OSTEOPOROSIS Flashcards
What is the most common metabolic bone disease?
Osteoporosis
When does bone density increase & peak?
Increases dramatically in puberty Peaks in young adults (early 20’s)
What are some determinants to bone density?
Age, race, genetics, timing of puberty (delayed or premature menopause), exercise, calcium intake
Genetics!
When does bone loss begin?
Begins before menses cease; accelerated the first 5-10 years post menopause!!
Ongoing after age 60
Where is most of the bone loss occurring?
Trabecular (cancellous) > cortical (compact) bone
What is causing the increased bone loss?
Increased bone resorption
From sex hormone deficiency = hypogonadism
Hyperparathyroidism = increased PTH
Thyrotoxicosis = Increased bone metabolism
Alcoholism, anorexia, and vitamin D deficiency
What must we ALWAYS ask about in a post-menopausal female when taking a history?
Family history of osteoporosis!
Define osteopenia vs. osteoporosis
Osteopenia = BMD 1-2.5 SD below peak bone density
Osteoporosis = BMD >2.5 SD below peak
How is “peak bone density” determined?
Comparison to bone density of a young healthy adult of same gender and race
In an elderly person, what signs & symptoms might we look for in association with osteoporosis?
Back pain, decrease in height, kyphotic deformity
We must remember that men have osteoporosis too. How does their lifetime risk compare to women’s? How do men with osteoporosis do after a hip fracture?
15-25% vs. 50% in females
They do not do well, 36% of men with hip fractures die the following year
What will you often find on labs for osteoporosis?
NORMAL ionized calcium, PO4
Vitamin D levels low (can be lacking due to diet & sun!)
When indicated test: TSh, cortisol, estradiol, testosterone, PTH
What is our test of choice for osteoporosis?
Bone densitometry: DEXA
What does a DEXA scan look at?
Spinal bone, proximal femur, and other bones (distal radius)
Looks at both trabecular & cortical bone
If a patient has an unexplained hip fracture, or minimal to no trauma, and you get a DEXA scan and she is 1 SD below peak, what does she have?
Severe Osteoporosis!! (not osteopenia, she is automatically put into a higher category)
If a patient has a DEXA scan and the score comes back 2 SD below peak, what treatment would you give her?
Calcium (if she doesn’t meet requirements) Vitamin D (even if levels are normal)
When do we screen for osteoporosis?
Early postmenopause + risk factors
Or >65
What are risk factors for osteoporosis?
Family history, malnourished, alcoholism, renal failure
At what point do you initiate therapy?
Osteoporosis (>2.5 SD below peak)
Presence of “fragility” fracture
Once you start a patient on treatment, can it reverse osteoporosis?
No – can only increase bone density, decrease factures, and halt/slow progression
What are the treatment options for osteoporosis?
Treat underlying etiology; bisphosphonates; SERMS; Calcitonin; Vit D; Calcium; PTH
Can we use estrogen replacement to treat osteoporosis?
CAN ONLY USE WITH HYPOGONADISM OR PREMATURE MENOPAUSE due to adverse side effects
How do bisphosphonates work?
Inhibit osteoclastic bone resorption
How long is the half life of a bisphosphonate?
VERY LONG ~10 years once in the bone
