Osteoporosis Flashcards
What is it?
What BMD is required?
Decreased bone mass leading to bone weakness leading to increased risk of fragility fractures
BMD>2.5 from SD
What are some risk factors for osteoporosis?
Post menopausal ~ decreased estrogen
Smoking
Immobilization
Low boy weight
Malabsorption issues
Bone malignancies
Long term corticosteroid use
What is primary & secondary OP?
Primary
- post menopausal
- senile
- idiopathic
Secondary
- Medications: Corticosteroids, PPIs, anticoagulants
- Endo/met: hyperthyroidism, hyperparathyroidism, DM, Cushing’s
- Malignancy: MM
- GI; malabsorption ~ celiac, IBD
- other: immobilization, SLE, RA, lots EtOH consumption, smoking (COPD)
What is the clinical presentation of OP like?
Commonly asymptomatic
Fragility fractures or fractures: femur, humerus, wrist
Dowager’s hump
Less teeth<20
Height loss (bc vertebral collapse)
What is screening like for BMD?
All adults >65 yo = BMD every 1-3 years
Younger than it depends on risk factors: corticosteroid use, current smoker, fragility fracture in past, lots EtOH consumption
What 2 sites are used to assess OP with BMD?
What T score would classify someone as OP?
Femoral neck
Lumbar spine
T score > -2.5
When should you consider treatment based on T score?
Low risk: vitamin D, calcium, exercise, every 5-10 years BMD
Mod risk: pt preference, every 1-3 years BMD
High risk >20%: begin pharm tx & repeat BMD 1-3 years following
What medications could be used?
1) bisphosphonates
- alendronate, risendronate, zoledronic acid (IV)
- inhibiting osteoclasts
- major concerns: a vascular necrosis jaw, atypical fractures of femur, esophageal issues: inflammation, ulcers, dysphagia, hypocalcemia
Dunosemab ~ anti RANKL antibody
- osteoclasts are not activated
- major issue: once you stop this medication, BMD severely drops
Raloxifene ~ estrogen agonist/antagonist
- prevents bone resorption
- hot flashes & vaginal dryness, increases risk PE/DVT
