Osteoporosis Flashcards
What are the symptoms of uncomplicated osteoporosis?
none –> silent disease
Osteoporosis
silent systemic disease of bone –> low bone mass/density, microarchitectural disruption of bone quality –> increased risk of fx
Osteoporosis affects ____ # of americans
10 million
T/F osteoporosis prevalence decreases with age
F –> increases
T/F osteoporosis affects both sexes equally
F –> F>M
1 out of ____ women will experience an osteoporosis related fx
2
1 out of ____ men will experience an osteoporosis related fx
5
Which races have an especially higher risk of osteoporosis
asians and caucasians
T/F 2/3 of vertebral fx are symptomatic
F –> 2/3 are asymptomatic
____% of people do not regain pre- hip fracture level of independence
40%
T/F vertebral fx complications are worse than hip fx complications
F –> hip is worse: mortality is greatest during first year after hip fracture
Colles fracture
distal radius fx
T/F a greater proportion of women will die in the first year after hip fx than men
F –> 30% of men with hip fx and 17% of women will die in first year
T/F diagnosis of osteoporosis depends on both bone quality and bone density
F –> both are important pathophysiological factors but we only dx based on density
Low bone density pathophysiology
low peak bone mass: modeling
or
excess bone loss later in life: remodeling
Primary osteoporosis
no known cause in postmenopausal women and aging men
secondary osteoporosis
due to glucocorticoids or diseases like hypogonadism (low T/E)
Pathophysiology in both primary and secondary osteoporosis has to do wiwth more _____than _____
bone resorption than construction
Lifestyle factors that influence osteoporosis
low calcium intake, Vitamin D insufficiency, 3+ alcohol drinks/day, low BMI
T/F family hx increases hip fracture rixk
T
T/F idiopathic hypercalciuria can increase hip fracture risk
T
Endocrine disorders that increase osteoporosis
hypothalamic amenorrhea, thyrotoxicosis, hyperparathyroidism, cushing, androgen insensitivty, hyperprolactinemia, diabetes mellitus
GI disorders that increase osteoporosis
celiac disease, cystic fibrosis, short gut, ibd, etc.
Hematological disorders that can increase osteoporosis
multiple myeloma, hemophilia, thalassemia, etc.
T/F RA can increase risk of osteoporosis
T
Medications that can increase osteoporosis
Anticonvulsants, PPIs, aromatase inhibitors, glucocorticoids, depo, tzd, lithium, gnrh analogs, etc.
T score
of SD below normal young adult control in bone mineral density –> used for diagnosis
Z score
of SD below age-matched control subjects in bone mineral density
Which people can have a dx of osteoporosis?
postmenopausal women and men>50
T score cutoff
-2.5
DXA scan
dual energy xray absorptiometry of hip, femoral neck, and lumbar spine (+/- forearm)
T score >-1.0
normal
T score between -1.0 and -2.5
low bone mass: osteopenia
T/F patients who have had one or more osteoporosis fractures are deemed to have normal osteoporosis
F –> severe or established osteoporosis
T/F can dx osteoporosis without DXA
T –> if history of fragility low trauma fracture
Osteoporosis screening
no risk factors or hx: all women >65, men>70
clinical risk factor: younger post menopausal women and men 50-69
T/F Fracture risk doubles with every sd decrease in bmd
T
T/F most fx occur among those with osteopenia
T
Risk factors for bone quality
previous fx, age, family hx, low bmi, alcohol, glucocorticoids, current smoking
FRAX
fracture risk assessment tool
People to treat for osteoporosis
T score20% for all fx, >3% for hip)
Tx that stimulate osteoblast activity
teriparatide/rPTH
Non pharm tx of ostoeporosis
modify risk factors, supplements, exercise, fall prevention
Tx that inhibit osteoclast activity
biphosphonates, denosumab, calcitonin, SERM, estrogen
Osteoclast activity is increased by _____ ligand from the ____ cell
RANKL from preosteoblast
Osteoblasts secret ____ which blocks RANKL action on osteoclasts
OPG
Bisphosphonates MOA
first line tx (prevention and tx) –> antiresorptive by inhibiting osteoclasts and promoting their death
Adverse effects of bisophosphonates
GI, increase in creatinine, flue like illness, atypical fracture of femur, osteonecrosis of jaw
Denosumab MOA
monoclonal Ab that acts like OPG by inhibiting RANKL –> antiresoptive (not renally excreted)
Adverse effects of denosumab
hypocalcemia, infections, skin reactions
Teriparatide MOA
second line tx, anabolically increases osteoblast activity
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
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
Calcitonin MOA
third line therapy –> inhibits osteoclasts, acute fx or pain setting
Adverse effects of calcitonin
nausea, vomiting, etc –> avoid if hypersensitive or hypocalcemic
SERM MOA
ER agonist on bone and antagonist on breast/uterus (raloxifene) -
adverse effects of raloxifene
headache, hot flushes, leg crams, thromboembolism
ERT MOA
decrease osteoclast activity –> increase breast cancer risk and thromboembolism
