Osteoporosis Pathophys Atanda

Question 1

What two groups have the highest osteoporosis fragility fracture rates?

Answer 1

caucasian

hispanic

Question 2

Calcium homeostasis is maintained by what two things?

Answer 2

vitamin D 
parathyroid hormone (PTH)

Question 3

Calcium absorption is 30-35% under normal conditions and decreases to __ to __ with low vitamin D levels

Answer 3

10, 15

Question 4

Vitamin D levels depend on what 3 things?

Answer 4

skin conversion
dietary/supplemental intake
PTH

Question 5

What is the most abundant source of vitamin D?

Answer 5

cholecalciferol (D3)

Question 6

Where does conversion from cholecalciferol and ergocalciferol to 25(OH) vitamin D (calcidiol) occur?

Answer 6

liver

Question 7

Where does conversion from active vitamin d (calcitriol) occur?

Answer 7

kidneys

Question 8

What effect does high calcium levels in the blood have on parathyroid?

Answer 8

signals parathyroid to stop making PTH

Question 9

What is released when calcium levels in the blood are low?

Answer 9

PTH

pulls calcium from stomach, then renal system, then bones if not sufficient

Question 10

Estrogen:

Accelerated bone loss begins during perimmenopause and continues up to __ years post menopause

Answer 10

8

Question 11

What type of bone is most susceptible to estrogen deficiency?

Answer 11

trabecular

Question 12

The estimated bone loss bc of estrogen deficiency is __ % per year

Answer 12

2

Question 13

How do PPIs cause bone loss?

Answer 13

calcium malabsorption due to acid suppression

Question 14

Glucocorticoids __ bone resorption and __ bone formation

Answer 14

increase, decrease

Question 15

Which type of diuretics can cause osteoporosis?

Answer 15

loop

furosemide

thiazides can cause HYPERcalcemia

Question 16

Which is not associated with increased risk of osteoporosis?

a. thiazides
b. loop diuretics
c. PPI
d. SSRI
e. thiazolidinediones

Answer 16

a. thiazides

Question 17

Type I osteoporosis lasts about __ years

Answer 17

10

Primary osteoporosis:

• type I
• type II

Question 18

Which type of osteoporosis occurs equally in men and women of ANY age?

Answer 18

type III

secondary osteoporosis

Question 19

Which type of osteoporosis is postmenopausal?

Answer 19

type I

Question 20

Which type of osteoporosis is type II?

Answer 20

age-related/senile

primary osteoporosis:

• type I
• type II

Question 21

Which type of osteoporosis occurs in men and women over 75 years old?

Answer 21

type II

primary osteoporosis:

• type I
• type II

Question 22

Which type of osteoporosis is associated with vertebral and distal forearm fractures?

Answer 22

type I (postmenopausal)

primary osteoporosis:

• type I
• type II

Question 23

Which type of osteoporosis is associated with vertebral, hip, and wrist fractures?

Answer 23

type II (age-related or senile)

primary osteoporosis:

• type I
• type II

Question 24

Which type of osteoporosis is associated with drug related causes?

Answer 24

type III

ex. glucocorticoids

secondary osteoporosis

Question 25

Which type of osteoporosis is associated with impaired osteoblast function and increased osteoclast activity?

Answer 25

type III (occurs equally in men and women of any age) secondary osteoporosis

Question 26

Which type of fractures have the greatest increase in morbidity and mortality?

Answer 26

hip

Question 27

What T-score is indicative of osteoporosis?

Answer 27

- 2.5 and below

Question 28

What test is the gold standard for measuring bone mineral density?

Answer 28

X-ray absorptiometry (DXA) T score 2.5 and below

Question 29

Loss of height of > __ inches or historic height loss of > __ inches is indicative of osteoporosis

Answer 29

0.8, 1.5 0. 8 inches = 2cm 1. 5 inches = 4cm

Question 30

2 tools for osteoporosis risk factor assessment?

Answer 30

FRAX | Garvan

Question 31

Women __ years and older should get DXA screening

Answer 31

65 increased risk for osteoporosis

Question 32

Postmenopausal women > __ years should get DXA screening

Answer 32

50 increased risk for osteoporosis

Question 33

Should men get DXA screening?

Answer 33

insufficient data to recommend screening

Question 34

Which assessment tool uses 11 risk factors and BMD at the femoral neck?

Answer 34

FRAX fracture risk assessment tool

Question 35

The FRAX tool assesses what?

Answer 35

major osteoporotic (spine, forearm, hip, shoulder) and hip fracture in next 10 years

Question 36

FRAX assessment is validated in postmenopausal women or men __ and older

Answer 36

50

Question 37

FRAX assessment is validated for use in what populations?

Answer 37

- postmenopausal women or men 50 and older - people with low bone density (osteopenia) - people who have not taken osteoporosis meds

Question 38

__ is low BMD or "pre-osteoporosis"

Answer 38

osteopenia

Question 39

What DEXA T-score indicates osteopenia?

Answer 39

-1 to -2.5

Question 40

What DEXA T-score indicates osteoporosis?

Answer 40

-2.5 and below

Question 41

Which DEXA score uses comparison to young adult reference?

Answer 41

T-score

Question 42

Which DEXA score uses comparison to age matched reference?

Answer 42

Zscore