Osteoporosis

Question 1

Which aromatase inhibitor can cause osteoporosis?

Answer 1

Anastrazole (used for breast cancer)! Must add bisphosphonate if taking anastrozole.

Question 2

What is T-score used for?

Answer 2

osteoporosis=T-score <-2.5

Question 3

What is Z-score used for?

Answer 3

Z-score is useful for identifying PRE-menopausal women art risk of secondary osteoporosis. Z-score <-2.0 is risk of osteoporosis.

Question 4

What are risk factors for osteoporosis?

Answer 4

age, parental hx hip/spine fracture, BMI<20, smoking, alcohol
- diminished ovarian reserve
- hyperparathyroid
- hypocalcemia, premature menopause, RA, turner’s, vitamin d deficiency
- antiepileptic drugs (lithium, phenytoin, carbamazepine, primidone, phenobarbital), aromatase inhibitors
- heparin, antiretrovirals, chemo drugs, GNRH agonists/antagonists. Genetics accounts for 80% variability!!!

Question 5

What are bisphosphonates?

Answer 5

. If low/mod risk, discontinue after 5 years (if PO) or 3 years if IV use. If high risk, can do up to 10 years.
SE: GI irritation, muscle aches/pain. If pain in thigh/groin, get Xray w/ MRI if on longterm use.
- Contra-indicated if acute renal failure.

Question 6

What is denosumab?

Answer 6

Denosumab=monoclonal Ab, binds RANK-L
- If incr risk of fracture who prefer q6months administration
- If discontinue denosumab, transition to treatment with another antiresorptive agent.
-AVOID W/ HYPOCALCEMIA. can have rare jaw osteonecrosis

Question 7

When are parathyroid hormone analogs teriparatide and abaloparatide used?

Answer 7

If very high risk fracture or sustained fractures while taking anti-resorptive therapy
- can only use for 2 years bc incr risk osteosarcoma. Avoid if Paget’s disease, alk phos, hypercalcemia.

Question 8

What are anabolic osteoporosis medications?

Answer 8

Increase bone density by stimulating bone formation
- Parathyroid hormone analogs (teriparatide and abaloparatide))
- sclmrostin-binding inhibitors (romosozumab)

Question 9

What are anti-resorptive osteoporosis medications?

Answer 9

Increase BMD and decrease bone turnover by inhibiting osteoclasts
- SERM
- Calcitonin
- RANK-L inhibitor (denosumab)
- Bisphosphonates

Question 10

What are causes of secondary bone loss?

Answer 10

• AIDS/HIV
• anorexia
• type 1/type 2 DM
• diminished ovarian reserve
• gastric bypass
• hyperparathyroid, hypocalcemia
• premature menopause, primary ovarian insufficiency
  -renal impairment, RA, Turner’s, vitamin d DEFICIENCY
• ANTIEPILEPTIC DRUGS
• ANTIRETROVIRAL DRUGS
• AROMTASE INHIBITORS
• CHEMO
• GLUCOCORTICOIDS
• GNrh AGONISTS, GNrh antagonists
• heparin
• workup: CBC, CMP, TSH, urine calcium

Question 11

What are bone formation markers?

Answer 11

Osteocalcinin
bone specific alkaline phosphatase
Procollagen type 1
N-terminal pro-peptide

Question 12

What are bone resorption markers?

Answer 12

urinary deoxypyridinoline (u-DPD)
-urinary collagen type I cross-linked N telopeptide (u-NTX)
- serum collagen type I cross-linked C telopeptide (s-CTX).

Question 13

What are worrisome frax scores?

Answer 13

If your FRAX score is 3% or more for hip fracture, or 20% or more for other major osteoporosis fractures

Question 14

How do you diagnose osteoporosis?

Answer 14

DEXA of Lumbar spine