Osteoporosis I Flashcards
Osteoposis is characterized by __ bone strength, low __ mass, disrupted bone architecture, and normal __. there is an increased risk of __.
Osteoposis is characterized by decreased bone strength, low bone mass, disrupted bone architecture, and normal mineralization. there is an increased risk of fracture.
T/f people with osteoporosis have low minteralization, making their bones brittle
false. they have normal amount of mineralization but the bone mass in its entirety is just lower
5 factors of bone that play a role in its’ strength.
- geometry
- density
- turnover
- mineralization
- micro-architecture
adynamic bone disease
people with this disease have NO bone resorption at all. You still need some organized breakdown– you gotta resorv part of it to build up.
adynmamic bone disease is seen in kidney failure patients
Note; osteoposis is common. it is often asymptomatic until there are fractures. fractures drastically affect quality of life. fractures are costly.
Trabecular bone is aka ____ bone. Makes up ___% of the bone mass.
cancellous bone. 20% of bone mass. spine, radius, calcaneus.
cortical bone is aka ___ bone. Seen in ___% bone structures
cortical bone is aka COMPACT bone. seen in 80% of bone mass. affects long bones and femoral neck
what type of bone undergoes the most turnover?
trabecular bone has more turnover. thus increases malignancies in this area– a lot of metastases often affects the travecualr spine.
modeling vs remodeling
modeling happens when growing, and remodeling happens when you are an adult undergoing skeletal maintenance.
peak bone mass occurs in the mid ___, and you plateau by late ___
mid 20s, then you plateau late 30s
T/f you lose bone mass during menopause
true. there’s a 1-2% loss/year post menopause
factors that influence peak bone mass
- GENETICS- biggest factor
- Sex
- Mechanical factors (exercise and body weight)
- endocrine factors
- nutrition
- smoking
- alcohol
- ehtnicity (black people have higher bone mass)
- medical comorbidities
Outline risk factors for osteoposis (there’s like 26)
- immobilization/inactivity
- prior fracture
- age
- inflammation
- diabetes
- chronic illness
- smoking,etOH
- genetics
- hyperparathyroidism
- family history
- poor nutrition
- malabsorption
- medications, steroids,
- vitamin D deficiency
- hypogonadism
- endocrinopathies
Drugs that increase bone loss. What is the most impactful/common drug cause?
- GLUCOCORTICOIDS
- TZDs
- anticoagulants like heparin and warfarin
- cyclosporine
- loop diuretics
- antidepressants
- PPIs
- levothyroxine
- progesterone
- vitamin A
- retinoids
- antiepileptics
- anti-retrovirals
- chemotherapy
FRAX can assess general fracture risk, and ___ fracture specifically in the next __ years
hip fracture or major clinical fracture in the next 10 years.
12 factors that FRAX score takes into consideration
- age
- sex
- weight
- height
- previous fracture
- parent fractured their hip
- CURRENT smoking
- glucocorticoids
- rheumatoid arthritis
- secondary osteoposis
- alcohol more than 3 units/day
- femoral neck BMD
should should be included in an osteoposis history?
physical exam for an osteoporosis work up
4 components to do prior to arriving at a osteoporosis diagnosis
- DXA
- FRAX
- Labs, history, physicial
- biopsy
FOR DXA:
at low energy, bone>soft tissue.
at high energy, bone = soft tissue.
you use two different energies to get a proper absorptiometry reading.
Can look at bone density.
NOF Indications for BMD:
- women over ___,
- men over ___
- perimenopausal women with __ ___
- fractures after the age of ___
- adults with condition or medications leading to bone loss.
Women 65+
• Men 70+
• Perimenopausal women or men 50-70 with risk
factors
• Fracture after age 50
• Adults with condition or medication leading to
bone loss
NOTE: canada regulatiosn aer different:
t/f DXA has more radiation than an XRAY
false. DXA is much lower than an Xray of the spine
what two things must you NOT talke prior to doing a DXA BMD scan
- no calcium supplements for 24 hours
- no contrast in the last 7 days of the GI system. if there is contrast in the gut, soft tissue affects hard bone visualization
2 ways to quantigy BMD
T score; compared to a 25 year old control. this is done in older people; post menopausal women and men over 50.
Z score; compared to an age matched control. done in pre-menopausal women and men uner 50.
note; bascially the older you get, the less density your bones have
VFA indications
VFA= vertebral fracture assessment.
done if you have a Tscore <1 on the BMD, PLUS ONE OR MORE OF THE FOLLOWING:
- women over 70, men over 80.
- historical heigh loss of over 4cm.
- self reported but undocumetned prior vert number
- glucocorticoids equivalent to 5mg pred/d in three months. Steroids are a huge risk factor for fractures.
how is BMD affected by heigh
in small stature people, bone density may say its worse than it is.
How does the FRAX score influence treatment for osteoporosis?
if the risk for a major fracture is over 20%, or if the risk of hip fracture is >3%, consider treatment.
- if the risk for a major fracture is UNDER 20%< or if the risk of hip fracutre is UNDER 3%, treatment is unlikely.
FRAX takes 12 factors into consideration when calculating the risk for fracture. What are the limitations to this scoring system?
Falls
rate of bone loss
medications other than steroids
other family history
yes/no but multiple risks
untreated patients only
age 40-90- not valid in someone younger
- can’t be used to monitor response to therapy
routine blood work labs for osteoporosis workup
- CBC
- TSH
- ALP
- PTH
- Calcium levels
- Lytes
- Albumin
- Vitamin D
- Creatinine
- Phosphate
two lab values that can indicate bone turnover measurs
CTX and NTX
- these labs are not done on every person
Putting it all together: When to Treat osteoporosis– 1 or more of
- T < -___
- • FRAX >__% major fracture, __ hip%
- • ___ hip or spine fracture
- • 2+ ___ fractures
- • Moderate risk + patient preference
T < -2.5
- FRAX >20%, 3%
- Prior hip or spine fracture
- 2+ fragility fractures
- Moderate risk + patient preference
