Osteoporosis

Question 1

When to use T score vs Z score?

Answer 1

T score: preferred for postmenopausal women and men older than 50 years

Z score: preferred for premenopausal women or men younger than 50 years.

Question 2

Describe vertebral fracture assesment

Answer 2

VFA uses DXA imaging to evaluate for vertebral fracutre, uses less radiation exposure.

It’s recommended for

• women age >70 years
• men age >80 years
• height loss >4 cm (>1.5 inches)
• glucocorticoid therapy (>5 mg of prednisone for ≥3 months)
• self-reported vertebral fracture

Question 3

Treatment of osteoporosis

Answer 3

Modify risk factor so smoking and alcohol
Increase phyiscal actiity
Ca and VitD supplementaiton

1. Bisphosphonates, with DEXA monitoring q1-3 years to assess treatment response

Question 4

Risk of bisphosphonate therapy

Answer 4

atypical femoral fracture
jaw osteonecrosis

Therefore, drug holiday after 3-5 years is recommended

Question 5

How do steroids cause ostoeporosis

Answer 5

Increase osteoclast activity, decrease osteoblastogenesis