wk 12 key Flashcards
causes of secondary osteoporosis
medical: hyperparathyroid, anorexia, hyperthyroid, hypogonad etc.
meds: glucocorticoids, steroids, PPIs, chemo etc.
high LRs for osteoporosis
weigh t< 51kg
<20 teeth
self reported hump back
wall occuput
rib pelvic
armspan height difference
sx of osteoporosis
mostly asymptomatic
dx of osteoporosis
DEXA (for BMD)
indications for measuring BMD
> 65 yoa
> 50 and have risk factors (i.e smoking, meds, parental hip fracture, low body, RA)
<50 and (fragility fracture, hypogonad, premature menopause, glucocorticoids)
T score vs Z score on DEXA
T: compared to young health controls at like age 30
Z: compare to healthy aged matched controls
z score
< -1.5 warrants workup
FRAX
to predict an individual’s 10-year risk of sustaining a hip or other
major osteoporotic fracture (fragility fracture of spine, wrist,
forearm or humerus)
- Applicable to individuals aged 40 to 90 who have not received
pharmacotherapy for osteoporosis
Combines clinical risk factors (age, sex, BMI, ethnicity, prior fractures,
parental hip fracture history, smoking, alcohol use, glucocorticoid use, rheumatoid arthritis, secondary osteoporosis) and femoral neck BMD T- score to calculate the 10-year fracture risk
osteoporosis self assessment tool (OST)
OST= (weight-age) * 0.2
if <2 have high risk
CAROC (Canadian Association of
Radiologists and Osteoporosis Canada) Risk
Assessment Tool
use bone density (femoral neck T score) and age to predict 10 year fragility fracture risk
(increase category via corticosteroids or fragility fracture at other site)
Male Osteoporosis Risk Estimation Score (MORES)
age, weight, chronic obstructive pulmonary disease (COPD)
score >6= DXA screen
USPTF osteoporosis screening guidelines
and national osteoporosis foundation guidelines
women >65yoa
younger post menopausal women
no evidence to screen for men
———-…..———–
screen women >65 and men >70
screen 50-69 yoa if FRAX and risk
screen >50 if have any adult fracture
osteoporosis guidelines for treatment
low 10 year fracture risk= no pharm; reassess 5 yrs
moderate 10 year fracture risk; discuss tx, consider pharmaceuticals, repeat BMD in 1-3 yrs
high 10 year fracture risk: initiate pharm
tx for osteoporosis
bisphosphonates
Alternative therapy: RANK ligand inhibitors (denosumab), selective estrogen
receptor modulators (raloxifene), estrogen/progesterone hormone therapy,
parathyroid hormone analogues (teriparatide), calcitonin
prolonged use of bisphosphonates linked to
osteonecrosis of the jaw
atypical subtrochanteric femur fracture
osteoporosis reccoooss
- National Osteoporosis Society recommends starting treatment in all
postmenopausal women with a history of any fragility fracture - National Osteoporosis Foundation recommends performing DXA scans on
patients sustaining nonvertebral fragility fractures and decision to treat with
pharmacotherapy is based on a T-score >-2.5
SLIDE 42
A 78-year-old male patient with a history of chronic obstructive pulmonary disease (COPD) presents for a routine health evaluation. He has never been screened for osteoporosis and is concerned about his risk factors. He weighs 75 kg (165 lbs).
Based on the Male Osteoporosis Risk Estimation Score, what is his total score, and does he meet the threshold for recommending dual-energy x-ray absorptiometry (DXA) for osteoporosis screening?
Question 3 Answer
a.
Total score of 7; meets the threshold for DXA screening
b.
Total score of 11; meets the threshold for DXA screening
c.
Total score of 3; does not meet the threshold for DXA screening
d.
Total score of 4; does not meet the threshold for DXA screening
A 55-year-old woman presents with osteopenia, having a T score of -2.0.
Which of the following sets of investigations is most appropriate to evaluate the underlying causes of her condition?
Question 2 Answer
a.
Serum PTH, liver function tests, and serum electrolytes
b.
Serum BUN, creatinine, albumin, calcium, phosphate, alkaline phosphatase, 25-OH vitamin D, and CBC
c.
Thyroid function tests, serum cortisol, and repeat dual-energy X-ray absorptiometry (DEXA) scan
d.
Bone marrow biopsy, serum protein electrophoresis, and renal ultrasound
b.
Serum BUN, creatinine, albumin, calcium, phosphate, alkaline phosphatase, 25-OH vitamin D, and CBC
A 40-year-old woman is receiving ongoing treatment for inflammatory bowel disease. She has had multiple prolonged courses of corticosteroids and is a current smoker. Her mother has experienced a hip fracture and the patient is now asking her naturopathic doctor about whether she should have her bone mineral density (BMD) measured.
How should this patient be advised regarding BMD measurements?
Question 4 Answer
a.
She has not experienced premature menopause and has no endocrine disorders that would act as indications for BMD measurement at this time, so it should not be performed
b.
Her current smoking and the her mother’s hip fracture are indications for her to have BMD measurements at this age
c.
Prolonged used of corticosteroids and the potential for malabsorption are indications for her to have a BMD measurement at this age
d.
She has some risk factors for reduced BMD, but BMD is not typically measured until age 50 in women in cases like this one
c.
Prolonged used of corticosteroids and the potential for malabsorption are indications for her to have a BMD measurement at this age
A 62-year-old woman inquires about the value of bone mineral density (BMD) measurement using DEXA scans.
Which of the following is the most accurate information about the reason for measuring BMD?
Question 5 Answer
a.
Many studies have shown that screening using DEXA scans is effective in reducing osteoporotic fractures
b.
Assuming a 12% prevalence of osteoporosis and that treatment reduces hip fracture by 66%, in women her age, one hip fracture is prevented for every 200 women screened using DEXA scan
c.
Screening in this way is virtually free of downside, since test results cannot be misinterpreted (it is a DEXA scan, not a physical exam), patient anxiety is minimal (because it is not life-threatening), the medications used are inexpensive and there are no medication side effects
d.
Mortality rate in the first year after hip fracture is approximately 20%, and it is believed that screening in this way with subsequent follow-up and management reduces fracture risk
d.
Mortality rate in the first year after hip fracture is approximately 20%, and it is believed that screening in this way with subsequent follow-up and management reduces fracture risk
