Osteoporosis

Question 1

What is the definition of osteoporosis?

Answer 1

Osteoporosis = decreased bone mass + disrupted bone architecture + normal mineralization, resulting in increased fragility/propensity to fracture

Question 2

What are the top 5 RFs for fracture?

Answer 2

RFs for fracture: low bone mass, prior fragility fracture (this one trumps all), FHx, older than 65 years, glucocorticoid use

Question 3

When should you measure 25-vit D?

Answer 3

Measure 25-Vit D when investigating abnormal calcium, non-menopausal bone disease (metabolic bone disease), malabsorptive states (celiac, short gut, IBD)

Question 4

Which drugs put patients at risk for bone loss?

Answer 4

Glucocorticoids, Aromatase inhibitors, Anti-convulsants, Chemotherapy, Progesterone, Contraception, PPIs, SSRIs

Question 5

What is the clinical function of bisphosphonates and what are the adverse effects?

Answer 5

Bisphosphonates:
-reduce extent and rate of bone resorption, prevents trabecular perforations via inhibition of osteoclasts
-clinically bisphosphonates increase bone strength, prevent further losses and reduce fragility fractures
Adverse effects: GI upset (oral), fever and acute phase reaction (IV), both IV and oral formulations may result in osteonecrosis of the jaw, and transverse femur fractures

Question 6

How does Denosumab work? What are the adverse effects?

Answer 6

Denosumab: anti-RANK ligand Ab
-very potent inhibition of RANK-L and therefore osteoclast function
Adverse effects: skin reaction, ONJ, atypical femoral fractures

Question 7

How does Raloxifene work and what are the adverse effects?

Answer 7

Raloxifene: estrogen agonist on bone

Adverse effects: +++ hot flashes