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CMLFInal Sem2 > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What are the stats for a patient that breaks a hip with osteoporosis?

A

50% mortality within 6 months and 80% within one year

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2
Q

In the following three patients, which do you expect would have osteoporosis?
A) 76 y.o male with continued thinning of horizontal trabeculae and wider separation of vertical strucutres of bone
B) 50 y.o man with almost perfect continuous trabecular network
C) 87 y.o woman with advanced breakdown of entire network showing unsupported vertical trabeculae
D) 58 year old man with thinning of the horizontal trabeculae and some loss of continuity

A

A & C

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3
Q

What two things are responsible for most postmenopausal osteoporosis?

A

Estrogen deficiency & age – bone tissue is lost progressively

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4
Q

What are the gender stats for osteoporosis?

A

women»men

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5
Q

At age ____ we see a decline in bone strength

A

30

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6
Q

The lifetime osteoporotic fracture risk for a woman who reaches age 50 is ______% whereas it is _____% for a man?

A

50% women and 20% man

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7
Q

This med is a major culprit for osteoporosis

A

Prednisone

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8
Q

What are some causes of secondary osteoporosis?

A
  • Steroids, antiepileptics
  • vit D deficiency
  • Alcohol
  • Chronic illness
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9
Q

___________ is a major RF for osteoporosis

A

smoking

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10
Q

A FRAX algorithm calculates a patient’s ____ year risk probability for _______

A

10, a fracture

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11
Q

What does the FRAX algorithm take into consideration?

A
  • Age, height, weight, sex
  • previous fxr
  • parent fractured hip
  • -current smoking
  • glucocorticoids
  • RA
  • secondary osteoporosis
  • 3 or more alcohol a day
  • femoral neck BMD
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12
Q

What is the gold standard for bone density? What body parts is it done on?

A

Bone densitometry (DXA) of the lumbar spine and hip

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13
Q

Is there a DXA screening recommendation for men?

A

No

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14
Q

Who needs a DXA scan?

A
  • Women greater than or equal to 65
  • younger but at risk for osteoporosis or osteomalacia
  • pathologic fractures
  • radiographic evidence for diminshed bone denisty
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15
Q

A higher T-score means more frequent or less frequent scans?

A

Less frequent

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16
Q

A patient has a T-score of -1.2. When will her next scan be?

A

5 years

T-score -1 to -1.5 every 5 years

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17
Q

A patient with a T-score of -1.8 should get their next scan when?

A

3-5 years

T-score -1.5 to -2.0 every 3-5 years

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18
Q

A patient has a t-score of -4. When should they get their next scan?

A

T-score

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19
Q

BMD is within 1 st dev of a young normal adult (T score is greater than -1.0)

A

Normal

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20
Q

BMD is between 1 and 2.5 std dev below a young normal adult (T score is -1 to -2.5)

A

osteopenia (low bone density)

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21
Q

BMD is 2.5 SD or more below a young normal adult (T score is less than -2.5)

A

Osteoporosis

22
Q

BMD is 2.5 SD or more below a young adult with 1 or more fragility fractures

A

Severe or established osteoporosis

23
Q

Fracture risk _______ for every st dev

A

doubles

24
Q

What are the bone density criteria numbers (T-score ranges)?

A

-1 or greater = normal
-1 to -2.5 = osteopenia
-2.5 or greater = osteoporosis
below 2.5 SD or more below norm = severe or estab osteoporosis

25
Q

A patient may refer to these body parts if they have osteoporosis

A

May refer into

  • flank
  • anterior abdomen
  • posterior superior iliac spine

*radiation into legs rare

26
Q

Radiographs show this for osteoporosis?

A
  • radiolucency
  • occult fractures
  • cortical thinning

ROC

27
Q

How much calcium should a patient with osteoporosis take?

A

1200 mg/Ca per day

28
Q

What are the guidelines for pharmacologic intervention in postmenopausal women and men greater than or equal to 50 years of age?

A
  1. hx of hip or vertebral fxr
  2. dxa score less than or equal to -2.5 at the femoral neck or spine, after appropriate eval to exclude secondary causes
  3. Osteopenia category however their risk is 3% for hip fxr or 20% for other fxr
29
Q

What should a patients total vit D intake be?

A

800 units

30
Q

What are the s/e of calcium supplements?

A

inc risk of nephrolithiasis (kidney stones), may inc CVD, dyspepsia, constipation**, may interfere with iron and thyroid hormone

31
Q

What are the s/e of Vit D?

A

I excessive amounts- hypercalcemia, hypercalciuria, nephrolithiasis

32
Q

What are chronically high levels of Vit D related to?

A

-Cancer, mortality and falls

33
Q

WHat test can determine if your vit D levels are too high?

A

25(OH)D

34
Q

What medications are a good first line therapy for those that have fractures and shown to improve BMD and decrease fractures?

A

Alendronate and risendronate (bisphosphonates)

35
Q

What two things do you need to correct prior to starting bisphosphonates?

A

hypocalcemia and Vit D deficiency

36
Q

Contraindications to bisphosphonates?

A

Esophagral disorders, after bariatric surgery, or unable to follow the dosing requirements

37
Q

How must you take bisphosphonates?

A

Taken 1st thing in morning or on an empty stomach for maximal absorption with 8 oz of water

38
Q

Can a patient taking bisphohonates take it with soda?

A

NO only water

39
Q

What are directions for after taking bisphosphonates?

A

Do not drink or take any other meds for at least 30 min after and remain upright (sit or stand) for 30 min after admin

40
Q

When can you stop taking bisphosphonates?

A

If taking aldenronate or risdendronate for 5 years or zoledronic acid (reclast) yearly x 3 years + stable BMD + no hx vertebral fractures + low risk for fracture in near future
–> d/c drug

41
Q

When can you stop taking bisphosphonates if high risk for fxr?

A

-Continue PO therapy up to 10 years and IV up to 6 years

42
Q

Name 4 risks of taking bisphosphonates

A
  1. Upper GI irritation (relux, esophagitis, esophageal ulcers)
  2. IV bisphos rxns (FAM)
  3. osteonecrosis of jaw
  4. renal probs
43
Q

What are the s.e of IV bisphos?

A

Can cause acute phase reaction (FAM- fever, arthralgia, myalgia)

44
Q

Renal patients can not take bisphosphonates if their CrCl is less than what?

A

30

45
Q

This osteoporosis tx is used for acute pain and Increases spine bone density & may decrease vertebral fracture risk

A

Calcitonin

46
Q

Can you use calcitonin long-term?

A

No-for short term pain relief in those with acute pain related to vertebral fractures

47
Q

Adverse rxns of calcitonin?

A

-Rhinitis, increased malignancy risk

48
Q

What is the best two oral analgesics for osteoporosis and what should not be used?

A
  • Acetaminophen (Tylenol)
  • NSAIDs **ibuprofen can inhibit bone healing and repair potentially
  • Narcotics shouldnt be used
49
Q

If a patient has a significant height loss due to osteoporosis, what should the patient do?

A

get a kyphoplasty

50
Q

WHen is a kypho or vertebroplasty indicated?

A

In patients unable to achieve pain control or significant impairment in structure and fxn

51
Q

What is the difference bt percutaneous vertebroplasty and balloon kyphoplasty?

A
  • percutaneous vertebroplasty: put cement in spine **less expensive & invasive
  • balloon kyphoplasty: put a balloon in spine first to expand crushed vertebrae before cement

CMLFInal Sem2 (10 decks)

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