Therapy of Osteoporosis Flashcards
Osteoporosis is a bone disorder characterized by:
1) Low bone mineral density
2) Impaired bone architecture
3) Compromised bone strength
Risk factors for osteoporosis?
1) Female gender
2) Advanced age
3) Low body weight
4) Systemic oral glucocorticoid therapy
5) Cigarette smoking
6) Alcohol (3 or more drinks/day)
7) Low calcium intake
8) Low physical activity
9) Vitamin D insufficiency and deficiency
Which drugs can cause osteoporosis?
1) Glucocorticoids
2) Proton pump inhibitors (PPIs)
3) Antidepressants
4) Aromatase inhibitors
5) Androgen-Deprivation Therapy (GnRH)
6) Anticonvulsant therapy
7) Furosemide
8) Heparin
9) Thiazolidinediones
10) Canagliflozin (SGLT2 inhibitors)
In people taking glucocorticoids, fracture risk increases before ___ are detected.
Changes in bone mass density
What do glucocorticoids do?
1) Decrease osteocyte and osteoblast function
2) Increase osteocyte and osteoblast apoptosis
3) Increase osteoclast proliferation
4) Decrease osteoclast apoptosis
What do glucocorticoids do in reference to calcium?
1) Decrease calcium absorption
2) Increase urinary calcium excretion
Via alterations in calcium transporters
How do antidepressants cause osteoporosis?
Increased peripheral serotonin levels = Increased osteoclastic activity
How do aromatase inhibitors cause osteoporosis?
Reduce peripheral estrogen levels =
1) Upregulates osteoclast formation
2) Increases the lifespan of osteoclasts
Estrogen deficiency leads to:
1) Increased bone loss
2) Cortical porosity
3) Enlarged resorption areas
How does androgen-deprivation therapy cause osteoporosis?
Increases interleukin-6 (IL-6) = Stimulates osteoclastogenesis.
What do androgen receptors (ARs) on osteoblasts do?
Promote osteoblast differentiation = Decreases bone resorption.
How does Furosemide cause osteoporosis?
Via increased calcium excretion by the kidney
The primary goal of osteoporosis care should be:
Prevention
What should you do to reduce the future incidence of osteoporosis?
Optimize skeletal development and peak bone mass gain in childhood, adolescence, and early adulthood
Once low bone mass or osteoporosis develops, the objective is to:
1) Stabilize bone
2) Improve bone strength and mass
3) Prevent fractures
In patients who have already suffered osteoporotic fractures, the objective is to:
1) Reduce pain and deformity
2) Improve functional capacity
3) Improve quality of life
4) Reduce future falls and fractures
What is the first step in prevention and treatment of osteoporosis?
Adequate intake of calcium and vitamin D
___ is advised in any postmenopausal woman, or man age 50 years and older, presenting with a hip or vertebral fracture or low bone mass.
Prescription therapy
What increases calcium absorption?
1) Carbohydrates
2) Fat
3) Lactose
What decreases calcium absorption?
1) Fiber
2) Wheat bran
3) Phytates (beans)
4) Oxylates (spinach)
5) High-protein diets
6) Caffeine
7) Smoking
What are the 3 main sources of vitamin D?
1) Sunlight
2) Diet
3) Supplements
Vitamin D3 and D2 come from:
1) Oily fish
2) Eggs
3) Fortified dairy products
Inadequate concentrations of which form of vitamin D are common?
25(OH) vitamin D
Low vitamin D concentrations result from:
1) Insufficient intake
2) Dietary fat malabsorption
3) Decreased sun exposure
4) Decreased skin production
5) Decreased liver and renal metabolism of vitamin D
Endogenous synthesis of vitamin D can be decreased by:
Sunscreen use
Darkly pigmented skin can ___(increase/decrease) vitamin D production.
Decrease
When are the troughs and peaks in vitamin D in respect to the seasons?
Troughs: Late winter
Peaks: Late summer
How does alcohol increase the risk for fractures and osteoporosis?
1) Increases bone resorption and decreases bone formation by inhibiting signaling pathways
2) Increasing oxidative stress that results in osteoblast apoptosis
Alcoholics may have:
1) Poor nutrition
2) Decreased calcium absorption
3) Altered vitamin D metabolism
4) Impaired balance
Excessive caffeine consumption may be associated with:
1) Increased calcium excretion
2) Increased rates of bone loss
3) Modestly increased risk for fractures
The effect of smoking on bone mass density is dependent on what?
1) Dose
2) Duration
How does smoking increase the risk of osteoporosis and fractures?
1) Reduces intestinal calcium absorption
2) Increases 25(OH) vitamin D catabolism
How does exercise decrease the risk of falls and fractures?
1) Stabilizes bone density
2) Improves muscle strength, coordination, balance, and mobility.
Lack of physical activity can lead to:
1) Suboptimal loading/straining
2) Decreased stimulation of bone deposition
3) Reduced peak bone mass
