17

Question 1

disorders of the bone generally are categorized as

Answer 1

• osteoporosis
• paget disease
• osteomalacia

Question 2

bone disorder characterized by progressive loss of bone mass and skeletal fragility (increased risk of fracture)

Answer 2

osteoporosis

Question 3

disorder of bone remodeling that results in disorganized bone formation and enlarged or misshapen bones

Answer 3

paget disease

Question 4

what is different about paget disease compared to osteoporosis

Answer 4

paget disease is usually limited to one or a few bones

Question 5

a softening of the bones that is most often attributed to vitamin D deficiency

Answer 5

osteomalacia

Question 6

what is osteomalacia in children called?

Answer 6

rickets

Question 7

describe bone composition

Answer 7

an orderly collagen matrix on which calcium and phosphate are deposited in the form of hydroxyapatite

Question 8

reason for bone remodeling

Answer 8

to remove and replace damaged bone and to maintain calcium homeostasis

Question 9

cells that break down bone in a process known as bone resorption

Answer 9

osteoclasts

Question 10

following bone resorption, there are bone-building cells known as ____ which synthesize new bone

Answer 10

osteoblasts

Question 11

bone mineralization occurs when:

Answer 11

crystals of calcium phosphate known as the hydroxypatite are deposited in the new bone matrix

Question 12

describe the cyclical process of bone remodeling

Answer 12

bone loss occurs when bone resorption exceeds bone formation during the remodeling process

Question 13

what leads to the pathophysiological changes in osteoporosis

Answer 13

the disruption in the balance of bone resorption and bone mineralization

Question 14

some clinical measurements that show risk factors for osteoporosis

Answer 14

• BMD- bone mineral density

- bone mass (dual energy x-ray absorptionmetry- DXA and quantitative computed tomography (CT)

Question 15

risk factors for osteoporosis independent of BMD include:

Answer 15

• advanced age
• decreased physical activity
• cigarette smoking
• excess alcohol intake
• long term glucocorticoid therapy and/or proton pump inhibitors

Question 16

non-drug strategies for treatment of osteoporosis

Answer 16

• adequate dietary intake of calcium and vitamin D
• weight-bearing exercise
• smoking cessation
• avoid drugs that increase bone loss such as glucocorticoid therapy and/or proton pump inhibitors

Question 17

1st line therapy for drug strategies for osteoporosis

Answer 17

bisphosphonates

due to efficacy, cost, long-term safety

Question 18

list of drug strategies for osteoporosis

Answer 18

• bisphosphates
• teriparatide
• selective estrogen receptor modulators (raloxifene)
• calcitonin
• denosumab

Question 19

what is teriparatide?

Answer 19

recombinant human parathyroid hormone (SQ)

Question 20

selective estrogen receptor modulators (raloxifene)

Answer 20

• alternative for bisphosphate intolerant post-menopausal patients
• increases bone density due to estrogen-like effects on bone

Question 21

type of osteoporosis treatment that reduces bone resorption and provides relief of pain due to osteoporotic fracture

Answer 21

calcitonin

Question 22

type of osteoporosis treatment that is a monoclonal antibody for post-menopausal women at high-risk of fracture

Answer 22

denosumab

Question 23

bisphosphate therapy options

Answer 23

• alendronate (drug of choice)
• risedronate (2nd drug of choice)
• ibandronate

Question 24

possible ocular side effects of aldendronate (fosamax, binosto)

Answer 24

rare (<1%) reports of episcleritis, scleritis, and uveitis

Question 25

possible ocular side effects of risedronate (actonel, atelvia)

Answer 25

cataracts (7%), iritis and uveitis (rare)

Question 26

possible ocular side effects of ibandronate (boniva)

Answer 26

rare reports of iritis, scleritis, and uveitis

Question 27

possible ocular side effects of teriparatide (forteo)

Answer 27

very rare: posterior vitreous detachment, ocular hyperemia