Osteoporosis

Question 1

List 9 risk factors for Osteoporosis

Answer 1

Age >65
Fragility fracture after 40
Parents with hip fracture
Underweight
Poor mineral absorption from poor diet or gastric surgeries
>3 drinks per day
Smoking
Steroid use
Rheumitological condition
Female
Post menopausal, early meopause, late menarche

Question 2

How to diagnose osteoporosis

Answer 2

BMD
If moderate risk (10-20) then get thoracic lumbar x-ray

Question 3

What blood wokr would you get after diagnosing osteoporosis

Answer 3

HB
TSH
Ionized ca
Alk phos - pagets
Phosphate
Creat
Vit D - 25 OH
SPEP (if vertebral fracture) for MM

Question 4

How much calcium and vit D should people be taking

Answer 4

1000 IU daily of vit D
1200 mg calcium from all sources

Question 5

List Five things to do for someone with osteoporosis that aren’t prescriptions

Answer 5

Advise calcium
Advise Vit D
Advise Wt. bearing exercises
Advise OT home assessment for falls risk
Advise physio or kinesiology for balance exercises
Hip Guards

Question 6

List three categories of drugs and a drug in those categories for treatment of osteoporosis. Lise a major side effect for each

Answer 6

Bisphosphonates (alendronate)
-Esophogeal ulcer
-Atypical fractures
-Jaw osteonecrosis

Selective Estrogen Receptor Modulator (Raloxifene)
-PE/DVT

Parathyroid hormone analog (teriparatide)
-Hypercalciuria or hypercalcemia
-Angioedema

Monoclonal Antibody (denosumab)
-Joint pain
-Jaw osteonecrosis

HRT (Premarin)
-DVT

Question 7

What is the osteoporosis and osteopenia diagnosic criteria

Answer 7

Osteoporosis

Question 8

Physical exam for osteoporsis

Answer 8

Height
Rib to pelvis distance (2 cm)
Kyphosis
Weight
Get up and go test

Question 9

When do you do a BMD in someone under 50

Answer 9

Fragility fracture
Prolonged steroid use
Aromatase inhibitors
Premature menopause (<45)
Malabsorption syndrome

Question 10

What is the OST

Answer 10

Weight -Age
<10 should do BMD

Question 11

When to do BMD in >50

Answer 11

> 65
Fragility fracture after 40
Prolong glucocorticoids
Aromatase inhibitors
Anticovulsants
Parental Hip fracture
Malabsorption
Vertebral fracture
Smoker
EtOH >3 per day
Low body weight
Rheumatoid

Question 12

List seven secondary cuases of osteoporosis

Answer 12

DM
Hypoparathyroidism
Alcoholism
Anorexia
Liver dx
Celiac
Crohns
Medications (PPI, Steroids, Aromatase injibitors, Anti epileptics, Lithium, chemo
HIV
CKD
RA

Question 13

Specifically what exercise should you recommend to patients to prevent

Answer 13

Strength twice per week
Balance 20 minutes per day
Aerobics 30 min 5 times per day
Posture 10 min per day

Question 14

How long should someone be on Bisphosphonates

Answer 14

Reassess after 3-5 years
If still high risk can continue for additional five years

If low or mod risk consider 3-5 year drug holiday and then reassess
Can put them back on it for 5 more years
No studies past 10 years

DON”T GIVE DRUG HOLIDAY FOR DENOSUMAB. If you are stopping it put them on bisphosphonate

Question 15

What to give men with osteoporosis

Answer 15

Alendronate
Risendronate
Zolendronic acid

Question 16

What to give LTC residents

Answer 16

Alendronate or risedronate, zolendronic acid or denosumab

Question 17

Someone is mod risk with no # on x-ray. When do you repeat the BMD

Answer 17

1-3 years

Question 18

How long can someone be on Abaloparatide or teiparatide

Answer 18

up to 2 years
If stopping put them on a bisphosphonate