4 - Osteoporosis Flashcards

Question

What T-score indicates osteoporosis?

Answer 1

T-score < -2.5

Answer 2

1) Patient's risk of fracture 2) Efficacy 3) Patient's goals 4) Desire for specific harm avoidance 5) Comorbidities such as autoimmune disorders (on steroids), HTN (at risk of dizziness and increased falls), early menopause 6) Feasibility

Answer 3

If they've already had a fragility fracture OR they have osteoporosis (T score < -2.5)

Answer 4

Hip fracture RRR = 30-50% Vertebral fracture RRR = 40% Major osteoporotic RRR = 40%

Answer 5

30-50% | 40% is also acceptable

Answer 6

Those with moderate to high risk (10 year risk fracture of >10% to >20%).

Answer 7

- inform pt of benefit | - discuss risks of medication and assist the pt in making an informed decision regarding medication use

Answer 8

Common: GI (abdominal pain, dyspepsia, diarrhea, nausea, reflux) Less common: esophageal or gastric ulceration, erosion, perforation Rare: ONJ (tell people about these even though it is rare because it is in the media)

Answer 9

injection rxn MSK pain, decreased Ca, rarely A fib, ONJ

Answer 10

flushing, leg cramps, flu like symptoms

Answer 11

rash, MSK pain, decreased Ca, ONJ, infection

Answer 12

nausea, dizziness, leg cramps, rarely increased uric acid and Ca

Answer 13

- An area of exposed alveolar bone (mandible or maxilla) that does not heal after 8 weeks * bone-related, not tendon-related

Answer 14

- smokers - TMJ - dental procedures - diabetes - chemotherapy - glucocorticoid use - high dose bisphosphonaters - poor dental hygiene

Answer 15

- Appear to develop as femur stress fractures - May present as new thigh pain - Most commonly associated with increased duration of use, especially > 5 years

Answer 16

For patients who are undergoing treatment, repeat measurement of bone mineral density should initially be performed after one to three years; the testing interval can be increased once therapy is shown to be effective **BMD is similar to LDL testing in the sense that you don't really need to test it often bc it is just a small part of fracture risk An alternative: Do not re-assess BMD within the first 5 years of therapy for patients who opt to initiate medication therapy

Answer 17

Depends on the risk - Some clinicians say that high risk patients need to be on it for 10 year and no break. - If they have low risk, break for 5 years is prob a reasonable approach 5 vs 10 year treatment (FLEX trial): -there was an increase in vertebral fractures by about 3% NNH = 34 -if you explain this to patients, they may have differing opinions *some may want to stay on it (really don't want a fracture), some may not want to

Answer 18

**No evidence of protective effects of bisphosphonates on HIP or WRIST fractures in women > 80 years with prior hip or vertebral fractures. **Bisphosphonates decrease VERTEBRAL fractures in women > 80, most (84%) of whom had previous vertebral fractures with an effect seen over 1-3 years SO if they're gonna live longer than 1-3 years, had previous VERTEBRAL fracture, and over 80 yo, can give them bisphophonate and will decrease vertebral fractures by ARR of 2-2.5%. ALSO think about our #1 goal which is to prevent falls. If we can make other interventions there, medication may not be necessary !!!

Answer 19

1) Continue to monitor for and address fall risk in all patients 2) Encourage an individualized exercise plan 3) Counsel on and document use/intake of calcium + Vitamin D 4) The benefit for pharmacologic therapies is in "secondary prevention" (i.e. T score < -2.5 or previous fracture) 5) When deciding (with the patient) whether to initiate treatment, assess fracture risk and absolute benefit rather than BMD alone 6) Re-testing BMD in patients on therapy provides minimal (if any) benefit in therapeutic management 7) Duration of therapy should be discussed with patients at baseline and at 5 years

4 - Osteoporosis Flashcards

(43 cards)