11
Q

which peaks first in bone mass density:

  • skeletal/appendicular, or
  • spine/axial?
A

skeletal/appendicular (ages 18-20)

spine/axial peaks at ages 25-30

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12
Q

Bone modeling, an increase in bone mass and size, is done through what?

A

Endochondral ossification of the axial skeleton

Periosteal application of the appendicular skeleton

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13
Q

bone remodeling is the process of?

A

bone resorption and subsequent formation that results in repair of damaged bone

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14
Q

Bone remodeling provides what to the systemic circulation?

A

calcium

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15
Q

The cellular apparatus that facilitates remodeling is the B<u></u>

A
  • bone resorbing osteoclasts
  • bone forming osteoblasts
  • bone lining cells
  • embedded osteocytes
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16
Q

In a BMU, the first 10-20 osteoclasts resorb old or damaged tissue. they then recruit how many osteoblasts to produce new bone matrix?

A

1000-2000 osteoblasts

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17
Q

osteocytes account for what percent of bone cells?

A

90-95% cells

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18
Q

osteocyte activity produces active release of

A

cytokines (RANKL and OPG) for osteoclast development

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19
Q

the balance of RANKL and OPG cytokines determine what?

A

the rate of bone resorption

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20
Q

how does paget’s disease affect bone structure?

A

it is abnormal bone formation

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21
Q

how does the loss of estrogen increase resorption of bone?

A
  • increases upregulation of cytokines (RANKL)

- decreases OPG production (inhibits resorption)

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22
Q

why is there a slower rate of bone loss in older obese women?

A

estrogen stores in adipose tissue

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23
Q

Low vitamin D (25-hydroxy) can acelerate bone loss but can also result in what?

A

secondary hyperparathyroidism

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24
Q

What are the signs and symptoms of osteoporosis?

A

commonly none, can have dorsal kyphosis (dowagers hump) and loss of height

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25
Q

what are the most common fractures associated with osteoporosis?

A

spine/vertebral fractures

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26
Q

kyphosis (dowagers hump) is due to

A

vertebral fractures

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27
Q

what type of fracture has a risk that increases exponentially with age?

A

proximal femur - costly! usually due to a fall

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28
Q

what fractures are common prior to age 60, but then decreases in risk

A
  • distal forearm (esp: Colles)
  • proximal humerus
  • pelvis
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29
Q

what might a patient complain about with a spinal fracture?

A
  • may or may not have pain
  • fell and heard a “pop” followed by sharp midline back pain
  • back is “tired” and feels better when they sit or lie down
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30
Q

what percent of women with type 1 osteoporosis have associated secondary causes?

A

20%

31
Q

what measured height loss suggests a vertebral fracture?

A

> 4 cm

32
Q

how is the diagnosis of osteoporosis made?

A

bone mineral density (BMD)

33
Q

what does DEXA stand for?

A

Dual-Energy X-ray Absorptiometry

34
Q

who should get a bone density test (bone densitometry)?

A
  • all women over 65
  • all women under 65 with risk factors (weight under 127 lbs, parental history of hip fracture, use of medication that causes bone loss, smokers, alcoholics, or RA)
35
Q

DEXA scores are called T scores; what are the scores for:

  • normal
  • osteopenia
  • osteoporosis
A
  • normal: above -1
  • osteopenia: -1 to -2.5
  • osteoporosis: below -2.5
36
Q

lower T-scores reflect ______ bone density

A

lower

37
Q

what does a Z score do?

A

compares bone density to what is normal for someone of comparable age and body size; can be misleading

38
Q

what is a normal Z score?

A

above -2

39
Q

for whom do experts recommend using a Z score for?

A
  • children
  • teens
  • women still having periods
  • younger men
40
Q

repeat BMD testing for women with normal bone density of mild osteopenia

A

10-15 years

41
Q

repeat BMD testing for women with moderate osteopenia

A

3-5 years

42
Q

repeat BMD testing for advanced osteopenia

A

annually

43
Q

most DEXA cannot measure BMD in patients weighing more than

A

300 lbs; try peripheral BMD of forearm or heel

44
Q

other screening tests for BMD?

A
  • PDXA (peripheral dual energy xray absorptiometry)
  • QUS (quantitative ultrasound)
  • PQCT (peripheral quantitative computed tomography)
45
Q

what other imaging tests can help evaluate bone health?

A

nuclear bone scans

  • CT scans
  • MRIs
46
Q

What are some lab tests you can run?

A
  • serum BMP (eval for renal and hepatic function)
  • parathyroid hormone levels
  • CBC (nutritional status)
  • thyroid function tests
  • 25-hydroxyvitamin D
  • serum calcium
  • 24 hr urine for calcium
  • testosterone for men
47
Q

what are 2 bone resorption markers that can be found on biochemical marker tests in relation to bone density?

A
  • NTX: N-telopeptide cross links

- CTX: C-telopeptides

48
Q

are the levels of resorption markers high or low in high turnover osteoporosis?

A

high

49
Q

are the levels of resorption markers high or low in low-normal turnover osteoporosis?

A

low or normal; no accelerated bone loss

50
Q

what type of therapy does high turnover osteoporosis respond best to?

A

anti-resorptive therapy

51
Q

what type of therapy does low turnover therapy respond best to?

A

drugs that enhance bone formation

52
Q

do most premenopausal women with low bone density have an increased risk of breaking a bone?

A

no

53
Q

are osteoporosis medications approved for premenopausal women?

A

no

54
Q

if a pregnant mother doesn’t have enough calcium to meet the fetus’ needs, what will the fetus do?

A

take it from her bones

55
Q

does pregnancy associated osteoporosis go away?

A

yes, it’s rare and goes away shortly after birth

56
Q

does having more children increase a woman’s chances of getting osteoporosis?

A

no, actually the opposite, it can help protect the woman from osteoporosis and broken bones

57
Q

can breast feeding cause bone loss?

A

yes but it’s temporary

58
Q

what are some common ways to help prevent bone loss?

A
  • minimize risk factors
  • stop smoking
  • resistance and high-impact exercise
  • supplemental calcium and vitamin D
59
Q

what are some first line treatments in women that can help combat osteoporosis?

A
  • supplemental calcium
  • supplemental vitamin D
  • bisphosphonates
  • denosumab
60
Q

women 19-50 and men 19-70 can take how many mg of supplemental calcium?

A

1000 mg

61
Q

women over 50 and men over 70 can take how many mg of supplemental calcium?

A

1200 mg

62
Q

amount of supplemental vitamin D age 19-70

A

600 IU/day

63
Q

amount of supplemental vitamin D age 71+

A

800 IU/day

64
Q

how do bisphosphonates help to decrease bone loss?

A

decrease bone resorption by decreasing osteoclast activity

ibandronate: monthly; alendronate, risedronate: weekly; zoledronic acid IV: yearly

65
Q

how does denosumab (monoclonal antibody) help to decrease bone loss?

A

decreases bone resorption by inhibiting formation and activity of osteoclasts

(60 mg every 6 months)

66
Q

what are some second line treatments to help combat osteoporosis in women?

A
  • parathormone (daily injection)

- selective estrogen receptor modulators (raloxifine)

67
Q

what are some last line treatments to help combat osteoporosis in women?

A
  • calcitonin
  • HRT/ERT (sig. cardiac risk)
  • combination estrogen/alendronate or estrogen-progestin/alendronate
68
Q

what are some FDA approved treatments for women to combat bone loss even if they don’t have an indication of osteoporosis?

A
  • calcitriol (stimulates calcium and phosphorus absorption)
  • etidronate (paget’s disease or hypercalcemia; inhibits osteoclast activity)
  • thiazide
69
Q

who is more likely to die within a year after breaking a hip, men or women?

A

men, due to problems related to the break

70
Q

what are some risk factors for osteoporosis in men?

A
  • hypogonadism
  • hyperthyroidism
  • GI disorders
  • anticonvulsant meds
  • excess alcohol intake
  • hypercalciuria
  • immobilization
  • glucocorticoid therapy
71
Q

what is primary treatment for osteoporosis in men?

A

-supplemental calcium and vitamin D

72
Q

what are some other treatments for osteoporosis in men?

A
  • bisphosphonates

- parathyroid hormone

73
Q

what body parts should be evaluated by the DEXA?

A
  • hip
  • spine
  • wrists

Clinical Medicine Ortho (42 decks)

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