Osteoporosis

Question 1

Osteoporosis

Answer 1

“Porous bone”

Decreased bone mass and increased risk of fracture

Question 2

Osteopenia vs osteoporosis

Answer 2

Osteopenia: bone thinning/loss

Osteoporosis: severe bone/loss
Marked by increase risk of fracture with minimal trauma

Question 3

Normal bone turnover

Answer 3

5% of adult bone is actively being remodeled

Age 30 is the age where osteoclast activity outpaces osteoblast activity

Question 4

what is the main fuel of osteoclast activity?

Answer 4

RANKL activity fuels roughly 90% of osteoclast activity

increases are common after menopause for women

Question 5

Dowingers hump/ hunchback

Answer 5

Colloquial terms for increased osteoclast activity in the thoracic region increasing thoracic kyphosis

Question 6

Decrease in what hormone increases RANKL activity?

Answer 6

Estrogen

Question 7

What are the percentages of women with prevalence osteoporosis at ages 70, 80 and 90 respectively?

Answer 7

20%, 40%, 66%

Question 8

What is the chance of women and men greater than 50 will develop an osteoporotic fracture

Answer 8

1/2 in women

1/5 in men

Question 9

Levels of Hormones that influence increased osteoporosis prevalence

Answer 9

PTH increase

Decreases in Estrogen and testosterone

Thyroxine increase

Question 10

Why is osteoporosis known as a “silent” disease?

Answer 10

Asymptomatic and no physical exam findings until fractures occur

Question 11

Most common fractures in osteoporosis

Answer 11

Vertebral fractures (most common)

Hip fractures

Collies fractures

Question 12

Heel ultrasound pros and cons

Answer 12

Tests for osteoporosis

Pros:
Cheap portable and no radiation, good specificity

Cons:
Low sensitivity, Tscore isn’t accurate

Question 13

FRAX score

Answer 13

Screening tool that Predicts osteoporotic risk

Tests 11 risk factors but is not very sensitive and specific

Question 14

QFracture questionare

Answer 14

Osteoporosis screening tool that assess for 24 risk factors

Question 15

DEXA use

Answer 15

Measures bone density typically at hip and spine

For each 1 SD drop in bone density = 2.6x increase fracture risk

Question 16

what T-scores signal risk for osteoporosis?

Answer 16

Normal = 0 to -1.0

Osteopenia = -1.0 to -2.49

Osteoporosis = < -2.5

Question 17

Treatment for osteopenia

Answer 17

Meds not recommended just monitor unless FRAX score is higher than 3%

Question 18

Treatment of osteoporosis

Answer 18

Meds recommended if DEXA score = -2.5 or worse and have experienced a osteoporotic fracture

Question 19

Bisphosphonates

Answer 19

Potent anti-resorption bone meds.

Should not take after 3 years since it can eventually increased bone density beyond normal levels

Side effects: GI distress, osteonecrosis of the jaw and increased femoral fractures

Question 20

Selective Estrogen Receptor Modulators (SERMs)

Answer 20

Mimic to estrogen and limits RANKL numbers. Decreases risk of spinal fractures

Also decreases uterine and breast cancers

First one discovered = Tamoxifen

Side effects: headaches, flushing, possible DVTs

Question 21

Human Monoclonal Antibody (Denosumab)

Answer 21

RANKL inhibitor decreasing osteoclast activation.

Marked decrease in risk of spine/hip/wrist fractures

Is one of the only treatments of osteoporosis that is safe with impaired renal functions

Side effects: nausea, hypocalcemia, osteonecrosis of the jaw

Question 22

Calcitonin

Answer 22

Inhibits osteoclast activity by decreasing PTH activity. Causing increased OPG release from osteoblasts

Decreases bone pain in acute fractures.

Not a 1st line therapy since it is not very effective long term

Side effects: hepatic cancer, hypersensitivity, hypocalcemia, epistaxis