Osteoporosis and Osteosarcoma Flashcards
1
Q
What does an osteoclast do?
A
Breaks down bone
2
Q
What does an osteoblast do?
A
create/deposit bone
3
Q
When is the peak adult bone mass?
A
early 20’s to 30/35 years old
4
Q
When is the greatest amount of decline in bone mass?
A
immediately after menopause (51-52)
5
Q
What is osteopenia?
A
A bone condition characterized by bone loss that is not as severe as in osteoporosis
6
Q
What is the definition of osteoporosis?
A
Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and an increased risk factor
7
Q
Describe the need for an early diagnosis of osteoporosis
A
Early diagnosis and quantification of bone loss and fracture risk are important because of the availability of therapies that can slow or even reverse the progression of osteoporosis
8
Q
What will be on the exam word for word?
A
Osteoporosis, which literally means porous bone (porous bone matrix) is a disease in which the density and quality of bone are reduces (bones are brittle, porous and prone to fracture). As bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs silently and progressively. Often there are no symptoms until the first fracture occurs.
9
Q
Osteoporosis is a skeletal disorder characterized by (1)?
A
Loss of bone integrity
10
Q
How is bone integrity lost?
A
Rate of bone formation is often normal while rate of bone resorption is increased
11
Q
Osteoporosis is a skeletal disorder characterized by (2)?
A
A decrease in the amount of bone present to a level below which it is capable of maintaining the structural integrity of the skeleton; Depleted bone integrity
12
Q
Osteoporosis is a skeletal disorder characterized by (3)?
A
The bone density and architectural changes of osteoporosis lead to impaired skeletal strength and markedly increase risk of fracture
13
Q
How many fractures does osteoporosis cause annually?
A
about 2 million
14
Q
How many vertebral fractures occur per year due to osteoporosis?
A
547,000
15
Q
How many wrist fractures occur per year due to osteoporosis?
A
397,000
16
Q
What is a fracture of the wrist called and what mechanism causes it?
A
Colles fracture; FOOSH
17
Q
How many hip/femur fractures occur per year due to osteoporosis?
A
300,000
18
Q
How many pelvic fractures occur per year due to osteoporosis?
A
135,000
19
Q
How many total Americans have osteoporosis? How many are female?
A
10 million total; 8 million are female
20
Q
Describe a pathological fracture
A
an affected bone that is not as strong as normal and may fracture with minor trauma; a bone fracture in the absence of significant force
21
Q
What could be the cause of a break with minor trauma?
A
Osteoporosis, cancer, abuse
22
Q
If a patient’s leg is shortened and externally rotated, what is the fracture?
A
Hip fracture
23
Q
What is primary osteoporosis?
A
bone loss that occurs during the normal human aging process
24
Q
What is secondary osteoporosis?
A
bone loss that results from specific, well-defined clinical disorders
25
What is a drug that chronic use may lead to osteoporosis?
Steroids
26
What are the four most common risk factors for osteoporosis?
Aging, corticosteroids, postmenopausal/ amenorrhic, alcohol use
27
What are other risk factors for osteoporosis?
Female, asian/caucasian, >50, estrogen deficiency, Early menopause, Low BMI (<19), anorexia, Maternal family history of osteoporosis, inactive lifestyle, lack of weight bearing exercises, decreased calcium, decreased vitamin D, Smoking, nicotine
28
What medications are a risk factor for osteoporosis?
Steroids, thyroid medications, hormone suppressants, cancer treatment
29
What medical condition are a risk factor for osteoporosis?
Rheumatoid arthritis, eating disorders, hyperthyroidism, hyperparathyroidism, osteogencia imperfecta
30
What are symptoms of osteoporosis?
none until fracture occurs
31
What are the 3 ways that osteoporosis can be diagnosed?
Fragility fracture, T-score < or equal to -2.5, FRAX 10-year probability of major osteoporotic fracture is > or equal to 20% or 10-year probability of hip fracture is > or equal to 3%
32
How is a T-Score measured?
DXA scan: dual energy x-ray absorptiometry
33
When should a DXA scan be repeated if the T-score is -1.0 to -1.5?
Every 5 years
34
When should a DXA scan be repeated if the T-score is -1.5 to -2.0?
every 3-5 years
35
When should a DXA scan be repeated if the T-score is under -2.0?
every 1-2 years
36
What is a T-score?
difference between a patient's BMD and that of a young adult reference population
37
What is a Z-score?
Comparison of the patient's BMD to am age-matched population
38
When is a Z-score considered below the expected range for age? What should be done?
-2; Prompt careful scrutiny for coexisting problems such as glucocorticoid therapy or alcoholism, that can contribute to osteoporosis
39
What is the gold standard for evaluation of bone density?
DXA scan
40
What structures are a DXA scan used to determine the density of?
lumbar spine and hip
41
Who should a DXA scan be performed on?
Patients who are at risk of OP or osteomalacia, patients who have pathologic fractures, radiographic evidence of diminished bone density
42
What does a DXA scan deliver?
negligible radiation exposure and tremendous results
43
How can a healthcare provider rule out osteoporosis?
Careful history with addressing of lifestyle factors that are known risk factors; Height and weight should be measured
44
What does FRAX stand for?
Fracture risk assessment tool
45
What does FRAX do?
estimates the 10-year probability of hip fracture and major osteoporotic fracture
46
How does FRAX measure probability of fracture?
using easily obtainable clinical risk factors for fracture with or without femoral neck bone mineral density (BMD)
47
Should an x-ray be used to diagnose osteoporosis?
No; usually very insensitive to detection of OP unless very severe or if there is an acute fracture
48
What are the baseline laboratory tests that should be performed so that abnormalities that may increase the risk of osteoporosis can be identified?
Thyroid function test for metabolism and check for hyperthyroidism (risk factor); 25-hydroxyvitamin D test for vitamin D deficiency
49
What are six preventative measures to avoid osteoporosis?
Diet should be adequate in protein, total calories, calcium, and vitamin D; Corticosteroid doses should be reduced or discontinued if possible; High impact physical activity (jogging) significantly increase bone density in both men and women; Stair climbing increases bone density in women; Weight training - increase muscle strength as well as bone density; fall avoidance!
50
How can one's home be improved to avoid falls?
Adequate lighting; loose rugs removed; keep floors clutter free; pets under foot; wet/cracked paving; ice or snow; handrails on stairs; use cane/walker if needed; balance exercise; avoid smoking/alcohol
51
What can increase the risk of falls?
impaired vision (cataracts); footwear with slippery soles or high heels
52
Why might a patient recovering from a hip fracture not be able to go back home?
stairs; no one to take care of them; fall risks
53
Why is a rehab center a bad place for someone recovering from a hip fracture?
Bad conditions; depression/lose will to live; more infection exposure
54
*What can happen when an elderly person falls in their home?
They may lay for hours until someone finds them; rhabdomyolysis
55
*Define Rhabdomyolysis
the breakdown of damaged skeletal muscle that causes the release of myoglobin into the blood stream; Too much myoglobin in the blood can cause kidney damage
56
*What are 3 signs of rhabdomyolysis?
dark/tea colored urine; increase BUN/Cr (blood urea nitrogen/creatine) which is a kidney function test; K+ comes out of the cells so the serum K is high - look for EKG changes (can cause cardiac arrest)
57
What is the first reason for pharmacological intervention in postmenopausal women and men 50 and older?
History of hip or vertebral fracture
58
What is the second reason for pharmacological intervention in postmenopausal women and men 50 and older?
T-score < or equal to -2.5 at the femoral neck or spine after appropriate evaluation to exclude secondary causes
59
What is the third reason for pharmacological intervention in postmenopausal women and men 50 and older?
T-score between -1 and -2.5 at the femoral neck or spine and a 10 year probability of hip fracture > or equal to 3 percent or a 10 year probability of any major osteoporosis-related fracture > or equal to 20% based upon the US adapted WHO algorithm
60
What is the first line of therapy for treating osteoporosis?
Bisphosphonates
61
What type of patients are bisphosphonates indicated for?
patients with DXA < or equal to -2.5 in spine, hip, or femoral neck; patients with pathologic fracture of spine or hip
62
What is the mechanism of action for bisphosphonates?
Inhibit osteoclast-induced bone resorption
63
How do bisphosphonates work?
They increase bone density significantly and reduce the incidence of both vertebral and non-vertebral fractures
64
When and how must bisphosphonates be taken? Why?
They must be taken in the morning with at least 8 ounces of water at least 40 minutes before consumption of anything else to ensure intestinal absorption
65
What is the first bisphosphonate with dosing?
Alendronate (Fosamax) 70 mg once weekly
66
What is the second bisphosphonate with dosing?
Risedronate (Actonel) 35 mg orally once weekly
67
What is the third bisphosphonate with dosing?
Ibandronate sodium (Boniva) 150 mg taken once monthly
68
What are the side effects of bisphosphonates?
abdominal pain. nausea, heartburn, irritation of esophagus, anemia, joint and muscle pain
69
What side effect of bisphosphonates is avoided by taking it with plenty of water?
irritation of esophagus
70
Bisphosphonates are specifically helpful in preventing what type of osteoporosis?
corticosteroid induced osteoporosis
71
What is the second option for osteoporosis treatment?
Vitamin D and Calcium
72
Are sun exposure and vitamin D supplements useful in preventing and treating osteoporosis?
No; It is helpful in preventing and treating ostemalacia
73
What is the recommended intake of vitamin D and calcium for patients with osteomalacia?
1200mg of elemental calcium daily, total diet plus supplement, and 800 international units of vitamin D daily are advised
74
Why is vitamin D needed by the body?
necessary for absorption of calcium in the GI tract
75
By what percentage does vitamin D supplementation reduce incidence of a vertebral fracture by?
37%
76
How is vitamin D synthesized?
in the skin on exposure to sunlight or in foods; sunscreen blocks the production of vitamin D in the skin
77
What foods have vitamin D?
egg yolks, fish, liver, cereals, milk, OJ
78
When is calcium supplementation useful?
When dietary intake is low; it does not reduce the fracture risk in otherwise healthy postmenopausal women
79
Who is recommended to take calcium supplements?
Patients at a high risk for osteoporosis and for those with established osteoporosis
80
What is calcitonin? How is it administered?
An antiresorptive medication; route is via nasal spray
81
Does calcitonin reduce the risk of vertebral body fracture?
yes, but efficacy has not been demonstrated by non-vertebral fracture; therefore, it is not often used because there are more effective medications
82
What are SERMs?
Selective estrogen receptor modulators
83
What is an example of a SERM
Evista - raloxifene
84
Who is able to use SERMs?
postmenopausal women in place of estrogen for prevention of OP
85
How do SERMs help with osteoporosis?
Bone density increases about 1% over 2 years
86
What are other medical benefits of SERMs?
Reduces LDL (low-density lipoprotein) cholesterol; Risk of breast cancer reduced 76% in women taking for 3 years
87
What are adverse reactions of SERMs
Hot flashes - intensifies hot flashes; Deep vein thrombosis (DVT) which can be lethal; Leg cramps; cerebrovascular accident (CVA or stroke)
88
Are SERMs safe for pregnant women?
No; it is contraindicated in pre-menopausal women - teratogen to fetus
89
Is estrogen/progestin therapy a good option for treatment?
No; it is no longer a first-line approach for the treatment of osteoporosis in postmenopausal women
90
Why is estrogen/progestin therapy no longer used?
It increases the risk of breast cancer, stroke, colon cancer, and uterine cancer
91
What is a complication of osteoporosis?
Back pain; it is the most common clinical presentation of OP secondary to vertebral compression fracture
92
What is an acute event of back pain related of OP?
Vertebral body compression fracture causes back pain
93
Back pain may be secondary to?
spontaneous fracture or collapse of a vertebra
94
What is another type of acute event that is possible?
Malignancy; especially multiple myeloma
95
What are two examples of chronic manifestations from OP?
Loss of height and spinal deformity - "Dowager's Hump"
96
What does dowager mean?
Dignified elderly woman
97
What are the 5 treatment options for osteoporosis?
Bisphosphonates; Vitamin D and Calcium; Calcitonin; SERMs; estrogen/progestin therapy
98
What are medical management options for a vertebral compression fracture?
Pain management (narcotics); Braces
99
What are the shortcoming of medical management options for a vertebral compression fracture?
May fail to relieve pain; Does not provide long-term functional improvement; May exacerbate bone loss; Does not attempt to restore the anatomy
100
What is another option for treating a vertebral compression fracture?
Kyphoplasty or open surgical intervention
101
What is the goal of a kyphoplasty?
restore the height of vertebra
102
How does a kyphoplasty work?
A provider inflates a balloon-like device in the bone to make space; the space is then filled with cement
103
When should open surgical intervention be used to treat vertebral compression fracture?
if neurological deficit
104
What type of procedure is open surgical intervention?
instrumental infusion; invasive procedure
105
What is osteosarcoma?
Most common malignancy of the bone; usually develops in teenagers when a teen is growing rapidly
106
In what type of person does osteosarcoma typically present, where, and how?
In an adolescent who presents with pain or swelling in a bone or joint, especially the knee
107
When do osteosarcoma symptoms often begin to appear?
following a sports injury which can cause accurate diagnosis to be delayed
108
What are the symptoms of osteosarcoma?
Bone pain often worse at night; tenderness and swelling if tumor is large; pathologic fracture
109
What is the prevalence of osteosarcoma in different bones in the body?
42% in the femur
19% in the tibia
10% in the humerus
8% in the skull and jaw
8% in the pelvis
110
What are the appropriate diagnostic evaluations of osteosarcoma?
X-ray of affected area
CT scan of affected area
CT scan of chest to look for metastasis to lungs
Biopsy
Bone scan
111
Which diagnostic evaluation is required for definitive diagnosis?
Biopsy
112
What is treatment for sarcoma based upon?
Staging; where it is found in the body
113
When does treatment for sarcoma typically start?
After biopsy
114
What should be done before major surgery in a case of sarcoma?
chemotherapy
115
What is the goal of surgery to treat osteosarcoma?
to remove any remaining tumor while attempting to spare the affected limb
116
What is rare but may be necessary to treat osteosarcoma?
amputation
