Osteoporosis Flashcards
What is the lifetime risk of fracture of common sites for white women?
40%
What does the USPSTF recommend for osteoporosis screening for women?
Women 65 and older; younger women whose fracture risk is 9.3% or greater than that of a 65 year old white woman
What are the risk factors for osteoporosis (personal history and lifestyle factors )?
Falls, fragility Fx, menopause <45, recent discontinuation of estrogen therapy; smoking, excessive ETOH, sedentary lifestyle
What is the ‘formula’ for bone strength?
Bone strength = quantity + quality
Bone strength = quantity + quality; what is quantity and quality?
Quantity is the density (DXA); quality is microstructure
What regions of the hip are used to evaluate for osteoporosis?
Femoral neck and total hip score
What is a T score on the DXA scan?
Number of standard deviations above or below the average BMD for healthy young women
What is the Z score of a DXA scan?
Number of standard deviations above or below the average BMD for age, ethnicity and gender-matched controls
What Z score is suggestive of secondary osteoporosis?
-2.0 or lower than T scores
When evaluating premenopausal women, what score needs to be used in evaluating osteoporosis from DXA scan?
Z score
What is a normal T score?
-1.0 or greater
What T score is consistent with osteopenia?
Between -1.0 and -2.5
What T score is suggestive of osteoporosis?
-2.5 or greater
Who should be treated for osteoporosis?
Patients with hip or vertebral fractures; T scores less than or equal to -2.5 without secondary causes
When is treatment for osteopenia started?
If patient has a previous fragility fracture, risk factors for a fracture, 10-yr probability of hip fracture of greater than or equal to 3%; 10-year probability of major osteoporotic fracture of greater than or equal to 20%
What labs might be helpful in evaluating osteoporosis?
Renal panel, CBC, Calcium, albumin, alk phos, phosphorous, magnesium, TSH, PTH, 25-OH Vit D, 24 hr calcium and Cr
What is the recommended dose of calcium?
1200 mg per day
What is the recommended dose of Vitamin D?
800-1000 units per day
What is the goal vitamin D level for patients with osteoporosis?
> 30
What is the national osteoporosis foundations recommendations for treatment?
Low bone mass (T-score -1 to -2.5, osteopenia) at the femoral neck, total hip, or spine and 10-year hip fracture probability ≥3%
What is the US-adapted WHO absolute fracture risk model recommendations on treatment?
10-yr all major osteoporosis related fracture probability of greater than or equal to 20%
What are the limitations of FRAX score?
Doesn’t apply to the spine
Doesn’t apply if patient on a bisphosphonate
Some will use it if patient is off meds for 2 years
Doesn’t apply to premenopausal woman -(Use Z scores)
