Osteoporosis

Question 1

Z-score vs T-score

Answer 1

Z score - BMD compared to average healthy individual of SAME AGE
T score - BMD compared mean to ‘young normal’ adult”

Question 2

Osteoporosis

Answer 2

2.5 standard deviations below T score for ‘young normal’ adult

T score

Question 3

Osteopenia

Answer 3

Between -1 and -2.5 below T score

Question 4

At 50 what does the NOF recommend for all men and women?

Answer 4

Start counseling on risk of fractures, checked for possible secondary causes of osteoporosis, have adequate calcium and vitd, perform regular weight bearing exercises

Question 5

According to USPSTF, when to start screening?

Answer 5

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

Question 6

What about men?

Answer 6

Insufficient evidence to assess balance of benefits and harms of screening in men

Question 7

Preferred screening modality

Answer 7

DEXA scan of femoral neck and lumbar spine

Question 8

Secondary causes of osteoporosis

Answer 8

hyperthyroidism, primary hyperparathyroidism, vitD deficiency, amenorrheic conditions, chronic corticosteroid use

Question 9

What substances can increase risk for osteoporosis?

Answer 9

alcohol and tobacco use

Question 10

Standard lab workup in patient with osteoporosis

Answer 10

CBC, kidny and liver function tests, serum calcium, TSH, and 25-hydroxy vitD levels

consider estrogen/testosterone levels in hypogonadism

Question 11

Criteria for treatment?

Answer 11

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

Question 12

What is a universal recomendation for postmenopausal women and patients with osteoporosis

Answer 12

calcium and vit D supplements

Question 13

Treatment goal of 25-hydroxy vit D

Answer 13

serum level of greater than 30 ng/mL

Question 14

First line treatment agents for osteoporosis

Answer 14

oral bisphosphonates (alendronate, riserdronate, ibandronate)

DRONATES

Question 15

Special instructions for taking oral bisphosphonates

Answer 15

taken on empty stomach with full glass of water, must stay in uprightstanding for at least 30 minutes after dosing to avoid esophagitis

Question 16

What to consider for prevention of osteoporosis in woen with significant menopausal vasomotor symptoms?

Answer 16

Estrogen replacement….but controversial due to risk of thrombosis and breast cancer

Question 17

How to use estrogen replacement

Answer 17

lowest effective dose for shortest possible time

Question 18

How to limit risk of endometrial cancer with estrogen replacement

Answer 18

If patient hasn’t had hysterectomy, give progesterone to protect against endometrial cancer

Question 19

FDA approved selective estrogen receptor modulator (SERM) for prevention and treatment of osteoporosis

Answer 19

raloxifene

Question 20

Raloxifene side effects

Answer 20

=reduce risk of breast cancer

• increases vasomotor symptoms
• increases risk of DVT

Question 21

Who should take raloxifene

Answer 21

postmenopausal women who do not tolerate bisphosphonates, hwo do not have vasomotor sypmtoms, and who have a high risk of developing breast cancer

Question 22

Second line agent, nasal spray, can help prevent vertebral compression fractures

Answer 22

calcitonin

Question 23

Teriparatide

Answer 23

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

Question 24

Monoclonal antibody that prevents osteoclast differentiation and limits bone turnover

Answer 24

denosumab;

Question 25

How to track treatment

Answer 25

BMD testing every two years

Question 26

T/F: Inhaled corticosteroids represent significantly more risk for fracture than oral

Answer 26

FALSE…INHALED CORTICOSTEROIDS AREN’T A RISK FACTOR