Osteoporosis Flashcards
contributors to osteo
hypogonadism
early menopause
hyperthyroidism
primary hyperparathyroidism
drugs that may contribute to osteo
prednisone glucocorticoids phenytoin aromatse inhibitors PPI androgen deprivation therapy
mechanism of glucocorticoid induced osteo
decreased bone formation , bone mass
increased bone resorption
2x more likely to get a fracture
who is a BMD test indicated in on glucocorticoids
5-7.5mg prednisone equivalents for >3months
what is the single strongest risk factor for fractures
falls —— should focus on prevention
risk factors for falls
incontinence - get up at night ice, dark loose carpet hypotension dizzy alzeihmers meds, sedative, opioids parkinsons, weak poor sight previous falls advanced age fear of falling psychotropic meds diabetes, arthritis, stroke, incontinence, dementia gait and balance problems
whats a fragility fracture
fracture occurring spontaneously or following minor trauma such as a fall from standing height or less
does low BMD diagnose OP
technically yes but just one of severeal risk factors for fractures
what kind of exercise is recommended
does it decrease fractures
weight bearing and stability
aerobics, strength training, walking , tai chi
decreases falls and increase BMD but no decrease in fractures
primary goal of therapy
decrease future risk of fracture
whats clinical vertebral
brings a person in to say that theyre back hurts
in just vertebral the spinal fracture isnt identified
whats a major osteoporotic fracture
proximal humerus
wrist
hip
clniical vertebral
what is the benefit if vit d and calcium
minor decrease in fractures except for clinical vertebral
what doses of vit d
600-800 IU
dose of calcium
1200mg/day from ALL sources diet and supplement
any harms of supplementation
not for vit D unless above 400iu/day
calcium - nausea, constipation, hypercalcemia, renal calculi, CV diseas?
how much calcium in 250ml of milk, serving of yogurt, chunk of chees
300mg
do we generally get lots of vitd naturally
no just supplement
what does the BMD t score represent
number of standard deviations above or below the mean for a healthy 30 year old adult of same sex and ethnicity
what does treatment depend on
patients risk of fracture efficacy patients goals desire for specific harm avoidance cormorbidities feasibility
do we use teriparatide
no expensive and useless
relative risk reduction of bisphosphonates
30-50%
what do you do for someone with a low fracture risk of <10% 10 year fracture risk
unlikely to benefit from pharmacotherpay
reassess in 5years
what do you do for someone with 10 year fracture risk 10-20%
offer medication
inform patient of the benefit and risks
and then make a decision to initiate therapy or reassess in a year
what do you do with someone with a >20% 10 year fracture risk or prior fracture of hip or spine
pharmacology therapy should be offered
not the best evidence for this
how should bisphosphonates be taken
once a week on empty stomach in morning with water while upright for 30 min 30 min before taking other meds expect to take for 5 years
side effects of bisphosphonates
abdominal problems
osteonecrosis of the jaw
bone breaks in femur
esophageal or gastric ulceration or erosion
denosumab adverse events
rash
musculoskeletal pain
decreased calcium
infection
what is osteonecrosis of the jaw and who is at risk
area of exposed alveolar bone that doesnt heal after 8 weeks
smokers, dental procedures, bad teeth, diabetes, chemo, radiation, glucocorticoids
when do they recommend to repeat BMD
1-3 year
but no evidence and consumes health care resources
when should you reassess BMD for patients on bisposphonates
5 years
do you stay on bisphosphonates for ever
takes at least 3 years to see optimal benefit then in 5 years have a conversation with the patientabout stopping
what was the difference between stopping bisphosphonate at 5 or 10 years
no different in non-vertebral
about 3% increase in vertebral
BMD remained still above levels before treatment although decreased a little bit
no studies done in patients over 80, which people over 80 would we consider a bisphosphonate
decrease vertebral fractures in women >80 who had a previous vertebral fracture and we think will survive the 1-3 years necesssary to see an effect
ARR of fractures that will result in pain for women >80 with previous fractures on bisphosphonate
2-2.5%
what should we do for patients >80 in deciding on medication
educate on what exactly the treatment provides and does not instead of saying it is strongly recommended
