Osteoporosis Flashcards
Z-score vs T-score
Z score - BMD compared to average healthy individual of SAME AGE
T score - BMD compared mean to ‘young normal’ adult”
Osteoporosis
2.5 standard deviations below T score for ‘young normal’ adult
T score
Osteopenia
Between -1 and -2.5 below T score
At 50 what does the NOF recommend for all men and women?
Start counseling on risk of fractures, checked for possible secondary causes of osteoporosis, have adequate calcium and vitd, perform regular weight bearing exercises
According to USPSTF, when to start screening?
all women aged greater than or equal to 65 and those less than 65 years with risk factors that are equal to or greater than the risk of a healthy 65 year old Caucasian woman should be screened for osteoporosis
cannot have had previous known fractures or secondary causes of osteoporosis
What about men?
Insufficient evidence to assess balance of benefits and harms of screening in men
Preferred screening modality
DEXA scan of femoral neck and lumbar spine
Secondary causes of osteoporosis
hyperthyroidism, primary hyperparathyroidism, vitD deficiency, amenorrheic conditions, chronic corticosteroid use
What substances can increase risk for osteoporosis?
alcohol and tobacco use
Standard lab workup in patient with osteoporosis
CBC, kidny and liver function tests, serum calcium, TSH, and 25-hydroxy vitD levels
consider estrogen/testosterone levels in hypogonadism
Criteria for treatment?
postmenopausal women and men aged 50 and older with…
- hip or vertebral fracture
- T score less than or equal to -2.5 after excluding secondary causes
- T score -1 to -2.5 if high risk for fracture (FRAX algorithm)
but also consider patient preference
What is a universal recomendation for postmenopausal women and patients with osteoporosis
calcium and vit D supplements
Treatment goal of 25-hydroxy vit D
serum level of greater than 30 ng/mL
First line treatment agents for osteoporosis
oral bisphosphonates (alendronate, riserdronate, ibandronate)
DRONATES
Special instructions for taking oral bisphosphonates
taken on empty stomach with full glass of water, must stay in uprightstanding for at least 30 minutes after dosing to avoid esophagitis
What to consider for prevention of osteoporosis in woen with significant menopausal vasomotor symptoms?
Estrogen replacement….but controversial due to risk of thrombosis and breast cancer
How to use estrogen replacement
lowest effective dose for shortest possible time
How to limit risk of endometrial cancer with estrogen replacement
If patient hasn’t had hysterectomy, give progesterone to protect against endometrial cancer
FDA approved selective estrogen receptor modulator (SERM) for prevention and treatment of osteoporosis
raloxifene
Raloxifene side effects
=reduce risk of breast cancer
- increases vasomotor symptoms
- increases risk of DVT
Who should take raloxifene
postmenopausal women who do not tolerate bisphosphonates, hwo do not have vasomotor sypmtoms, and who have a high risk of developing breast cancer
Second line agent, nasal spray, can help prevent vertebral compression fractures
calcitonin
Teriparatide
recombinant human PTH that causes bone density growth by stimulating osteoblasts (DO NOT USE in patient risk for osteosarcoma like Paget’s disease)
reserve if cannot tolerate bisphosphonates and if osteo is severe
Monoclonal antibody that prevents osteoclast differentiation and limits bone turnover
denosumab;
How to track treatment
BMD testing every two years
T/F: Inhaled corticosteroids represent significantly more risk for fracture than oral
FALSE…INHALED CORTICOSTEROIDS AREN’T A RISK FACTOR
