Osteoporosis Lecture Powerpoint

Question 1

Osteoporosis definition

Answer 1

Disease characterized by low bone mass and microarchitectural deterioration of bone tissue that is associated with increased fragility and a consequent increased risk of fractures

Question 2

Bone density over the aging process

Answer 2

Active growth of bone mass peaking at 30 and then loss begeins gradually until 50 (menopause for women) followed by rapid continuing loss

Question 3

Osteoporosis morbidity and mortality

Answer 3

• hip fracture sreduce survival by 12-20% related to coexisting chronic medical conditions
• after hip fracture only half of patients are able to return to ambulation independently
• 60k nursing home admissions yearly attributed to hip fracture
• same lifetime risk of dying as breast cancer

Question 4

Who should be tested for osteoporosis? (7)

Answer 4

• All women over age 65
• all individuals taking long term corticosteroids
• all individuals over 50 that suffer an osteoporotic fracture
• postmenopausal women with major risk factors
• men with hypogonadal conditions
• men over 70
• patients with diseases associated with bone loss and fracture

Question 5

Bone mineral density testing

Answer 5

Bone density measurements predict fracture risk better than cholesterol measurements and predict the risk of heart disease better than blood pressure does for stroke, most often done via a DXA scan

Question 6

Distribution of fracture rates in women

Answer 6

-Based on T score, lower the T score greater risk however because more women exist in the middle than at the extremes we actually see more fractures there, therefore we treat earlier rather than later

Question 7

When should secondary causes be considered in testing for osteoporosois (3)

Answer 7

• vit D deficiency

- low Z score (age matched control T score)

Question 8

What is tested for when assessing osteoporosis (6)

Answer 8

• 25 OH vit D level
• PTH
• serum calcium, phosphorus, creatinine
• CBC
• TSH
• serum testosterone in men

Question 9

Universal recommendtiaons for osteoperosis treatment (3)

Answer 9

• adequate ca2+ and vit D intake
• exercise
• behavioral strategies

Question 10

Pharmacologic treatments for osteoporosis (3)

Answer 10

• bisphosphonates
• Raloxifene (selective estrogen reuptake modulator)
• PTH derivatives

Question 11

Biphosphonates concerns (2)

Answer 11

• osteonecrosis of the jaw (very rare, benefits always outweigh concerns about it)
• subtrochanteric fracture of femur (midshaft of femur in area where hypertrophy occurs - happens with very long duration of therapy)

Question 12

Duration of osteoporosis treatment

Answer 12

• begin therapy until treatment considered a success

- take drug holiday for several years

Question 13

Monitoring treatment of osteoporosis (3)

Answer 13

• repeat DXA scan every 2 years
• when bone density is stable or improved, it is felt that treatment is successful in decreasing risk in fracture
• if still decreases, then may be due to other underlying condition or or noncompliance