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54 MSK > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

Significant causes for decrease in bone mass

A
  1. Age
  2. Menopause
  3. Alcohol consumption
  4. Smoking
  5. Medication use
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2
Q

What drugs can cause osteoporosis?

A
  1. Glucocorticoids
  2. Immunosuppressants
  3. Anti-seizure medications
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3
Q

Clinical presentation of osteoporosis

A
  • Asymptomatic
  • Undiagnosed until presented with fragility fracture
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4
Q

Common sites of fragility fracture

A
  1. Spine (vertebral compression: height loss, kyphosis)
  2. Hip (neck of femur, intertronchanteric)
  3. Wrist
  4. Humerus
  5. Pelvis
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5
Q

Goals of treatment

A
  1. Prevent fracture
  2. Improve QoL
  3. Reduce economic burden
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6
Q

Who are considered for BMD screening?

A
  1. Post-menopausal women
  2. Men >65 years old
    Especially if risk factors are present
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7
Q

What tool can be used to detect women’s osteoporosis risk?

A

OSTA = age in years - weight in kg

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8
Q

In OSTA, what is considered high risk?

A

> 20 → consider DXA

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9
Q

In OSTA, what is considered medium risk?

A

0-20 → consider DXA if any other risk factors present

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10
Q

How is osteoporosis diagnosed?

A
  1. History of fragility fracture
    OR
  2. BMD measurement using DXA
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11
Q

What does BMD T-score compare against?

A

Young adult reference population

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12
Q

What dose BMD Z-score compare against?

A

Expected BMD for patient’s age and sex

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13
Q

What is the significance of BMD Z-score ≥ -2?

A

Coexisting problems (e.g. alcoholism, GC therapy) that can contribute to osteoporosis

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14
Q

What BMD score represents osteoporosis?

A

T-score ≤ -2.5 SD

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15
Q

What BMD score represents osteopenia?

A

T-score -1 to -2.5 SD

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16
Q

What BMD score represents normal bone density?

A

T-score ≥ -1 SD

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17
Q

Risk factors for BMD screening

A
  1. Family history of osteoporosis or fragility fracture
  2. Previous fragility fracture
  3. Ageing
  4. Low body weight
  5. Height loss (>2cm within 3 years)
  6. Early menopause
  7. Medications
  8. Smoking
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18
Q

Clinical risk factors for FRAX

A
  1. Age
  2. Sex
  3. Weight
  4. Height
  5. Previous fracture
  6. Parent fractured hip
  7. Current smoking
  8. Glucocorticoids (current or >3 months PO Prednisolone >5mg OD)
  9. RA
  10. Secondary osteoporosis
  11. Alcohol 3 or more units/day
  12. BMD
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19
Q

What drug class is Alendronate

A

Bisphophonates

20
Q

What drug class is Zoledronic acid

A

Bisphophonates (IV)

21
Q

What drug class is Raloxifene

A

SERM

22
Q

What drug class is Denosumab

A

RANKL

23
Q

What drug class is Risedronate

A

Bisphophonates

24
Q

What drug class is Teriparatide

A

Recombinant PTH (SQ)

25
Q

What drug class is Romosozumab

A

Sclerostin Inhibitor (SC)

26
Q

Contraindications of bisphophonate

A
  1. CrCl <35ml/min
  2. Hypocalcemia
  3. Oesophagel or gastric abnormality
  4. Unable to sit upright for >30min
  5. Aspiration risk
27
Q

Dosing of Alendronate

A

70mg every week

28
Q

Treatment duration for low risk fracture for bisphosphonates

A

PO: 5 years
IV: 3 years

29
Q

Dosing of Riserdronate

A

35mg every week

30
Q

SE/Safety of bisphosphonates

A

ONJ
Atypical femoral fracture

31
Q

Which other drug classes have same SE/safety concern as bisphosphonates?

A

Romosozumab
Denosumab

32
Q

Dosing of Romosozumab (SC)

A

Once a month for 1 year

33
Q

Dosing of Denosumab

A

Every 6 months

34
Q

CI of Teriparatide

A
  1. CrCl <30ml//min
  2. Paget’s disease/history of bone radiation
  3. Hypercalcemia
35
Q

SE of Teriparatide

A

Postural hypotension

36
Q

Treatment duration of Teriparatide

A

<2 years

37
Q

CI of Denosumab

A

Hypocalcemia

38
Q

CI of Raloxifene

A
  1. CrCl<30ml/min
  2. History/current VTE
  3. Hepatic/renal impairment
39
Q

What labs should be done prior to starting pharmacological treatment?

A
  1. Serum calcium
  2. Serum 25(OH) VItamin D (20-30ng/ml < 50 -100ng/ml)
40
Q

Treatment monitoring

A
  1. SCr
  2. Serum calcium
  3. Serum 24(OH) vitamin D
41
Q

Fracture prevention

A
  1. Exercise (weight bearing - 30min daily, muscle strengthening & balance 2-3x weekly)
  2. Smoking cessation
  3. Limit caffeine intake
  4. Limit alcohol intake
  5. Reduce risk for falls
  6. Ensure adequate calcium intake
  7. Maintain Vitamin D status (800IU/day cholecalciferol for those at risk of Vit D insufficiency)
42
Q

MOA of bisphosphonates

A

Slow bone loss by increasing osteoclast cell death

43
Q

MOA of sclerotin inhibitor

A

Removes sclerotin inhibition of the canonical Wet signalling pathway that regulates bone growth

44
Q

MOA of PTH therapies

A

Stimulate new bone formation and increase bone strength

45
Q

MOA of RANKL inhibitor

A

Prevents development of osteoclasts

54 MSK (6 decks)

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