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Repro-Endo > Osteoporosis > Flashcards

Osteoporosis Flashcards

0
Q

Is just the density of the bone affected in osteoporosis?

A

No. Quality is decreased as well.

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1
Q

Is osteoporosis often silent?

A

Yep.

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2
Q

How many US men and women will have an osteoporosis-related fracture in their lifetimes?

A

1 in 2 women.

1 in 5 men.

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3
Q

What factor contributing to bone strength do we measure?

A

Density, with DXA.

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4
Q

Two main causes of low bone density late in life?

A

Low peak bone mass - never built it up.

Excess loss.

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5
Q

4 lifestyle factors that contribute to osteoporosis?

A

Low calcium intake
Vitamin D deficiency
EtOH intake > 3 drinks/day
Low BMI

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6
Q

2 significant genetic risk factors for osteoporosis?

A

Family Hx of hip fractures.

Idiopathic Hypercalciuria

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7
Q

3 endocrine disorders that contribute to osteoporosis?

A

Hypothalamic Amenorrhea
Hyperparathyroidism
Thyrotoxicosis
(there are many others - Cushing’s, DM, hyperprolactinemia, etc.)

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8
Q

Main GI disease to screen for related to osteoporosis?

A

Celiac

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9
Q

Most important (according to highlighting) hematologic disorder related to osteoporosis?

A

Multiple myeloma.

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10
Q

Why does end stage renal disease (ESRD) contribute to osteoporosis?

A

Impaired Vitamin D activation.

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11
Q

Does rheumatoid arthritis contribute to osteoporosis?

A

Yeah.

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12
Q

5 medications that cause osteoporosis?

A 
Anticonvulsants
PPIs
Aromatase inhibitors
Depo-medroxyprogesterone
Glucocorticoids
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13
Q

Osteoporosis diagnosis is only given to what demographic?

A

Post-menopausal women.

Men over age 50.

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14
Q

What part of the DXA scan results matters for osteoporosis diagnosis? What is the cut-off for diagnosis of osteoporosis?

A

T-score

Cut-off = -2.5

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15
Q

What is the T-score in DXA scans?

A

Number of standard deviations away from average bone density of young adults.

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16
Q

What is the Z-score in DXA scans?

A

of standard deviations away from average bone density of age-matched controls.

17
Q

What areas are usually scanned in DXA?

A

Lumbar spine, total hip, femoral neck (and sometimes forearm).

18
Q

What T-scores for DXA are in the normal range?

A

-1 to 1

19
Q

What’s a T-score of -1 to -2.5 called?

A

Osteopenia.

20
Q

What gives a osteoporosis diagnosis a designation as “severe”?

A

Having had a fracture.

21
Q

How can you diagnose osteoporosis without a DXA scan?

A

History of “low-trauma” fracture.

22
Q

Do the majority of fractures happen in people with osteoporosis?

A

No. (hip fractures in women do, though)

…is this just because there are more people with osteopenia and normal bone density???

23
Q

7 risk factors in the Fracture Risk Assessment Tool (FRAX)?

A 
Previous fracture
Age
Family Hx of osteoporotic fracture
Smoking
Low BMI
Alcohol
Glucocorticoids
24
Q

What’s the main utility of FRAX?

A

To decide if people in the “osteopenic” (i.e. not quite osteoporosis) category should get treatment.

25
Q

3 reasons why you would pharmacologically treat post-menopausal women and men over 50?

A

DXA scan T score of -2.5 or less.
History of hip or spine fracture.
FRAX score >20% for all fractures or >3% for hip fracture.

26
Q

4 non-pharm treatment to reduce fracture risk?

A

Reduce risk factors.
Take calcium and Vitamin D.
Exercise.
Reduce fall risk.

27
Q

What are the 2 mechanisms by which bone density increasing drugs work?

A

Inhibiting osteoclast activity.

Increasing osteoblast activity.

28
Q

What’s the one drug that works to stimulate osteoblasts?

A

Teriparatide (recombinant PTH)

29
Q

5 drugs that inhibit osteoclast activity?

A 
Bisphosphonates
Denosumab
Calcitonin
Selective estrogen receptor modulator (SERM)
Estrogen
30
Q

What main molecule promotes osteoclast activity? (What cell makes it?)
What endogenous molecule blocks the activity of that molecule? (What cell make that?)

A

RANKL activates osteoclasts. (made by immature osteoblasts)
OPG (osteoprotegrin) blocks RANKL. (Made by mature osteoblasts -recall from CTB that it’s basically soluble RANK, the receptor for RANKL)

31
Q

How do bisphosphonates work?

A

Bind to bone… preventing osteoclasts from working. Apparently the osteoclasts die, too.

32
Q

Adverse effect of bisphosphonates? (short-term and long-term)

A

Short-term: GI discomfort - ulcers, constipation (oral). Increase in creatinine (IV). Flu-like illness (IV).
Long-term: May actually weaken bones -> atypical femur fractures. Osteonecrosis of jaw.

33
Q

Denosumab MoA? Adverse effects?

A

mAb that soaks up RANKL - effectively giving OPG.

Adverse effects: hypocalcemia (when works too well), infections and skin reactions.

34
Q

What’s the deal with giving Teriparatide (rPTH)?

A

You can give it for about 2 years, and there’s a net increase in bone density. After 2 years, the stimulation of osteoclast activity exceeds the stimulation of osteoblast activity.
(We don’t why this doesn’t mimic hyperparathyroidism… it’s interesting.)

35
Q

Adverse effects of Teriparatide? Who is it not given to?

A

Hypercalcemia, nause, orthostasis stuff.
Osteosarcoma - seen in rats, never in humans.
It’s not given to people with existing bone proliferative diseases, like Paget’s.

36
Q

Utility of calcitonin?

A

Good for acute fracture and pain. Not so good for prevention.

37
Q

What’s the SERM used for osteoporosis? Why is it such a cool drug? Adverse effects?

A

Raloxifene
It’s cool because it agonizes estrogen receptors in bone, but antagonizes in breast and uterus - reducing the risk of reproductive cancers.
Adverse effects: Thromboembolism, symptoms of menopause (hot flashes, etc.)

38
Q

Is estrogen prescribed for osteoporosis these days?

A

Not much. The risks outweigh the benefits.

39
Q

Which three drugs are considered the most effective drugs?

A

Bisphosphonates (first line)
Denosumab
rPTH / Teriparatide

Repro-Endo (60 decks)

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