Osteoporosis I

Question 1

Osteoposis is characterized by __ bone strength, low __ mass, disrupted bone architecture, and normal __. there is an increased risk of __.

Answer 1

Osteoposis is characterized by decreased bone strength, low bone mass, disrupted bone architecture, and normal mineralization. there is an increased risk of fracture.

Question 2

T/f people with osteoporosis have low minteralization, making their bones brittle

Answer 2

false. they have normal amount of mineralization but the bone mass in its entirety is just lower

Question 3

5 factors of bone that play a role in its’ strength.

Answer 3

1. geometry
2. density
3. turnover
4. mineralization
5. micro-architecture

Question 4

adynamic bone disease

Answer 4

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

Question 5

Note; osteoposis is common. it is often asymptomatic until there are fractures. fractures drastically affect quality of life. fractures are costly.

Question 6

Trabecular bone is aka ____ bone. Makes up ___% of the bone mass.

Answer 6

cancellous bone. 20% of bone mass. spine, radius, calcaneus.

Question 7

cortical bone is aka ___ bone. Seen in ___% bone structures

Answer 7

cortical bone is aka COMPACT bone. seen in 80% of bone mass. affects long bones and femoral neck

Question 8

what type of bone undergoes the most turnover?

Answer 8

trabecular bone has more turnover. thus increases malignancies in this area– a lot of metastases often affects the travecualr spine.

Question 9

modeling vs remodeling

Answer 9

modeling happens when growing, and remodeling happens when you are an adult undergoing skeletal maintenance.

Question 10

peak bone mass occurs in the mid ___, and you plateau by late ___

Answer 10

mid 20s, then you plateau late 30s

Question 11

T/f you lose bone mass during menopause

Answer 11

true. there’s a 1-2% loss/year post menopause

Question 12

factors that influence peak bone mass

Answer 12

1. GENETICS- biggest factor
2. Sex
3. Mechanical factors (exercise and body weight)
4. endocrine factors
5. nutrition
6. smoking
7. alcohol
8. ehtnicity (black people have higher bone mass)
9. ​medical comorbidities

Question 13

Outline risk factors for osteoposis (there’s like 26)

Answer 13

1. immobilization/inactivity
2. prior fracture
3. age
4. inflammation
5. diabetes
6. chronic illness
7. smoking,etOH
8. genetics
9. hyperparathyroidism
10. family history
11. poor nutrition
12. malabsorption
13. medications, steroids,
14. vitamin D deficiency
15. hypogonadism
16. endocrinopathies

Question 14

Drugs that increase bone loss. What is the most impactful/common drug cause?

Answer 14

1. GLUCOCORTICOIDS
2. TZDs
3. • anticoagulants like heparin and warfarin
4. cyclosporine
5. loop diuretics
6. antidepressants
7. PPIs
8. levothyroxine
9. progesterone
10. vitamin A
11. retinoids
12. antiepileptics
13. anti-retrovirals
14. chemotherapy

Question 15

FRAX can assess general fracture risk, and ___ fracture specifically in the next __ years

Answer 15

hip fracture or major clinical fracture in the next 10 years.

Question 16

12 factors that FRAX score takes into consideration

Answer 16

1. age
2. sex
3. weight
4. height
5. previous fracture
6. parent fractured their hip
7. CURRENT smoking
8. glucocorticoids
9. rheumatoid arthritis
10. secondary osteoposis
11. alcohol more than 3 units/day
12. femoral neck BMD

Question 17

should should be included in an osteoposis history?

Answer 17

Question 18

physical exam for an osteoporosis work up

Answer 18

Question 19

4 components to do prior to arriving at a osteoporosis diagnosis

Answer 19

1. DXA
2. FRAX
3. Labs, history, physicial
4. biopsy

Question 20

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.

Answer 20

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:

Question 21

t/f DXA has more radiation than an XRAY

Answer 21

false. DXA is much lower than an Xray of the spine

Question 22

what two things must you NOT talke prior to doing a DXA BMD scan

Answer 22

1. no calcium supplements for 24 hours
2. no contrast in the last 7 days of the GI system. if there is contrast in the gut, soft tissue affects hard bone visualization

Question 23

2 ways to quantigy BMD

Answer 23

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.

Question 24

note; bascially the older you get, the less density your bones have

Question 25

VFA indications

Answer 25

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.

Question 26

how is BMD affected by heigh

Answer 26

in small stature people, bone density may say its worse than it is.

Question 27

How does the FRAX score influence treatment for osteoporosis?

Answer 27

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.

Question 28

FRAX takes 12 factors into consideration when calculating the risk for fracture. What are the limitations to this scoring system?

Answer 28

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

Question 29

routine blood work labs for osteoporosis workup

Answer 29

1. CBC
2. TSH
3. ALP
4. PTH
5. Calcium levels
6. Lytes
7. Albumin
8. Vitamin D
9. Creatinine
10. Phosphate

Question 30

two lab values that can indicate bone turnover measurs

Answer 30

CTX and NTX

• these labs are not done on every person

Question 31

Question 32

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

Answer 32

T < -2.5

• FRAX >20%, 3%
• Prior hip or spine fracture
• 2+ fragility fractures
• Moderate risk + patient preference