Osteoporosis Screening and Treatment Flashcards
What is the lifetime risk of fracture of common sites for white women?
40%
same as breast, ovarian and colon cancer COMBINED
Approximately how many vertebral fractures and hip fractures occur annually?
700,000 vertebral fractures
300,000 hip fractures
You risk for hip fractures is __ times higher if you have osteoporosis.
4x
What is the USPSTF recommendation grade for osteoporosis screening in women aged 65 or older?
grade B
There is also a grade B recommendation for screening younger women in what scenarios?
if their fracture risk is greater or equal to that of a 65 yr-old white woman who has no additional risk factors (9.3%)
What is the USPSTF recommendation grade for osteoporosis screening in men?
Grade I, so insufficiency evidence
What are the risk factors for primary osteoporosis?
- family history
- Personal history of falls
- Personal history of fragility fractures
- Early menopause (before age 45)
- recent discontinuation of estrogen theray
- Smoking
- Excessive ETOH
- Sedentary lifestyle
- Loss of height
- Kyphosis
- BMI less than 21
What are some medical conditions that will cause secondary osteoporosis?
Endocrine diseases (thyroid, hyperparathyroid, DM, low testosterone)
Malabsorption, chronic liver disease
organ transplant (meds)
RA
Chronic lung disease
renal insufficiency
malignancies
anorexia nervosa
Vitamin D deficiency, calcium deficiency
Bone strength is related to both the quantity and quality of the bone structure. Which one can be measured by a DXA scan?
quantity (bone mineral density)
quality (microstructure) will be missed
What are the two views used for the DXA scan?
PA spine views
hip views
What is a T score?
the number of standard deviations above or below the average BMD for a healthy young woman
(so doesn’t compare the woman to other women her age)
What is a Z score?
the number of standard deviations above or below the average BMD for age, ethnicity and gender-matched controls
True or false: premenopausal women can only use Z-scores, they cannot use T-scores.
true- they can only use Z-scores
What is a normal T score?
greater than or equal to -1.0
A T-score of ____ to ___ suggests osteopenia (low bone mass)
between -1.0 and -2.5
A T-score less than ___ suggests osteoporosis.
-2.5
A z-score less than ____ is suggestive of secondary osteoporosis.
-2.0
How can you use the difference between the z-score and t-score to determine if a woman has secondary osteoporosis?
z-scores that are lower than the T-score suggests secondary osteoporosis.
Who should be treated for osteoporosis?
anyone with a hip or vertebral fracture
anyone with a t-score less than or equal to -2.5 without secondary causes
Who should be treated if they just have osteoporosis?
- history of fragility fractures
- risk factors for a a fracture (not helpful)
- 10-probability of hip fracture greater than or equal to 3%
- 10-yr probability of major osteoporotic fracture of greater than or equal to 20%
How can you tell what a person’s 10-yr risk for a fracture is?
Use the FRAX calculator
What additional tests should you run to look for secondary causes of osteoporosis?
renal panel CBC calcium albumin alk phos phosphorous magnesium LFTs TSH
Further testing would include PTH, Vitamin D and 24-hr urinary calcium and creatinine if you suspect
Why do they need to look at multiple vertebral levels ion the DXA?
Because arthritis and compression fractures will increase bone density and falsely elevate the T-score (giving false negative results)
What is the recommended daily calcium intake for someone to reduce risk of osteoporosis?
1200 mg/day
dietary is best, but supplement if needed
What is the recommended Vitamin D intake?
800-1000 units/day
What is the Vitamin D level goal here?
over 30
What are some limitations of the FRAX score?
- it only predicts hip fracture, it doens’t predict spine fracture
- it doesn’t apply if the patient is on a bisphosphonate
- doesn’t apply to premenopausal women
What is the first line option for treatment and prevention of osteoporosis?
bisphosphonates
What is a good alternative to bisphosphonates (but not FDA approved)?
estrogen
True or false: calcitonin is also a very effective treatment for osteoporosis.
false - it’s a relatively weak therapy, but can help with pain from comrpession fractures
