Ch 12 - Osteoporosis

Question 1

What is a T-score?

Answer 1

of SD away from the mean peak bone mass (PBM) of young adults with the same race and gender

Question 2

What is normal bone density?

Answer 2

T-score b/w −1 SD and +1 SD

Question 3

What is Osteopenia?

Answer 3

T-score is between –1 and –2.5, including –2.5

Question 4

What is Osteoporosis?

Answer 4

T-score is less than –2.5

Question 5

What is Osteomalacia?

Answer 5

Defective skeletal mineralization of calcium or phosphate of bone osteoid

Question 6

What is Diffuse idiopathic skeletal hyperostosis (DISH)?

Answer 6

Excessive bone growth characterized by ossification of the ALL of the spine and extra spinal ligaments

Question 7

What is the Z-score?

Answer 7

of SDs the patient’s bone density is in relation to adults of the same age, gender, and ethnicity

Question 8

What is peak bone mass?

Answer 8

Highest level of bone mass achieved as a result of normal growth generally occurs between adolescence and age 35, with variation at specific skeletal sites

Question 9

What is the most common metabolic bone disease?

Answer 9

Osteoporosis

Question 10

What are non-modifiable risk factors of osteoporosis?

Answer 10

– Caucasian or Asian 
– Female 
– Loss of ovarian function/estrogen depletion, testosterone deficiency 
– Advanced age 
– Diminished PBM at skeletal maturity 
– + family history 
– h/o fracture as adult

Question 11

What are modifiable risk factors of osteoporosis?

Answer 11

– Malnutrition 
– Smoking 
– Excess alcohol 
– Excess caffeine intake 
– Inactivity/immobilization 
– Exercise-induced amenorrhea 
– Low BMI <20

Question 12

What is the MCC of osteomalacia?

Answer 12

Vitamin D deficiency

Question 13

What is Type I osteoporosis?

Answer 13

Postmenopausal
– 15-20 years following menopause 
– Females 50-65 yo
– Trabecular > cortical bone loss 
– Fx in spine, hip, and wrist

Question 14

What is Type II osteoporosis?

Answer 14

Senile osteoporosis
– >70 yo
– 2:1 female:male ratio – Trabecular ≈ cortical bone loss
– Fx hip, spine, pelvis, humerus

Question 15

What is the MCC of medication induced osteoporosis?

Answer 15

Corticosteroids inhibits bone formation (↓ osteoblasts); mainly trabecular bone loss

Question 16

What is the female athlete triad?

Answer 16

Disordered eating
Menstrual disorders
Low BMD

Question 17

What is the Gold standard for BMD measurement testing?

Answer 17

Dual x-ray absorptiometry (DXA)

Question 18

What skeletal sites are measured with DXA?

Answer 18

Spine
Hip
Radius

Question 19

What are proximal femur density measurements useful for?

Answer 19

Predicting hip fractures

Question 20

What are spine density measurements useful for?

Answer 20

Monitoring response to therapy

Question 21

What can lead to false readings on DXA?

Answer 21

Spinal osteophytes and aortic calcifications

Question 22

What % of bone mass loss must occur before demineralization can be detected on x-ray?

Answer 22

30-35%

Question 23

What are codfish vertebrae?

Answer 23

Increased concavity of endplates if nucleus pulposus has not degenerated

Question 24

What is the optimal daily intake of Ca?

Answer 24

400-1,500 mg depending on age and estrogen status

Question 25

What is the optimal daily intake of Vitamin D?

Answer 25

400-800 IU daily

Question 26

What is the function of calcitonin?

Answer 26

Directly inhibits osteoclastic activity

Question 27

What can calcitonin be used for?

Answer 27

Derived from salmon
Can dec pain from compression fx
Preserves bone mass

Question 28

What do bisphosphonates do?

Answer 28

Inc bone mass and red incidence of spinal fx

Question 29

What are side effects of IV bisphosphonates?

Answer 29

Flu-like symptoms
Fever
Muscle and joint pain
HA
Osteonecrosis of jaw
Visual disturbances

Question 30

What are the Most common osteoporotic fractures?

Answer 30

Vertebrae > hip > wrist

Question 31

What are the Most common vertebral compression osteoporotic fractures?

Answer 31

Lower thoracic, upper lumbar areas

Question 32

What is the Most common fracture in females > 75 yo?

Answer 32

Wrist fx