Osteoporosis Flashcards
Define a fragility fracture. (DFCM)
- Fracture occurring spontaneously or following minor injury such as a fall from standing height or less or at walking speed or less
- Excluding craniofacial, hand, foot and ankle fractures
- Fragility fractures of the spine can occur due to bending, coughing, sneezing, reaching or other minor events
What % of fractures in menopausal women over age 50 are fragility fractures? (CMAJ)
- 80%
What proportion of white women and white men will have an osteoporosis-related fracture in their lifetime? (AFP)
- 1 in 2 white women
- 1 in 5 white men
Are postfracture mortality and institutionalization rates higher for men or women? (CMAJ)
- Men
Name 9 risk factors for osteoporotic fractures. (TOP)
- Fragility fracture after age 40 and at risk for future fractures
- Vertebral compression fracture or osteopenia identified on radiography
- Parental hip fracture
- Prolonged use of glucocorticoids (At least 3 months cumulative therapy in the previous year at a prednisone-equivalent dose >7.5 mg daily)
- Use of other high risk medications (e.g. aromatase inhibitors or ADT)
- Rheumatoid arthritis, malabsorption syndrome, other disorders strongly associated with osteoporosis (e.g. primary hyperparathyroidism, hypogonadism)
- Current smoker
- High alcohol intake (>3 units/day)
- Major weight loss (10% below their body weight at age 25)
At what age should men and women be assessed for osteoporosis and fracture risk? (CMAJ)
- 50 years old
What should clinicians do to assess for osteoporosis and fracture risk in the office prior to specific osteoporosis screening? (CMAJ)
- Measure height annually
- Assess history of falls – if there has been a fall, multifactorial assessment should be conducted including the ability to get out of a chair without using arms
What is the definition of osteopenia and osteoporosis according to WHO? (CMAJ/AFP)
- Osteopenia: BMD of 1.0 and 2.5 standard deviations below the peak bone mass for young adults (healthy 30-year olds) (-2.5 < T-score ≤ -1.0)
- Osteoporosis: BMD of 2.5 or more standard deviations below the peak bone mass for young adults (healthy 30-year olds) (T-score ≤ -2.5)
What is the difference between a T-score and a Z-score for osteoporosis?
- T-score – BMD SD compared to healthy 30-year olds
- Z-score – BMD SD compared to same age and body size
What tool is suggested for clinicians to use in the context of case finding individuals 50-64 years of age with no known risk factors who may be at risk of fracture? (TOP/TFP)
- Osteoporosis Self-Assessment Tool (OST)
What is the OST and what are indications for BMD testing? (TOP/TFP)
- OST = Weight (kg) – Age (years)
- <10 à Order BMD (Moderate-High Risk)
- ≥10 à Reassess OST in 5 years
What is the sensitivity and specificity of the OST in identifying femoral neck osteoporosis? (TOP)
- Sensitivity 92%
- Specificity 39%
What differentiates the OST from other tools to assess the risk of osteoporosis? (TOP/TFP)
- OST validated in both sexes and a variety of ages
According to the 2010 Canadian Osteoporosis guidelines, what are indications for measuring BMD in adults <50 years of age? (CMAJ)
- Fragility fracture
- Prolonged use of glucocorticoids
- Use of other high-risk medications (e.g. aromatase inhibitors, ADT)
- Hypogonadism or premature menopause (age <45 yr)
- Malabsorption syndrome
- Primary hyperparathyroidism
- Other disorders strongly associated with rapid bone loss and/or fracture
According to the 2010 Canadian Osteoporosis guidelines, what are indications for measuring BMD in adults ≥50 years of age? (CMAJ)
- Age ≥65 years (both women and men)
- Clinical risk factors for fracture (menopausal women, men age 50-64 yr)
- Fragility fracture after age 40 yr
- Prolonged use of glucocorticoids
- Use of other high-risk medications (e.g. aromatase inhibitors, ADT)
- Parental hip fracture
- Vertebral fracture or osteopenia identified on radiography
- Current smoking
- High alcohol intake
- Low body weight (< 60 kg) or major weight loss (> 10% of body weight at age 25 yr)
- Rheumatoid arthritis
- Other disorders strongly associated with osteoporosis
According to the 2010 Canadian Osteoporosis guidelines, what biochemical tests are recommended for patients being assessed for osteoporosis? (CMAJ)
- Calcium, corrected for albumin
- Complete blood count
- Creatinine
- Alkaline phosphatase
- Thyroid-stimulating hormone
- Serum protein electrophoresis (for patients with vertebral fractures)
- 25-Hydroxyvitamin D
- Should be measured after 3-4 months of adequate supplementation and should not be repeated if an optimal level (at least 75 nmol/L) is achieved
According to Choosing Wisely Canada, who should receive DEXA screening for osteoporosis? (CWC)
- All patients aged 50 years and older should be evaluated for risk factors using tools such as the OST
- DEXA not warranted on women under 65 or men under 70 at low risk
According to Choosing Wisely Canada, what is the minimum amount of time that should pass before repeating a DEXA scan? (CWC)
- Minimum of every 2 years
What is recommended for all women, and men with one or more risk factors, 65 years and older? (TOP)
- An absolute fracture risk assessment (includes BMD)
What is the TOP guideline for screening and treatment for osteoporosis and fracture risk?
What two tools are recommended for an absolute fracture risk assessment? (TOP)
- CAROC (Canadian Association of Radiologists and Osteoporosis Canada)
- FRAX (WHO – specific for Canada)
How does the CAROC stratify fracture risk? (TOP)
- Women and men over age 50 stratified into 3 zones of risk for MAJOR osteoporotic fracture within 10 years:
- Low (<10%)
- Moderate (10-20%)
- High (>20%)
What is required to use CAROC? (TOP)
- Age
- Sex
- T-score for the femoral neck CPG (BMD test)
How was the reference range determined for the CAROC? (CMAJ)
- Reference range for white women of the NHANES III