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
