Osteoporosis Study Tip Gal

Question 1

Risk Factors Patient Characteristics

Answer 1

Advanced age
Ethnicity (Caucasian and Asian are at increased risk)
Family history
Sex (females > males)
Low body weight

Question 2

Medical Diseases/Conditions Risk Factors

Answer 2

Anorexia nervosa
Diabetes
Gastrointestinal diseases (e.g., IBD, celiac disease,
gastric bypass, malabsorption syndromes)
Hyperthyroidism
Hypogonadism in men
Menopause
Rheumatoid arthritis, autoimmune diseases
Others (e.g., epilepsy, HIV/AIDS, Parkinson disease)

Question 3

Osteoporosis Lifestyle Factors

Answer 3

Smoking
Excessive alcohol intake (> 3 drinks per day)
Low calcium intake
Low vitamin D intake
Physical inactivity

Question 4

Medications that contribute to osteoporosis

Answer 4

Anticonvulsants (e.g., carbamazepine, phenytoin, phenobarbital)
Aromatase inhibitors
Depo-medroxyprogesterone
GnRH (gonadotropin-releasing hormone) agonists
Lithium
PPIs ( t gastric pH decreases Ca absorption)
Steroids* (> 5 mg daily o f prednisone or prednisone equivalent
fo r > 3 months)
Thyroid hormones (in excess)
Others (e.g., heparin, loop diuretics, SSRIs, TZDs)

Question 5

WHAT IS AT-SCORE?

Answer 5

It compares the patient’s measured BMD to the
average peak BMD o f a healthy, young, white
adult of the same sex.*

A DEXA (or DXA) measures BMD so a T-score can be determined.
T-scores are negative: a score at or above -1 correlates with stronger (denser) bones, which are less likely to fracture.**

Question 6

WHO SHOULD HAVE BMD MEASURED?

Answer 6

Women > 65 years and men > 70 years.

Younger patients at high risk for fracture.

Question 7

INTERPRETING T-SCORE RESULTS

Answer 7

Normal: > -1
Osteopenia (low bone mass): -1 to -2.4
Osteoporosis: < -2.5

Question 8

CALCIUM Recommended daily intake for most adults is

Answer 8

1,000-1,200 mg elemental calcium

Do not exceed 500-600 mg of elemental
calcium per dose

Question 9

Calcium carbonate (e.g.. Turns, Oscal)

Answer 9

□ 40% elemental calcium
□ Absorption: acid-dependent
□ Must take with meals

Question 10

Calcium citrate (e.g., Citracal)

Answer 10

□ 21% elemental calcium
□ Absorption; not acid-dependent
□ Can take with or without food

Question 11

VITAMIN D

Answer 11

Required fo r calcium absorption

■ Deficiency; serum vitamin D [25(OH)D] < 30 ng/mL

Question 12

Bisphosphonates

Answer 12

First-line for treatment or prevention in most patients of osteoporosis

Question 13

Bisphosphonates PO administration:

Answer 13

must stay upright for 30 minutes (60 minutes for ibandronate) and drink 6-8 oz of plain water

Question 14

Bisphosphonates Side effects:

Answer 14

esophagitis, hypocalcemia, Gl effects

Question 15

Bisphosphonates

Rare (but serious) side effects:

Answer 15

□ Atypical femur fractures

□ Osteonecrosis of the jaw (ONJ): jaw bone becomes exposed and cannot heal due to decreased blood supply

Question 16

Bisphosphonates Formulations:

Answer 16

□ PO: given weekly/monthly

□ IV: given quarterly/yearly (if Gl side effects or adherence issues with PO formulation)

Question 17

Bisphosphonates Treatment duration:

Answer 17

3-5 years in patients with a low risk of fracture (due to the risk o f femur fractures and ONJ)

Question 18

DENOSUMAB (PROLIA)

Answer 18

■ Alternative to bisphosphonates
■ SC administration every 6 months
■ Side effect: hypocalcemia

Question 19

TERIPARATIDE (FORTEO), ABALOPARATIDE

TYMLOS

Answer 19

■ Recommended for very high-risk patients only
(e.g., history of severe vertebral fractures)
■ SC administration daily
■ Side effect: hypocalcemia

Question 20

RALOXIFENE (EVISTA), BAZEDOXIFENE/ESTROGENS (DUAVEE)

Answer 20

■ Alternative to bisphosphonates if high risk of vertebral fractures
■ Increased risk for VTE and stroke
■ Raloxifene can be used if low-risk o f VTE or high-risk of breast cancer
□ Side effect: vasomotor symptoms

Question 21

Bazedoxifene/estrogens can be used in women with an intact uterus for prevention of osteoporosis

Answer 21

□ Also used as treatment for vasomotor symptoms

□ Side effect: increased risk of breast cancer