Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Clin Med MSK: > osteoporosis > Flashcards

osteoporosis Flashcards

(105 cards)

Start Studying
1
Q

what is the definition of metabolic bone disease

A

any bone disorder resulting from chemical aberrations - hormones, minerals

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are the two main types of metabolic bone disease

A

osteopenia and osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what is the definition of osteopenia and osteoporosis

A

low bone density

reduction of total bone mass
thinning of cortical and trabecular bone
increase porosity of cortical and trabecular bone

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what type of fractures arise from osteopenia and osteoporosis

A

fragility fractures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the subsets of osteoporosis

A

Primary vs Secondary

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what is primary osteoporosis

A

post-menopausal (F ages 50-70) -
Senile (age related; >70)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what is secondary osteoporosis

A

due to presence or treatment of other diseases

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what increases with increasing age

A

overall risk of developing osteopenia and osteoporosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what things can expedite bone loss

A

hormone deficiency (primarily estrogen)
excessive alcohol use
tobacco
malignancy
genetic disorders
lack of physical activity
GI disorders
medications

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what hormone is associated with increased risk of osteoporosis/osteopenia

A

estrogen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what medications most commonly affect bone loss

A

corticosteroids
SSRI’s (anti-depressants)
PPI’s (protein pump inhibitors - gerd)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

when is peak bone mass achieved

A

around age 30

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what reduces bone density decline in women

A

reduced estrogen after menopause

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what are the 6 steps to bone remodeling

A

Quinesence
Resorption
Reversal
formation
mineralization
quinesence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what changes after age of 30 for bone remodeling

A

increase bone resorption and decreased bone formation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what is activated when there is low levels of calcium within the blood

A

PTH is stimulated to release PTH which increases the osteoclasts to break down bone and increase serum calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what is stimulated when there is too high levels of calcium within the blood

A

thyroid is stimulated to release calcitonin to inhibit osteoclasts, increase excretion and decrease absorption of calcium to decrease serum calcium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is osteomalacia

A

softening of bone due to impaired mineralization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what is dysregulated during osteomalacia

A

calcium activates osteoclasts

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what is the typical presentation of osteopenia/osteoporosis

A

via screening or fragility fracture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is a fragility fracture

A

any fracture that results from low-energy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is the gold standard screening test for osteoporosis/osteopenia

A

dual-energy x-ray absorptiometry (DEXA)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what patients obtain DEXA scans

A

anyone with risk factors
anyone with a pathologic fracture
all post-menopausal women > 65
younger post-menopausal women with +FH and/or risk factors
all men >70

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what does a DEXA scan assess

A

measures bone mineral density (BMD)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
what patients get a wrist DEXA
non-dominant wrist when spine or hip measurements are unreliable -arthritis -lumbar compression fracture -hardware -hyperparathyroidism -men on androgen deprivation therapy
26
Who it T score used for
most patients
27
who is Z score used for
pre-menopausal women, young males add in age, race, sex matched controls for the mean
28
what are DEXA scan scores converted to
T or Z scores
29
what is inclusive on Z score
age, race, sex matched controls for the mean
30
what score categorizes osteoporosis
less than or equal to NEGATIVE -2.5 standard deviation below 0
31
what score categorizes osteopenia
less than or equal to NEGATIVE -1 standard deviation below 0
32
if a patient has a DEXA with a standard deviation of -2.8, what is their diagnosis
osteoporosis
33
if a patient has a DEXA with standard deviation of -1.2, what is their diagnosis
osteopenia
34
how much does the fracture risk increase per standard deviation below normal
fracture risk is increased 2x for each standard deviation below normal
35
how often do patients with a DEXA T score of -1 to -1.5 have follow up
every 5 years
36
how often do patients with a T score under -2.9 have to follow up
every 1-2 years
37
how often to patients with a T score of -1.5 to -2.0 follow up
every 3-5 years
38
what is a co-occuring deficiency associated with osteopenia/osteoporosis
co-occuring vitamin D deficiency is common
39
what is the best measurement of vitamin D
25-hydroxyvitamin D (25(OH)D) determines circulating (active) form of vitamin D
40
what is normal vitamin D levels
25-80 mg/mL
41
what level is vitamin D deficiency
< 20ng/mL
42
what is the calculation tool used for fracture risk with osteoporosis
FRAX (fracture risk assessment tool)
43
what is the first line treatment of osteoporosis
risk reduction/prevention
44
who gets pharmacologic treatment
based off of the DEXA scores T-score less than -2.5 gets referred for treatment
45
what patients automatically get pharmacologic treatment
any patient with a fragility fracture
46
when are osteopenic patients referred for pharmacologic treatment
10 year hip fracture risk of 3+% 10 year major fracture risk 10+% Based on FRAX calculation
47
what are the primary pharmacological treatment options
vitamin D + calcium Bisphosphonates Denosumab (monoclonal antibody) Teriperatide (PTH analogue) Selective estrogen receptor modulators (SERMs) calcitonin
48
why is vitamin D and calcium important
adequate levels necessary to optimal bone health, medication efficacy
49
what does vitamin D and calcium not do
reduce fracture risk
50
how much calcium do we need per day
about 1200mg/day
51
what patients might need calcium supplementation
malabsorption, special calcium deficient diets
52
how is calcium to be taken
only 500 mg absorbed at one time, divide doses or meals
53
what does calcium carbonate require for absorption
acid - take with food and avoid with H2, PPIs
54
what is the benefit of using calcium citrate
does not require acid for absorption - okay for patients on anti-acid medications to use
55
how much vitamin D do you need daily
about 800-1,000IU/day
56
what is the first line pharmacologic treatment
Bisphosphonates
57
what is the MOA of bisphophonates
inhibit bone resorption via osteoclasts
58
when are bisphosphonates indicated
prevention/treatment of post-menopausal osteoporosis/due to long term steroid use and in men
59
what are the most common bisphosphonate medicatison
alendronate, risedronate, zolendronic acid and ibandronate
60
what is ibandronate approved for
only approved for use of prevention/treatment of post-menopausal osteoporosis
61
when is aldendronate used over risedronate
for non-vertebral fracture
62
what medication does not reduce non-vertebral fracture risk
ibandronate
63
how often is aldendronate used
weekly PO
64
how often is risedronate used
once monthly PO
65
how often is ibandronate used
once monthly PO
66
how often is zolendronic acid used
IV once per year
67
what are the side effects of the PO bisphosphonates medications
erosive esophagitis N/V/abd pain osteonecrosis of the jaw (IV>Oral) atypical femur fractures
68
what are the side effects of IV bisphosphonates
fever, chills, flushing myalgias N/V/D fatigue, dyspepsia, edema headache, dizziness, osteonecrossis of the Jaw (IV> oral)
69
what are important factors with bisphosphonates
must be taken in the AM with atleast 8oz of water and 40 minutes before food patient must remain upright after taking to avoid esophagitis
70
when do bisphosphanates need to be adjusted
Renal dose adjustement with CrCl <35
71
when do patients taking bisphosphonates have a rechecked DEXA
at 3 years
72
what is the maximum length of bisphosphonate usage
5 years due to half life of 10 years within the bone
73
what is the primary fracture types are we preventing with bisphosphonates
hip fractures
74
what is denosumab
moniclonal antibody
75
what is the MOA of denosumab
inhibits osteoclast maturation Rank L inhibitor
76
what are the indications for Denosumab
treatment of osteoporosis (M and F) treatment of major fragility fracture treatment of osteopenia with high FRAX scores high risk with breast cancer, prostate cancer or hormone deprivation treatment
77
what does Rank L do
activates osteoclasts
78
what is the beneif of denosumab
reduces vertebral and hip fractures (vertebral > hip)
79
how is denosumab prescribed
SubQ every 6 months no renal adjustments needed
80
how long is denosumab prescribed for
only given for 3-5 years
81
what are the side effects of denosumab
flu-like symptoms hypocalcemia hypercholesterolemia eczema/dermatitis infections malignancies pancreatitis osteonecrosis of the jaw atypical femur fractures more immune system like symptoms
82
What is teriperatide
an PTH analog for osteoporosis
83
what is the MOA for teriperatide
decreases osteoblast apoptosis and promotes production of new bone matrix
84
what are the inidcations for teriperatide
treatment of osteoporosis (M and F) and ATYPICAL FEMUR FRACTURES (side effect of other medications)
85
how is teriperatide prescribed
Sub Q daily only approved for 2 years of treatment
86
what medications can teriperatide be used in combo with
Denosumab or follow with bisphosponates
87
what are the side effects of teriperatide
BLACK BOCK WARNING - INCREASED RISK FOR OSTEOSARCOMA injection site irritation orthostatic hypotension arthralgias myalgias depression pneumonia hypercalcemia
88
what patients are not given teriperatides
patients with Paget's, skeletally immature, history of sarcoma, or hx significant radiation
89
What does SERMs stand for
Selective estrogen receptor modulators
90
what does modulate mean
turn it on or off
91
what is the mechanism of action for SERMs
bind estrogen receptor -> protective effects
92
what is the indications for SERMs
PREVENTION not treatment of osteoporosis
93
what is SERMs given in replacement of
full estrogen replacement therapies
94
what are the two major SERMs medicatiosn
Raloxifene and Tamoxifen
95
when is Tamoxifen commonly given after
after breast cancer treatment
96
what is the benefit of SERMs
reduces vertebral fractures - but not hip/other non-vertebral fractures
97
how are SERMs prescribed
orally daily
98
when are SERMs contraindicated
pregnancy/potential pregnancy, VTE risk (venous thrombus embolus)
99
what are the side effects of SERMs
hot flashes thromboembolism reduced LDL reduced breast cancer risks
100
what is calcitonin do
inhibits osteoclasts and reduce serum calcium
101
what is the MOA for calcitonin
decreases bone resorption
102
when is calcitonin indicated
primary for pain associated with vertebral compression fracture - least effective agent for treatment or prevention
103
how is calcitonin prescribed
daily intranasal or SubQdaily
104
how long is calcitonin prescribed for
up to 3 months
105
what are the side effects of calcitonin
rhinitis/epistaxis flu-like symptoms allergy arthralgia/back pain headaches

Clin Med MSK: (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions