Geriatrics & Endo Flashcards
(17 cards)
Osteoporosis diagnosis
BMD T-score <2.5
Osteoporosis definition
Imbalance between bone resorption and formation, happens in trabecular (spongy) bone of the vertebrae and end of long bones (areas prone to o.fractures)
Things asked about in FRAX Tool
Smoking
Alcohol
Steroids
Rheumatoid Arthritis
Personal fracture hx
Parental hip fracture hx
BMD
age, gender, weight
Recommended calcium and vitamin d intake for osteoporosis
Calcium - 1200mg/day divided BID for absorption (max 600mg at a time)
Vit D - 600-800 IU per day
Typical symptoms of osteoporosis
loss of height
may have back pain and focal tenderness
fractures
chronic pain
Investigations for possible osteoporosis
Order a BMD to assess z-score
FRAX tool
Order calcium, phosphate, PTH, Vit D labs
What are pharmacological treatment options for osteoporosis?
First line is bisphosphonates (inhibit osteoclasts)
- can be taken weekly, monthly or yearly (IV)
Denusomab taken every 6 months SC injection
SERM Raloxifene
Teriparitide (PTH analogue) - for severe osteoporosis, daily injection
Who should be screened for osteoporosis?
Women > 65yo
Men > 70yo
Reasons to screen for osteoporosis early
*History of fractures after a minor trauma.
*Family history of osteoporosis or hip fractures.
*Low body weight (BMI < 19 kg/m²).
*Chronic use of corticosteroids (more than 3 months).
*Rheumatoid arthritis or other inflammatory conditions.
*Smoking or excessive alcohol consumption.
*Post-menopausal women or women with early menopause (before age 45).
*Other medical conditions such as hyperthyroidism, hyperparathyroidism, or celiac disease, which can affect bone health.
*Low calcium and vitamin D intake.
Which meds increase risk of osteoporosis
Steroids (>3mo use)
Anti-epileptics
HIV meds
Immunosuppressive
Chemotherapy
Depo-provera
Which medical conditions increase risk of osteoporosis
Anything requiring LT steroids (ex: COPD, transplants)
Inflammatory conditions like RA
Hyperthyroid and hyperparathyroid
Seizures (due to the meds)
What is the FRAX Tool
estimate the 10-year risk of a major osteoporotic fracture
stones, bones, moans and groans
Primary hyperparathyroidism
- high Calcium, high PTH, low phosphate, low/N Vitamin D
you develop stones, leeches from bones, abdominal pain and psych symptoms
primary hyperparathyroid can cause osteoporosis, what is the catchy phrase to remember this
stones, bones, moans and groans
secondary hyperparathyroid
typically associated with CKD or low Vit D levels
- Calcium will be low
- PTH high
- Phosphate high (need binders otherwise it binds calcium) or low if due to Vitamin D deficiency
- Vit D will be low
tertiary hyperparathyroid
also associated with CKD
- PTH is autologous - VERY high
- calcium and phosphate are high
- Vit D is low
what imaging do you do for hyperparathyroid
CT or ultrasound of PTH glands - likely adenoma for primary
