Osteoporosis

Question 1

What does BMD take into account?

Answer 1

• both bone mass and bone quality

Question 2

What are risk factors that are involved with falling

Answer 2

• syncope or low blood pressure
• orthostatic hypotension
• environmental things (ice)
• getting up at night
• sedating medications
• advanced age
• muscle weakness
• gait and balance problems
• poor vision
• chronic conditions such as arthritis, stroke, incontinence, diabetes, parkinson’s, dementia
• fear of falling
• psychotropic medications
• environmental factors

Question 3

What is one of the major things that could impair your stability

Answer 3

having neuropathy in the feet will affect the stability of the person

Question 4

What are the top medications associated with falls?

Answer 4

• sedative medications (antipsychotics, hypnotics, antidepressants)
• anti-hypertensives (including furosemide)
• opioids
• hypoglycemic agents (including insulin)

Question 5

What is a fragility fracture?

Answer 5

• a fracture occurring spontaneously or following minor trauma such as a fall from standing height or less

Question 6

What are the therapeutic alternatives for bisphosphonates in osteoporosis?

Answer 6

• exercise (keep walking, tai chi, basic strength exercise)
• resistance training- was shown to improve BMD score in the femoral neck- whatever you can get the patient to do if probably the best
• maybe not a definite reduction in fracture with this (1/6 studies in review)

Question 7

Do community dwelling people save more fractures or do hospital dwelling people save more fractures with supplementation?

Answer 7

• community dwelling people don’t really save that many fractures with just supplementation
• institutionalized people save more fractures per 1000 patients per year

Question 8

When does supplementation have the most value?

Answer 8

-has the most value when its being used as an adjunctive therapy with anti-resorptive or anabolic OP meds

Question 9

What are the main SE and complications associated with calcium?

Answer 9

GI symptoms, hypercalcemia and kidney stones, as well as CV disease

Question 10

What is considered to be a “high” FRAX score?

Answer 10

20-30% risk in 10 years

Question 11

What is the precent of risk reduction when using a bisphosphonate?

Answer 11

30-50%

Question 12

What are the important counselling points when talking to someone about using a bisphosphonate?

Answer 12

• sit upright
• drink an 8 ounce glass of water
• take this once a week
• take on an empty stomach in the morning
• take 30 minutes before eating or taking other medications
• expect to take this medication for 5 years
• take on an empty stomach to increase absorption of this med

Question 13

What is the main SE of bisphosphonates that we need to be aware of?

Answer 13

• esophageal perforation

Question 14

When is a good time to redo a BMD score?

Answer 14

3 years

- when on a therapy - redo in 5 years

Question 15

What do we want the target A1C to be in people that are over the age of 65?

Answer 15

• 7-9% is completely adequate