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Women's Health > Menopause and Osteoporosis > Flashcards

Menopause and Osteoporosis Flashcards

1
Q

typical age for menopause

A

45-55 years

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2
Q

Age for early menopause

A

40-45 years

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3
Q

If your patient is going through menopause and they are under 40 you should work them up for

A

ovarian disorder → primary ovarian insufficiency

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4
Q

what causes surgical menopause?

A

removal of ovaries surgically

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5
Q

How long must a woman have amenorrhea to be considered menopausal?

A

1 year

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6
Q

what will lab values be for a patient in menopause?

A

elevated FSH and low estradiol

consider TSH, HCG, prolactin

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7
Q

period where you transition from reproductive to non-reproductive years

A

perimenopause

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8
Q

what is the average duration of perimenopause? How many years before menopause does it occur?

A

4 years

5-10 years prior

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9
Q

How will cycle change in the perimenopause phase?

A

cycle may be shorter → shortened follicular phase

cycle may be longer → anovulation

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10
Q

What is the difference between perimenopause and menopause?

A

perimenopause is irregular menses and menopause is absence of menses

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11
Q

80% of women experience ___ with menopause

A

vasomotor symptoms

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12
Q

Symptoms associated with menopause

A

mood disturbances (anxiety, depression, irritable), sleep disturbance, poor concentration, heart palpitations, decreased interest/painful sex, drying/atrophy of vagina, infertility, fatigue, headache, tension, feelings of inadequacy or nonfulfillment

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13
Q

Two biggest effects of menopause

A

increased risk of CVD and increased risk for osteoporosis

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14
Q

Other effects of menopause

A

stress incontinence, loss of skin reilience and pliability, dry hair or loss, dry mouth, lower voice, easily traumatized skin, weight gain (truncal), osteoporosis

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15
Q

What are the treatment goals of managing menopause?

A

relieve symptoms

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16
Q

in which patients is HRT appropriate in treating postmenopausal women?

A

< 60 years, < 10 years out from onset of menopause, moderate to severe symptoms

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17
Q

Treatment for women with intact uterus to prevent endometrial hyperplasia

A

estrogen + progesterone

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18
Q

What type of HRT is preferred in women with moderate risk of CVD (decreases risk of thromboembolism)?

A

transdermal

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19
Q

What HRT method is preferred in women with genitourinary symptoms?

A

intravaginal

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20
Q

why are bioidentical hormone therapy preparations not recommended?

A

higher rates of adverse effects and lack of long term safety data

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21
Q

Contraindications for HRT

A

unexplained vaginal bleeding, thrombophilia, breast or endometrial cancer, arterila thromboembolic disease (stroke, TIA, MI, PE, DVT), liver disease, anaphylactic reaction, pregnancy

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22
Q

Benefits of HRT in menopause

A

reduced risk for hip fracture
reduced risk of colorectal cancer
reduced breast cancer risk (estrogen only HRT)

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23
Q

alternative to estrogen replacement for women at risk for osteoporosis who cannot or prefer not to take estrogen

A

Selective Estroen Receptor Modulators (SERMs)

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24
Q

Nonhormonal therapies for menopause

A

SSRI, SNRI, gabapentin, pregabalin

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25
Q

systemic skeletal disease involving low bone mass and micro architectual deterioration of bone tissue → increased bone fragility and increased fracture risk

A

osteoporosis

26
Q

How is osteoporosis diagnosed?

A

based on history of fragility fracture or BMD criteria

27
Q

fracture that occurs after an injury that wouldn’t have expected to result in a fractured bone

A

fragility fractures

28
Q

common sites of fragility fractures

A

hip, vertebrae, wrist

29
Q

DEXA definition of osteoporosis

A

BMD 2.5 standard deviations below young adult mean for women

30
Q

Most common form of osteoporosis

A

postmenopausal

31
Q

Where does DEXA take measurements - gold standard?

A

femoral neck or spine

32
Q

Normal BMD has T-score

A

higher than -1.0

33
Q

Low BMD (osteopenia) has T-score

A

between -1.0 and -2.5

34
Q

Osteoporosis has T-score

A

lower than -2.5

35
Q

Alternative method to DEXA in testing bone density?

A

quantitative ultrasound of calcaneous (QUS) → good at predicting risk but unclear on how useful in selecting medication

36
Q

who should get DEXA scan?

A

women >65 and men >70
young post menopausal women w/ risk factors
bone break after age 50

37
Q

what are some osteoporosis risk factors?

A

age, long term PPI therapy, low body weight, hypogonadism (men)

38
Q

“ACCESS” risk factors of osteoporosis

A

alcohol use, corticosteroids, calcium (low), estrogen (low), smoking, sedementary lifestyle

39
Q

Meds that can cause osteoporosis

A

depo provera (contraceptive), PPI, SSRI, glucocorticoids, tamoxifen, thyroid hormones

40
Q

autoimmune disorders that increase risk of osteoporosis

A

RA, Lupus, MS, ankylosing spondylitis

41
Q

medical procedures that may increase risk of osteoporosis

A

gastrectomy, GI bypass

42
Q

hematologic/blood disorders that may increase risk of osteoporosis

A

leukemia and lymphoma, multiple myeloma, sickle cell disease, thalassemia

43
Q

digestive and GI disorders that may increase risk of osteoporosis

A

Celiac, IBD, weight loss surgery

44
Q

Cancers that may increase risk of osteoporosis

A

breast and prostate

45
Q

Neuro disorders that increase the risk of osteoporosis

A

stroke, Parkinson, MS, spinal cord injuries

46
Q

Endocrine/hormonal disorders that increases the risk of osteoporosis

A

diabetes, hyperparathyroidism, hyperthyroidism, Cushings, thyrotoxins, irregular periods, premature menopause

47
Q

risk factors for fragility fractures

A

smoking, excessive alcohol, physical inactivity, poor nutrition

48
Q

computer based risk assessment tool to estimate 10 year probability of hip fractures and other major fractures for untreated patients 40-90 years old

A

FRAX

49
Q

What are some labs you’d want to order in working up a fragility fracture?

A

biochemistry profile (Ca, P, albumin, total protein, creatinine, Alkaline phosphatase, electrolytes)
25 hydroxyvitamin D
CBC
BMP

50
Q

Calcium and Vitamin D recommendations to prevent osteoporosis

A

1,200mg/day calcium

800 - 1,000 IU Vitamin D

51
Q

What are some calcium rich foods?

A

milk and dairy, leafy green vegetables, okra, sardines, soybreans/tofu, white beans, almonds

52
Q

Which patients should you consider osteoporosis treatment in?

A

T-score between -1 and -2.5

FRAX >3% or >20%

53
Q

Before initiating any osteoporosis treatment, what lab values must be normal and what must the patient be taking?

A

normal serum Ca and 25-hydroxyvitamin D

dietary supplements

54
Q

First line treatemnt for osteoporosis

A

PO bisphosphonates

55
Q

Biggest adverse effect of bisphosponates

A

upper GI irritation

56
Q

Other methods of treating/preventing osteoporosis - not first line

A

SERM, HRT, forteo, IV Zoledronic acid

57
Q

What do you consider when choosing a bisphosphonate?

A

preference, convenience, dosing schedule, cost

58
Q

Which bisphosphonate do you have to administer weekly? Which do you get once a year?

A

alendronate

zoledronic acid

59
Q

Side effects of oral bisphosphonates and how can you prevent?

A

stomach upset and heartburn → take with full glass of water on empty staomch and sit up for 30-60min after

60
Q

IV form of bisphosphonates cause what side effects

A

flu like symptoms

61
Q

second line for people who cannot take bisphosphonates

A

denosumbab

62
Q

Two second line therapies that can rebuild bone in osteoporosis

A

teriparatide and abaloparatide

Women's Health (9 decks)

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