Osteoporosis Flashcards
1
Q
blood work at osteoporosis diagnosis
A
- Ca, corrected
- CBC
- Cr
- Alk Phos
- TSH
- VitD
- Serum protein electrophoresis (pt with vertebral fracture)
2
Q
osteoporosis risk factors
A
MODIFIABLE
- smoking
- excess caffeine (>4/d)
- alcohol (>3/d)
- low body weight
- inactivity
NON-MODIFIABLE
- fragility fracture >40
- maternal hip fracture
- older age
- systemic steroids >3m
- comorbidities : RA, hyperthyroid, hyperparathyroid, hypogonadism, early menopause
3
Q
non-pharm management of osteoporosis
A
- exercise (strength, core, balance)
- calcium (1200 mg / d, max 600 through supplementation)
- Vit D 800 - 2000 IU / d
- smoking cessation
- limit caffeine
- limit alcohol
4
Q
what bumps you up a category in CAROC fracture risk assessment?
A
- fragility fracture >40
- systemic steroids >3 months
5
Q
indications for pharmacologic management of osteoporosis
A
- high risk (>20% 10 year fracture risk) on CAROC or FRAX
- fragility fracture of hip or spine
- 2 or more fragility fractures
- moderate risk (10-20%) PLUS additional risk factors:
- – vertebral # from spine x-ray
- – wrist fracture and age >65
- – lumbar spine score «_space;femoral neck score
- – rapid bone loss
- – steroids >3 months
- – recurrent falls
- – men on androgen-deprivation therapy (prostate ca)
- – women on aromatase-inhibitor therapy (br ca)
6
Q
medications that increase falls risk
A
- benzos
- antihistamines
- antipsychotics
- antidepressants
- muscle relaxants
7
Q
indications for pharmacologic management of osteoporosis
A
- high risk (>20% 10 year fracture risk) on CAROC or FRAX
- fragility fracture of hip or spine
- 2 or more fragility fractures
- moderate risk (10-20%) PLUS additional risk factors:
- – vertebral # from spine x-ray
- – wrist fracture and age >65
- – lumbar spine score «_space;femoral neck score
- – rapid bone loss
- – steroids >3 months
- – recurrent falls
- – men on androgen-deprivation therapy (prostate ca)
- – women on aromatase-inhibitor therapy (br ca)
8
Q
side effects of bisphosphonates
A
- GI
- osteonecrosis of the jaw
- atypical femur fractures
- association with a fib
9
Q
indications for BMD
A
- age >65 everyone
- age 50-65 and one risk factor:
- – fragility fracture > age 40
- – vertebral fracture
- – parental hip fracture
- – steroids >3 months
- – other high risk meds (aromatase-inhibitor, androgen-deprivation)
- – current smoking
- – high alcohol intake
- – low body weight
- – RA
