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Endocrine > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What are the symptoms of uncomplicated osteoporosis?

A

none –> silent disease

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2
Q

Osteoporosis

A

silent systemic disease of bone –> low bone mass/density, microarchitectural disruption of bone quality –> increased risk of fx

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3
Q

Osteoporosis affects ____ # of americans

A

10 million

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4
Q

T/F osteoporosis prevalence decreases with age

A

F –> increases

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5
Q

T/F osteoporosis affects both sexes equally

A

F –> F>M

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6
Q

1 out of ____ women will experience an osteoporosis related fx

A

2

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7
Q

1 out of ____ men will experience an osteoporosis related fx

A

5

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8
Q

Which races have an especially higher risk of osteoporosis

A

asians and caucasians

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9
Q

T/F 2/3 of vertebral fx are symptomatic

A

F –> 2/3 are asymptomatic

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10
Q

____% of people do not regain pre- hip fracture level of independence

A

40%

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11
Q

T/F vertebral fx complications are worse than hip fx complications

A

F –> hip is worse: mortality is greatest during first year after hip fracture

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12
Q

Colles fracture

A

distal radius fx

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13
Q

T/F a greater proportion of women will die in the first year after hip fx than men

A

F –> 30% of men with hip fx and 17% of women will die in first year

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14
Q

T/F diagnosis of osteoporosis depends on both bone quality and bone density

A

F –> both are important pathophysiological factors but we only dx based on density

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15
Q

Low bone density pathophysiology

A

low peak bone mass: modeling
or
excess bone loss later in life: remodeling

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16
Q

Primary osteoporosis

A

no known cause in postmenopausal women and aging men

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17
Q

secondary osteoporosis

A

due to glucocorticoids or diseases like hypogonadism (low T/E)

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18
Q

Pathophysiology in both primary and secondary osteoporosis has to do wiwth more _____than _____

A

bone resorption than construction

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19
Q

Lifestyle factors that influence osteoporosis

A

low calcium intake, Vitamin D insufficiency, 3+ alcohol drinks/day, low BMI

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20
Q

T/F family hx increases hip fracture rixk

A

T

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21
Q

T/F idiopathic hypercalciuria can increase hip fracture risk

A

T

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22
Q

Endocrine disorders that increase osteoporosis

A

hypothalamic amenorrhea, thyrotoxicosis, hyperparathyroidism, cushing, androgen insensitivty, hyperprolactinemia, diabetes mellitus

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23
Q

GI disorders that increase osteoporosis

A

celiac disease, cystic fibrosis, short gut, ibd, etc.

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24
Q

Hematological disorders that can increase osteoporosis

A

multiple myeloma, hemophilia, thalassemia, etc.

25
Q

T/F RA can increase risk of osteoporosis

A

T

26
Q

Medications that can increase osteoporosis

A

Anticonvulsants, PPIs, aromatase inhibitors, glucocorticoids, depo, tzd, lithium, gnrh analogs, etc.

27
Q

T score

A

of SD below normal young adult control in bone mineral density –> used for diagnosis

28
Q

Z score

A

of SD below age-matched control subjects in bone mineral density

29
Q

Which people can have a dx of osteoporosis?

A

postmenopausal women and men>50

30
Q

T score cutoff

A

-2.5

31
Q

DXA scan

A

dual energy xray absorptiometry of hip, femoral neck, and lumbar spine (+/- forearm)

32
Q

T score >-1.0

A

normal

33
Q

T score between -1.0 and -2.5

A

low bone mass: osteopenia

34
Q

T/F patients who have had one or more osteoporosis fractures are deemed to have normal osteoporosis

A

F –> severe or established osteoporosis

35
Q

T/F can dx osteoporosis without DXA

A

T –> if history of fragility low trauma fracture

36
Q

Osteoporosis screening

A

no risk factors or hx: all women >65, men>70

clinical risk factor: younger post menopausal women and men 50-69

37
Q

T/F Fracture risk doubles with every sd decrease in bmd

A

T

38
Q

T/F most fx occur among those with osteopenia

A

T

39
Q

Risk factors for bone quality

A

previous fx, age, family hx, low bmi, alcohol, glucocorticoids, current smoking

40
Q

FRAX

A

fracture risk assessment tool

41
Q

People to treat for osteoporosis

A

T score20% for all fx, >3% for hip)

42
Q

Tx that stimulate osteoblast activity

A

teriparatide/rPTH

43
Q

Non pharm tx of ostoeporosis

A

modify risk factors, supplements, exercise, fall prevention

44
Q

Tx that inhibit osteoclast activity

A

biphosphonates, denosumab, calcitonin, SERM, estrogen

45
Q

Osteoclast activity is increased by _____ ligand from the ____ cell

A

RANKL from preosteoblast

46
Q

Osteoblasts secret ____ which blocks RANKL action on osteoclasts

A

OPG

47
Q

Bisphosphonates MOA

A

first line tx (prevention and tx) –> antiresorptive by inhibiting osteoclasts and promoting their death

48
Q

Adverse effects of bisophosphonates

A

GI, increase in creatinine, flue like illness, atypical fracture of femur, osteonecrosis of jaw

49
Q

Denosumab MOA

A

monoclonal Ab that acts like OPG by inhibiting RANKL –> antiresoptive (not renally excreted)

50
Q

Adverse effects of denosumab

A

hypocalcemia, infections, skin reactions

51
Q

Teriparatide MOA

A

second line tx, anabolically increases osteoblast activity

52
Q

Why is teriparatide followed by an osteoclast inhibitor

A

anabolic window: induces bone formation but also increases bone resorption –> but first two years have more bone production than resorption –> then have to prevent it from being broken down

53
Q

Adverse effects of teriparatide

A

nausea, headache, leg cramps, hypercalcemia, osteosarcoma, avoid in paget’s disease/high alk phos, hypercalcemia, h/o of skeltal malignancy radiation or mets

54
Q

Calcitonin MOA

A

third line therapy –> inhibits osteoclasts, acute fx or pain setting

55
Q

Adverse effects of calcitonin

A

nausea, vomiting, etc –> avoid if hypersensitive or hypocalcemic

56
Q

SERM MOA

A

ER agonist on bone and antagonist on breast/uterus (raloxifene) -

57
Q

adverse effects of raloxifene

A

headache, hot flushes, leg crams, thromboembolism

58
Q

ERT MOA

A

decrease osteoclast activity –> increase breast cancer risk and thromboembolism

Endocrine (26 decks)

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