Osteoporosis

Question 1

Definition

Answer 1

-increased bone fragility which is major cause of fractures

primary osteoporosis: 2/2 age

secondary osteoporosis
-medications, endocrinopathy, toxins, or systemic disease

Question 2

Fragility fracture

Answer 2

• bone fracture caused by low trauma activity

- pathognemonic for osteoporosis, regardless of BMD

Question 3

Risk factors for screening

age, medications, PMHx, lifestyle, endocrinopathy

Answer 3

-increased age, <60kg (women)

medications:
- steroids (>5mg prednisone or equivalent for 3 months
- HAART
- high dose thyroxine

PMH

• rheumatoid arthritis
• IBD, celiac disease
• hx of gastric bypass
• any prior fracture as an adult
• HIV, ESLD, COPD, CHF

Lifestyle
-tobacco, alcohol use

endocrinoapthy
-diabetes, >cortisol, >thyroxine

Question 4

Exam findings

Answer 4

• decrease in height, weight, BMI

- kyphosis or focal back pain (suggestive of compression fracture)

Question 5

labs for new diagnosis

Answer 5

• CBC
• Ca, phos
• BMP (cr)
• LFTs
• 25-OH Vit D
• PTH
• TSH
• spot urine Ca

Question 6

indication for DEXA

Answer 6

• all women >65 and men >70

- all pts w/ fracture after age of 50

Question 7

DEXA interpretation

Answer 7

-femoral neck and spine

scoring:

• normal T score >= -1
• osteopenia between -1 and -2.5
• osteoporosis

Question 8

DEXA monitoring for treatment

Answer 8

• repeat 2 years after treatment

- if worsened refer to endocrine

Question 9

nonpharmacologic treatment

Answer 9

• weightlifting and walking
• calcium carbonate: taken w/ foo. goal is 1g to 1.2g daily via diet + supplement
• vit D: replete to serum >20
• limit etoh: <3 drinks increases risk by 38%

Question 10

pharmacologic therapy indications

Answer 10

• indicated in all pts w/ osteoporosis (incl hx of fragility fracture)
• osteopenia and 10y FRAX hip >= 3% OR 10y risk of major osteoporotic fracture >= 20%

Question 11

pharmacologic therapies

Answer 11

1st: bisophosphonates (replete vit D first)
-oral 1st line treatment
-take in am 30min prior to meds or food, take w/ 8oz water and remain upright 30 minutes
CONTRA: CrCl <35

duration: consider drug holiday after 5y if T score >-2.5

Question 12

raloxifene

Answer 12

SERM
-less effective than bisphosphonates but can be considered in postmenopasual women with CKD or who have FHx of breast cancer (decreased breast cancer risk)

SE: DVT/PE, edema, hot flashes, muscle cramps

Question 13

when to refer to endocrinology

Answer 13

-Men <50 or premenopausal women with osteoporosis

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