Osteoporosis

Question 1

An age above what age is a risk factor of osteoporosis?

Answer 1

• age over 50

Question 2

Which ethnic groups are high risk for osteoporosis?

Answer 2

White

Asian

Question 3

With respect to menstrual history name 3 findings that would increase ones risk of osteoporosis

Answer 3

1) Late menarche
2) Early menopause
3) Being in a post menopausal state
- Estrogen is a protective factor so being exposed to estrogen for shorter time period increases risk

Question 4

True or False, ones activity level can affect their chances of developing osteoporosis

Answer 4

• True
• Inactivity or immobilization are risk factors
• If you don’t use it you lose it -wrt bone density

Question 5

From a patients social history what factors would increase the patients risk of osteoporosis?

Answer 5

• Smoking (weak risk factor)
• Alcohol use
• Physical inactivity

Question 6

How does a woman’s parity affect their risk of osteoporosis?

Answer 6

• Parity appears to be unrelated

- no effect

Question 7

Explain how caffeine consumption increases the risk of osteoporosis

Answer 7

• Caffeine increases the excretion of calcium in the urine

- 175mg (less than a medium coffee) of caffeine intake increases calcium excretion by 6mg per day

Question 8

How does BMI relate to risk of osteoporosis?

Answer 8

• Thin build or small stature risk factors for osteo
• Also think female athlete triad
• A BMI > 26 is protective (fat makes peripheral estrogen)

Question 9

During the first 5 years post menopause bone density typically decreases by how much per year? (%)

Answer 9

• 5% per year

- After 5 years 1%/yr for life

Question 10

List some dietary sources of calcium

Answer 10

• Dairy
• Sardines
• Nuts
• Sunflower seeds
• Tofu
• Fortified foods (orange juice)

Question 11

How is osteoporosis diagnosed?

Answer 11

DEXA Scan

- measures bone density by measuring the patients bone density and comparing it to others

Question 12

During a Dexa score what is a T-score. What T-score is diagnostic for osteoporosi?

Answer 12

• Compares pt BMD to healthy young adults

- T less than or equal to -2.5 standard deviations

Question 13

What is a Z-score during a DEXA scan. What Z-score is diagnostic for osteoporosis?

Answer 13

• Compares the pts BMD to that of others the SAME age

- Z-score less than or equal to -2.0 standard deviations

Question 14

What drug class is used in the treatment of osteoporosis?

Answer 14

• Bisphosphonates

Question 15

What supplements can be taken to reduce the risk of osteoporosis?

Answer 15

• Vitamin D

- Calcium

Question 16

How would you counsel a patient about how to take oral bisphosphonates? Why?

Answer 16

1) Take first thing in the morning on empty stomach
- Very poor absorption, must be taken on empty stomach to maximize absorption
2) Drink with 8oz of water
- To ensure it does not get stuck in esophagus, if it does then you will likely not absorb as much as it will pass when you eat later
3) Remain sitting upright for 30 minutes
- To reduce risk of reflux

Question 17

At what age do you start screening patients with dexa scan for osteoporosis?

Answer 17

• age 65 for all

- age over 50 for those with risk factors for fractures