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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
T/F RA can increase risk of osteoporosis
T
26
Medications that can increase osteoporosis
Anticonvulsants, PPIs, aromatase inhibitors, glucocorticoids, depo, tzd, lithium, gnrh analogs, etc.
27
T score
of SD below normal young adult control in bone mineral density --> used for diagnosis
28
Z score
of SD below age-matched control subjects in bone mineral density
29
Which people can have a dx of osteoporosis?
postmenopausal women and men>50
30
T score cutoff
-2.5
31
DXA scan
dual energy xray absorptiometry of hip, femoral neck, and lumbar spine (+/- forearm)
32
T score >-1.0
normal
33
T score between -1.0 and -2.5
low bone mass: osteopenia
34
T/F patients who have had one or more osteoporosis fractures are deemed to have normal osteoporosis
F --> severe or established osteoporosis
35
T/F can dx osteoporosis without DXA
T --> if history of fragility low trauma fracture
36
Osteoporosis screening
no risk factors or hx: all women >65, men>70 | clinical risk factor: younger post menopausal women and men 50-69
37
T/F Fracture risk doubles with every sd decrease in bmd
T
38
T/F most fx occur among those with osteopenia
T
39
Risk factors for bone quality
previous fx, age, family hx, low bmi, alcohol, glucocorticoids, current smoking
40
FRAX
fracture risk assessment tool
41
People to treat for osteoporosis
T score20% for all fx, >3% for hip)
42
Tx that stimulate osteoblast activity
teriparatide/rPTH
43
Non pharm tx of ostoeporosis
modify risk factors, supplements, exercise, fall prevention
44
Tx that inhibit osteoclast activity
biphosphonates, denosumab, calcitonin, SERM, estrogen
45
Osteoclast activity is increased by _____ ligand from the ____ cell
RANKL from preosteoblast
46
Osteoblasts secret ____ which blocks RANKL action on osteoclasts
OPG
47
Bisphosphonates MOA
first line tx (prevention and tx) --> antiresorptive by inhibiting osteoclasts and promoting their death
48
Adverse effects of bisophosphonates
GI, increase in creatinine, flue like illness, atypical fracture of femur, osteonecrosis of jaw
49
Denosumab MOA
monoclonal Ab that acts like OPG by inhibiting RANKL --> antiresoptive (not renally excreted)
50
Adverse effects of denosumab
hypocalcemia, infections, skin reactions
51
Teriparatide MOA
second line tx, anabolically increases osteoblast activity
52
Why is teriparatide followed by an osteoclast inhibitor
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
Adverse effects of teriparatide
nausea, headache, leg cramps, hypercalcemia, osteosarcoma, avoid in paget's disease/high alk phos, hypercalcemia, h/o of skeltal malignancy radiation or mets
54
Calcitonin MOA
third line therapy --> inhibits osteoclasts, acute fx or pain setting
55
Adverse effects of calcitonin
nausea, vomiting, etc --> avoid if hypersensitive or hypocalcemic
56
SERM MOA
ER agonist on bone and antagonist on breast/uterus (raloxifene) -
57
adverse effects of raloxifene
headache, hot flushes, leg crams, thromboembolism
58
ERT MOA
decrease osteoclast activity --> increase breast cancer risk and thromboembolism

Endocrine (26 decks)

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