Osteoporosis

Question 1

define osteoporosis

Answer 1

chronic skeletal disorder of compromised bone strength associated with low bone density and deterioration of bone quality which often results in fractures

Question 2

what does bone strength depend on

Answer 2

bone mass and bone microarchitecture

Question 3

in healthy bones reabsorptions is equal to formation what causes reabsorption to be greater than formation

Answer 3

menopause
aging
disease
drugs

Question 4

what is a compression fracture

Answer 4

loss of >/= 25%vertebral height with end plate disruption

Question 5

what is kyphosis

Answer 5

extreme curvature of spine

Question 6

why is op called the silent theif

Answer 6

steals bone density over many years without signs until a bone breaks

Question 7

what are tht consequences of fractures

Answer 7

increased riskof additional fractures
chronic pain 
immobility 
decreased quality of life
loss of independence
institutionalization 
cost to health care
death

Question 8

common sites for fractures

Answer 8

hip
spine
wrist

Question 9

how is bone mineral density assessed

Answer 9

dual xray absorptiometry at the hip and spine

Question 10

what bmd t score is considered op

Answer 10

= -2.5

Question 11

expected z score for people under 50

Answer 11

above -2

Question 12

what is a normal t score fro someone over 50

Answer 12

> /= -1

Question 13

can BMD alone determine fracture risk

Answer 13

no

Question 14

who under 50 years of age should have their BMD tested

Answer 14

fragility fractures
prolonged use of glucocorticoids 
use of high risk meds
hypogonadism 
early menopause
malabsorption 
hyperparathyroidism

Question 15

who over 50 should have their BMD tested

Answer 15

anyone over 65 
fragility fracture after age 40 
high risk meds
rheumatoid arthritis 
smok
prolonged glucocorticoid use 
high alcohol intake 
low body weight or major weight loss

Question 16

what is the frax fracture risk assessment tool

Answer 16

computes the 10 year absolute risk for hip fracture along or major osteoporotic fracture

Question 17

what is the decision to treat independent of

Answer 17

BMD result

Question 18

the decision to treat is based on fracture history, what does that include

Answer 18

1) fragility fracture of hip?
2) spine?
3) if had >/= 2 non spine, non hip fragility fracture
4) if had one non spine, non hip fragility fraction after age 40 and prolonged glucocorticoid use in the previous year

Question 19

who should receive treatment

Answer 19

high risk and maybe some moderate risk patients

not those at low risk

Question 20

what is recommended for basic bone health

Answer 20

exercise 
fall prevention 
calcium 
vitamin D
smoking cessation 
limit alcohol 
good nutrition

Question 21

which medications increase risk of falls

Answer 21

sleep, anxiety, depression, mood, hypertension, allergies, pain, muscle spasm

Question 22

calcium sources

Answer 22

300 mg in 250ml of cows milk, almond soy, rice beverage, fortifiec orange juice, 3/4 yogurt

Question 23

what dose of calcium maximizes absorption

Answer 23

= 500mg

Question 24

types of calcium supplements

Answer 24

calcium carbonate

calcium citrate

Question 25

side effects of calcium over supplementation

Answer 25

kidney stones

Question 26

what does vit d do

Answer 26

helps body absorb and use calcium/phophorus to build and maintain strong bones and teeth

Question 27

sources of vit d3

Answer 27

UVB light | fish, meat, eggs, fortified milk, plant speciies

Question 28

sources of vit d2

Answer 28

wild mushrooms fungi yeast

Question 29

how is vit d converted into the active form

Answer 29

liver and kidneys

Question 30

what is the result of excess vit d

Answer 30

hypercalcemia, increased calcium depositions in body causes calcification of kidney, heart, lungs, blodd vessels

Question 31

result of low serum vit d

Answer 31

increased reabsorption from bones balance problems high fall rates low bmd and muscle weakness

Question 32

optimal serum levels of 25-OH

Answer 32

>75nmol/L

Question 33

anti resorptive agents

Answer 33

bisphosphonates monoclonal antibody SERM hormone therapy

Question 34

anabolic agents

Answer 34

PTH analogue

Question 35

benefits of OP medications

Answer 35

reduce fracture risk by 50% bone density improvment high risk patients benefit the most

Question 36

bisphosphonates

Answer 36

bind to bone and inhibit osteoclasts | analogs of pyrophosphate

Question 37

teriparatide

Answer 37

PTH analog

Question 38

raloxifene and estrogen

Answer 38

reduce RANK ligand

Question 39

denosumab

Answer 39

RANK ligand inhibitor

Question 40

what is first line for OP

Answer 40

bisphosphonates

Question 41

MOA of first gen bisphosphonate

Answer 41

bind directly to bone hydroxyapatite crystals and are taken up by osteoclasts during remodeling and are incorporated in ATP ATP analogues accumulate in osteoclasts and induce cell death through inhibition of ATP utilizing enzymes

Question 42

MOA of nitrogen containing bisphosphonates

Answer 42

bind to bone hydroypatite crystals and are taken up by osteoclasts during remodelling and inhibit enzymes in mevalonate path and can lead to osteoclast death

Question 43

how should bisphosphonates be taken - when, separation from other thigns

Answer 43

first thing in morning on empty stomach with water beverages decrease absorption must separate from everything by 30 min after dose and dairy 2-3 hours

Question 44

half life elimination of bisphosphonates

Answer 44

months to years | released with process of bone utrnover

Question 45

excretion of bisphosphonates

Answer 45

urine | feces

Question 46

denosumab MOA

Answer 46

human monoclonal antibody that targets RANKL in bloodstream preventing it from binding to receptors on osteoclasts in the circulation preventing development, activation, and survival of osteoclasts

Question 47

denosumab adverse effects

Answer 47

``` ONJ atypical fractures hypocalcemia severe infection dermatitis, eczema, rashes musculoskeletal pain hypersensitivity ```

Question 48

why does denosumab cause an increased risk of infection

Answer 48

activated T and B lymphocytes and lymph nodes express RANKL, denosumab inhibits this

Question 49

what is teriparatides anabolic action

Answer 49

stimulats osteoblast actibity ie increase GI calcium absorption, increase renal reabsorption of calcium

Question 50

result of teriparatide activity

Answer 50

increased bone mineral density, bone mass, and strength | decreased fractures

Question 51

difference between intermittent and prolonged PTH

Answer 51

intermittent promotes bone formation | prolonged causes bone reabsorption

Question 52

what is teriparatide indicated for

Answer 52

severe osteoporosis in men, postmenopausal women, and glucocorticoid induced

Question 53

adverse reactions for teriparatide

Answer 53

``` transient hypercalcemia 4-6 hours postdose orthostatic hypotension dizziness headache nausea arthralgia ```

Question 54

who is estrogen indicated for

Answer 54

postmenopausal osteoporosis with concomitant vasomotor symptoms

Question 55

how does estrogen work

Answer 55

decreases bone reabsorption, reduces RANKL

Question 56

what must estrogen be prescribed wiht if uterus is intact

Answer 56

progestin

Question 57

adverse effects of estrogen

Answer 57

increased risk of breast cancer increased risk of stroke DVT

Question 58

example of a SERM

Answer 58

raloxifene

Question 59

indication of SERMs

Answer 59

osteoporosis in postmenopausal women

Question 60

SERM effects

Answer 60

decreases bone reabsorption, reduces RANKL, increases BMD, reduces fractures at spine

Question 61

SERM MOA

Answer 61

agonist on bone | antagonist at breast and endometrium

Question 62

adverse effects of SERM

Answer 62

increase risk of DVT or PE hot flashed leg cramps, muscle spasms

Question 63

how do glucocorticoids affect the bones

Answer 63

increase osteoclast and decrease osteoblast proliferation | decrease the amount of calcium

Question 64

how to aromatase inhibitors affect the bone

Answer 64

blocka estrogen synthesis

Question 65

how does androgen deprivation therapu in males affect the bones

Answer 65

increase bone turnover