Osteoporosis Flashcards
what is osteoporosis
- breakdown in bone structure due to decreased bone mineral density
- decreased bone mass
- increased bone fragility
- increased fracture risk
what are fragility fractures
- attributable to osteoporotic bone shock
- all fractures that result from a low energy traumatic event
- associated with increased morbidity and morality
decreased bmd leads to __
decreased bmd -> brittle bones + low energy force -> easily broken
areas prone to fragility fractures
- distal radius
- vertebral fractures
patients with previous fragility fracture have __ risk of another fragility fracture
2x increased risk
low bmd = inc risk for 2ndary frcature
most devastating consequence of osteoporosis
hip fractures
- mortality rate 25% in first year
other implications of fragility fractures
- increase in financial cost
- ## treatment reduces mortality by 30%
biggest risk factor for future fracture
previous fragility fracture
all low energy fractures should be considered in fragility fractures EXCEPT
- facial bones
- skull
- feet
- hands
- digits
- patella
work-up for patients with decreased bmd
- dxa
- serum vit d level
- risk factor assessment
- younger than 50 = further evaluation for secondary osteoporosis
modifiable risk factors
- smoking
- alcohol (>3 drinks/day)
- overall nutrition
nonmodifiable risk factors
- age, gender
- fhx
- rheumatoid arthritis
- glucocorticoid use
- secondary osteoporosis
moa for bisphosphonates
- causes osteoclast cell death -> decreases bone resorption
bind calcium -> resorbed by osteoclasts -> causes osteoclast cell death -> decreased resorption of bone
initial therapy with bisphosphonates is recommended in ___
postmenopausal women
moa of calcitonin
- causes decreased bone resorption by osteoclasts
- does not reduce risk for non-vertebral fractures
- can control bone pain
calcitonin is indicated for ___
- women with osteoporosis at least 5 years post menopause
- nasal spray: only in high fracture risk women with osteoporosis who cannot tolerate other treatment options
what is raloxifene
- estrogen agonist in bone
- causes decreased bone resorption by osteoclasts
- reduced risk for vertebral fractures
raloxifene is indicated for ___
post menopausal women with
- low risk for dvt
- bisphosphonates or denosumab inappropriate
- high risk of breast ca
moa of teriparatide
- recombinant human pth
- greater ca absorption and stimulating osteoblastic activity -> increased bone mineral density
teriparatide is indicated for ___
- men and postmenopausal women with osteoporosis and high fracture risk
- teriparatide or abaloparatide for upto 2 years to reduce vertebral and non vertebral fractures
moa of denosumab
- receptor activator of rank ligand inhibitor
- rankl = increases osteoclast activity
- denosumab binds to rankl = decreased osteoclast aactivity
denosumab is indicated for ___
men and post menopausal women (alternative initial treatment) with osteoporosis and high fracture risk
90 mg sc every 6 mos
risk fracture reduction of denosumab
- vertebra 68%
- hip 40%
- non vertebral 20%
t/f drug holidays are recommended for denosumab
false, effects are reveresed after 6 mos if not taken on schedule
monitoring of treatment
- dexa every 1-3 years in postmenopausal
- bone turnover markers as an alternative
- ctx = anti-resorptive therapy
- p1np = bone anabolic therapy
guideline for postmenopausal women with osteoporosis taking bisphosphonates
- assess fracture risk after 3-5 years
- bisphosphonate holiday for upto 5 years
- reinitiate therapy earlier if significant bmd decline, intervening fractures, other factors
guideline for postmenopausal women with osteoporosis taking denosumab
reassessment after 5-10 years
adverse effects of oral bisphosphonates
- upper gi irritation (minimized by adherence to dosing procedures)
- atypical femoral fractures
- nonunion of atypical fractures
adjunct therapy for oral bisphosphonates
- daily calciuma and vit d
- especially if with low bmd and high risk of fractures
- to prevent hip fractures
factors in frax calculation tool
- oral glucocorticoids
- rheumatoid arthritis
- secondary osteoporosis
- t score of femoral neck
- alcohol
t/f prior clinical vertebral and hip fractures are stronger risk factors
true
t/f rheumatoid arthritis is protective
false
other interventions
- adequate calcium and vit d intake
- decrease alcohol, caffeine, and tobacco
- encourage regular physical activity
- fall prevention and home safety evaluation
daily ca intake
men 50-70 1000 mg
men >71 1200 mg
women >50 1200 mg
daily vit d intake
normal serum level 30-80 ng/ml
recommended 800-1000 iu
supplementation (<30 ng/ml) 50,000 iu/week for 8-12 weeks
t/f a patient who suffered a fracture from a low energy mechanism that would not cause a fracture in a normal person should be osteoporotic until proven otherwise
true
