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ENDO > OSTEOPOROSIS > Flashcards

OSTEOPOROSIS Flashcards

1
Q

What is the most common metabolic bone disease?

A

Osteoporosis

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2
Q

When does bone density increase & peak?

A

Increases dramatically in puberty Peaks in young adults (early 20’s)

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3
Q

What are some determinants to bone density?

A

Age, race, genetics, timing of puberty (delayed or premature menopause), exercise, calcium intake

Genetics!

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4
Q

When does bone loss begin?

A

Begins before menses cease; accelerated the first 5-10 years post menopause!!

Ongoing after age 60

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5
Q

Where is most of the bone loss occurring?

A

Trabecular (cancellous) > cortical (compact) bone

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6
Q

What is causing the increased bone loss?

A

Increased bone resorption

From sex hormone deficiency = hypogonadism

Hyperparathyroidism = increased PTH

Thyrotoxicosis = Increased bone metabolism

Alcoholism, anorexia, and vitamin D deficiency

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7
Q

What must we ALWAYS ask about in a post-menopausal female when taking a history?

A

Family history of osteoporosis!

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8
Q

Define osteopenia vs. osteoporosis

A

Osteopenia = BMD 1-2.5 SD below peak bone density

Osteoporosis = BMD >2.5 SD below peak

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9
Q

How is “peak bone density” determined?

A

Comparison to bone density of a young healthy adult of same gender and race

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10
Q

In an elderly person, what signs & symptoms might we look for in association with osteoporosis?

A

Back pain, decrease in height, kyphotic deformity

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11
Q

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?

A

15-25% vs. 50% in females

They do not do well, 36% of men with hip fractures die the following year

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12
Q

What will you often find on labs for osteoporosis?

A

NORMAL ionized calcium, PO4
Vitamin D levels low (can be lacking due to diet & sun!)
When indicated test: TSh, cortisol, estradiol, testosterone, PTH

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13
Q

What is our test of choice for osteoporosis?

A

Bone densitometry: DEXA

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14
Q

What does a DEXA scan look at?

A

Spinal bone, proximal femur, and other bones (distal radius)

Looks at both trabecular & cortical bone

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15
Q

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?

A

Severe Osteoporosis!! (not osteopenia, she is automatically put into a higher category)

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16
Q

If a patient has a DEXA scan and the score comes back 2 SD below peak, what treatment would you give her?

A

Calcium (if she doesn’t meet requirements) Vitamin D (even if levels are normal)

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17
Q

When do we screen for osteoporosis?

A

Early postmenopause + risk factors

Or >65

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18
Q

What are risk factors for osteoporosis?

A

Family history, malnourished, alcoholism, renal failure

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19
Q

At what point do you initiate therapy?

A

Osteoporosis (>2.5 SD below peak)

Presence of “fragility” fracture

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20
Q

Once you start a patient on treatment, can it reverse osteoporosis?

A

No – can only increase bone density, decrease factures, and halt/slow progression

21
Q

What are the treatment options for osteoporosis?

A

Treat underlying etiology; bisphosphonates; SERMS; Calcitonin; Vit D; Calcium; PTH

22
Q

Can we use estrogen replacement to treat osteoporosis?

A

CAN ONLY USE WITH HYPOGONADISM OR PREMATURE MENOPAUSE due to adverse side effects

23
Q

How do bisphosphonates work?

A

Inhibit osteoclastic bone resorption

24
Q

How long is the half life of a bisphosphonate?

A

VERY LONG ~10 years once in the bone

25
Q

What’s the most common bisphosphonate and how do we instruct our patient to take it?

A

Alendronate (Fosomax)

Take 30 minutes before breakfast, with 8 oz of water, and remain upright for 30 minutes after

26
Q

What’s the dosing of Fosomax and the S/E?

A

70mg weekly

S/E = gastritis & esophagitis

27
Q

What alternative bisphosphonate offers less GI side effects?

A

Risedronate (Actonel)

28
Q

What bisphosphonate can you take monthly?

A

Ibandronate

29
Q

What IV bisphosphonate is given every 3 months?

A

Pamidronate

30
Q

What IV bisphosphonate is given every 6-12 months?

A

Zoledronic Acid

31
Q

With all bisphosphonates, what’s the biggest issue?

A

Dental concerns!! Dental care is critical!

32
Q

Who do we treat with bisphosphonates & for how long?

A

Patients at high risk for fractures NO MORE THAN 5 YEARS

33
Q

When is a patient with Osteoporosis at risk for a fracture?

A

Prior fractures; Family History of osteoporosis; low body weight; cigarette consumption; excessive ETOH use; RA; those at risk for falls

34
Q

What is a SERM medication, who do we use it in?

A

Selective estrogen receptor modulators – alternative to estrogen!

For post-menopausal women with osteoporosis and those at an increased risk with osteopenia

35
Q

What medication is our SERMS? What does it prevent? What does it increase?

A

Raloxifene (Evista)

Doesn’t affect the breasts or uterus. Increases risk of thromboembolism

36
Q

What medication is inhaled, a by-product of salmon, and increases tensile strength of bone?

A

Calcitonin

37
Q

How much does calcitonin increase bone density?

A

2-3%

38
Q

What medication helps arrest bone loss the most?

A

Vitamin D

39
Q

What’s the recommended daily dose of vitamin D?

A

400-600 IU/day

40
Q

What are the recommended daily amounts of Calcium?

A

1200-1500mg

41
Q

What 2 patients do we need to be cautious about prescribing calcium to?

A

Those with thiazide diuretic & glucocorticoids

42
Q

What injectable medication is given to stimulate osteoblastic activity?

A

PTH

43
Q

What are the normal actions of PTH?

A

Stimulates osteoclasts & osteoblasts

44
Q

So, how does PTH injection work to just stimulate osteoblasts?

A

Paradoxical (anabolic) effect when given intermittently (20mcg)

45
Q

What medication is synthetic form of PTH?

A

Forteo

46
Q

Where does Forteo mainly reduce fractures in the body?

A

Spine

47
Q

In a patient who has developed a fracture in spite of use of bisphosphonates & calcitonin, what medication could we offer her?

A

Denosumab

48
Q

How does Denosumab work?

A

Monocolonal antibody that decreases bone resorption by inhibiting osteoclasts

Antibody to receptor activator of the nuclear factor-kappa B ligand

49
Q

What are the best lifestyle modifications for osteoporosis?

A

Healthy diet, weight bearing exercise!, fall precautions

ENDO (7 decks)

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