Pathophysiology of Osteoporosis Flashcards
What is osteoporosis
Decreased bone mass with normal mineralization of remaining bone
T/F: Osteoblasts form new bone and osteoclasts resorb old bone
True
What are the three types of osteoporosis,cause
Postmenopausal: Due to loss of estrogen production
Senile: multifactoral and related to changes seen with normal aging
Secondary: Disease/drug inducing
What drug is most associated with causing osteoporosis, others
Corticosteroids/ long-term heparin, Gn-RH agonists and Aromatase inhibitors, Depo, Anti-retrovirals, PPIs, AEDs, furosemide
What are clinical presentations of vertebral fractures, wthat causes distal forearm fractures
Back pain, loss of height/ associated with falls
Why are hip fractures treated with such urgency
only 40% regain pre-fracture mobility, 10-20% excess mortality within the 1st year of fracture
What is the most common way diagnose osteoporis, gold standard
Bone mineral Density, DEXA
T/F: BMD tests how much bone is present but not how strong
True
What scores are found in BMD tests and how are they
T score: Standard deviation difference from peak BMD of comparison population
Z score: Bone density in comparison to age and gender matched adults
What are the types of T scores
Normal: Greater than -1.0
Osteopenia: -1.0 to -2.5
Osteoporosis: Lower than -2.5
Severe Osteoporosis: Lower than -2.5 PLUS a history of nonviolent atraumatic fracture
What are risk factors for osteoporosis
Age, thin small frame, white or asian race, female gender, postmenpausal, history of ataumatic fracture,smoking, 3 or more drinks a day, family history
What disease state associated to osteoporosis
Rheumatoid arthritis
What diet and personal habits contribute to osteoporosis
Low calcium intake, high phosphorus intake, tobacco use, alcohol use, inactive/sedentary lifestyle
What are drugs that are protective of osteoporosis
Estrogen, thiazide diuretics
What exercises can aid in prevention in osteoporosis and how
Weight-bearing exercise: increases/maintains bone mass (most important)
Muscle-strength exercise: improve balance reducing risk of falls
Balance training: Reduce risk of falls
What supplement is controversial in treatment of osteoporosis, what are the ways to get it and which is the best way
Calcium (500-1000mg or 1200 after menopause), supplement and diet (best way)
T/F: Evidence shows that Vitamin D supplementation is always the best for a patient no matter their levels
False: Vitamin D supplementation decreases fracture risk ONLY in patients with low vitamin D levels, negligible in people with adequate vitamin D levels
What are risk factors for low Vitamin D levels
Housebound, corticosteriods and anticonvulsants, CKD/Renal failure, winter months in northern climates
What is the age where ALL adults should receive Vitamin D supplementation ,What is the recommended dose for Vitamin D3 for all
50 years or older, 800-1000 IU
What is vitamin D deficiency, how should it be treated
Less than 30 ng/mL, Ergocalciferol 50,000 int units weekly every 12 weeks THEN 1000-2000 daily
When should a patient be started on Osteoporosis
T score less than -2.5, Hip or vertebral fracture, T- score -1 to -2.5 AND secondary cause, -1 to -2.5 AND 10 year risk for hip fracture GREATER than 3% OR 10 year risk of other osteoportic fracture GREATER than 20%
T/F: If a patient is anticipated to use 2 months or more glucocorticoid therapy they should be started on anti-osteoporosis drugs
False: If a patient is anticipated to use 3 months or more glucocorticoid therapy they should be started on anti-osteoporosis drugs
T/F: All patients on pharmacologic therapy should ALSO be receiving adequate calcium and vitamin D supplementation
True
What are the anti-resorptive agents that are considered first-line, can only be used in women
Bisposphanates, Denosumab/ Estrogen, SERMS, TSEC, Calcitonin
T/F: Estrogen can be used for long-term osteoporosis prevention
False: Estrogen is only used short term (less than 5 years) for osteoporosis prevention due to risks
What are the bisphosphonates
Alendronate, Risedronate, Zoledronic acid, Ibandronate
Which bisposhonate is not indicated for osteoporosis in men or glucocortico-induced osteoporosis (prevention or tereatment)
Ibandronate
What are tips for taking bisphosphonates, who shouldn’t take bisphosphonates
Take at least 30 minutes prior to eating, take with 6-8 oz of plain water, should NOT recline for at least 30 minutes after ingestion, patients with CrCl less than 30
What are the adverse effects of bisphosphonates
Esophageal irritation/ulceration (avoid ORAL if patient got GERD), osteonecrosis of jaw and atypical femur fractures (rare, increased risk with longer term use)
When zoldronic acid is infused what can be given to prevent an infusion reaction, how often after the infusion reactions
Pretreat with acetaminophen, most common after the first dose
What is the monoclonal antibody used in osteoporosis, what is the MOA, adverse effects
Denosumab: blocks receptor activation of nuclear factor kappa B ligand (RANKL)/ Hypocalcemia, serious infections, dermatologic osteonecrosis of jaw and atypical femur fractures (rare)
What SERM is approved for prevention/treatment of osteoporosis along with reduction for risk of breast cancer, what are the adverse effects
Raloxifene/ Thromboembolism, hot flashes, leg cramps, joint pains
T/F: Patients taking Raloxifene cannot take this medication if they have uterus
False: Raloxifene does NOT cause endometrial hyperplasia
What FDA approved TSEC can be used in women WITH a uterus to aid in osteoporosis AND moderate to severe vasomotor symptoms
Conjugated Estrogen PLUS Bazedoxifene
What osteoporotic drug is FDA approved for treatment in women greater than 5 years postmenopausal, formulations
Calcitonin (Not a first or second line therapy)/ IM or SC administration
What are the anabolic agents
PTH analogs (Teriparatide, Abaloparatide), Romosozumab
T/F: Anabolic agents should be followed up with antiresorptive agents since bone loss is rapid after discontinuation
True
What are adverse effects of PTH analogs
Orthostatic hypotension, increased serum calcium, osteocarcomas (greater than 2 years of use), increase in urine calcium excretion, increase in serum uric acid
What is the MOA of Romosozumab, contraindications, length of therapy
Sclerostin inhibitor/ Heart attack, stroke within the past 12 months, high risk of stroke and heart attack, hypocalcemia, (12 months)
