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18 ORR > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

what is osteoporosis

A
  • breakdown in bone structure due to decreased bone mineral density
  • decreased bone mass
  • increased bone fragility
  • increased fracture risk
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2
Q

what are fragility fractures

A
  • attributable to osteoporotic bone shock
  • all fractures that result from a low energy traumatic event
  • associated with increased morbidity and morality
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3
Q

decreased bmd leads to __

A

decreased bmd -> brittle bones + low energy force -> easily broken

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4
Q

areas prone to fragility fractures

A
  • distal radius

- vertebral fractures

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5
Q

patients with previous fragility fracture have __ risk of another fragility fracture

A

2x increased risk

low bmd = inc risk for 2ndary frcature

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6
Q

most devastating consequence of osteoporosis

A

hip fractures

- mortality rate 25% in first year

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7
Q

other implications of fragility fractures

A
  • increase in financial cost
  • ## treatment reduces mortality by 30%
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8
Q

biggest risk factor for future fracture

A

previous fragility fracture

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9
Q

all low energy fractures should be considered in fragility fractures EXCEPT

A
  • facial bones
  • skull
  • feet
  • hands
  • digits
  • patella
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10
Q

work-up for patients with decreased bmd

A
  • dxa
  • serum vit d level
  • risk factor assessment
  • younger than 50 = further evaluation for secondary osteoporosis
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11
Q

modifiable risk factors

A
  • smoking
  • alcohol (>3 drinks/day)
  • overall nutrition
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12
Q

nonmodifiable risk factors

A
  • age, gender
  • fhx
  • rheumatoid arthritis
  • glucocorticoid use
  • secondary osteoporosis
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13
Q

moa for bisphosphonates

A
  • causes osteoclast cell death -> decreases bone resorption

bind calcium -> resorbed by osteoclasts -> causes osteoclast cell death -> decreased resorption of bone

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14
Q

initial therapy with bisphosphonates is recommended in ___

A

postmenopausal women

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15
Q

moa of calcitonin

A
  • causes decreased bone resorption by osteoclasts
  • does not reduce risk for non-vertebral fractures
  • can control bone pain
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16
Q

calcitonin is indicated for ___

A
  • 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

17
Q

what is raloxifene

A
  • estrogen agonist in bone
  • causes decreased bone resorption by osteoclasts
  • reduced risk for vertebral fractures
18
Q

raloxifene is indicated for ___

A

post menopausal women with

  • low risk for dvt
  • bisphosphonates or denosumab inappropriate
  • high risk of breast ca
19
Q

moa of teriparatide

A
  • recombinant human pth

- greater ca absorption and stimulating osteoblastic activity -> increased bone mineral density

20
Q

teriparatide is indicated for ___

A
  • men and postmenopausal women with osteoporosis and high fracture risk
  • teriparatide or abaloparatide for upto 2 years to reduce vertebral and non vertebral fractures
21
Q

moa of denosumab

A
  • receptor activator of rank ligand inhibitor
  • rankl = increases osteoclast activity
  • denosumab binds to rankl = decreased osteoclast aactivity
22
Q

denosumab is indicated for ___

A

men and post menopausal women (alternative initial treatment) with osteoporosis and high fracture risk

90 mg sc every 6 mos

23
Q

risk fracture reduction of denosumab

A
  • vertebra 68%
  • hip 40%
  • non vertebral 20%
24
Q

t/f drug holidays are recommended for denosumab

A

false, effects are reveresed after 6 mos if not taken on schedule

25
Q

monitoring of treatment

A
  • dexa every 1-3 years in postmenopausal
  • bone turnover markers as an alternative
  • ctx = anti-resorptive therapy
  • p1np = bone anabolic therapy
26
Q

guideline for postmenopausal women with osteoporosis taking bisphosphonates

A
  • assess fracture risk after 3-5 years
  • bisphosphonate holiday for upto 5 years
  • reinitiate therapy earlier if significant bmd decline, intervening fractures, other factors
27
Q

guideline for postmenopausal women with osteoporosis taking denosumab

A

reassessment after 5-10 years

28
Q

adverse effects of oral bisphosphonates

A
  • upper gi irritation (minimized by adherence to dosing procedures)
  • atypical femoral fractures
  • nonunion of atypical fractures
29
Q

adjunct therapy for oral bisphosphonates

A
  • daily calciuma and vit d
  • especially if with low bmd and high risk of fractures
  • to prevent hip fractures
30
Q

factors in frax calculation tool

A
  • oral glucocorticoids
  • rheumatoid arthritis
  • secondary osteoporosis
  • t score of femoral neck
  • alcohol
31
Q

t/f prior clinical vertebral and hip fractures are stronger risk factors

A

true

32
Q

t/f rheumatoid arthritis is protective

A

false

33
Q

other interventions

A
  • adequate calcium and vit d intake
  • decrease alcohol, caffeine, and tobacco
  • encourage regular physical activity
  • fall prevention and home safety evaluation
34
Q

daily ca intake

A

men 50-70 1000 mg
men >71 1200 mg
women >50 1200 mg

35
Q

daily vit d intake

A

normal serum level 30-80 ng/ml
recommended 800-1000 iu
supplementation (<30 ng/ml) 50,000 iu/week for 8-12 weeks

36
Q

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

A

true

18 ORR (21 decks)

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