Osteoporosis

Question 1

The world health organization classifies osteoporosis as what

Answer 1

a bone density that falls 2.5 STD dev below the mean for a young healthy adults of the same sex (t-score -2.5)

Question 2

women of what time frame of their menstrual cycle and what bone density score put them at risk for what?

Answer 2

postmenopausal who fall between -1.0 and -2.5 also have low bone density and are at risk of developing osteoporosis

Question 3

what are the values for a person to have osteopienia

Answer 3

between -2.5to 1.0

Question 4

what is the correlation between mortality with osteoporosis

Answer 4

very high due to the complications of treatment of fractures

Question 5

when are fractures of the radius most common

Answer 5

before the age of 50 and plateau by 60 w/ only a modest age related increase

Question 6

what is the incidence rate for hip fractures

Answer 6

doubles every 5 years after 70years old

Question 7

What types of fracture complications are their with osteoporosis

Answer 7

wrist fractures
hip fractures
vertebral fractures

Question 8

what are the complications that come with hip fractures

Answer 8

high incidences of DVT and PE (20-50%)

mortality rate between 5-20% during the 1st year after surgery

Question 9

what are the complications that arise with vertebral fractures

Answer 9

relatively asymptomatic
associated with long term morbidity and slight increase in mortality rates due to pulmonary disease
can cause loss of height and kyphosis and secondary pain and back discomfort’
thoracic fractures can be associated with restrictive lung disease

Question 10

what is a colles fracture

Answer 10

a fracture of the distal radius when a person attempts to break a fall using hands and arms

Question 11

what is primary type 1 osteoporosis

Answer 11

postmenopausal causing rapid bone loss w/in 6 years of menopause, mainly trabecular bone (spongy bone)

Question 12

what is primary type 2 osteoporosis

Answer 12

senile (men and women > 75 yrs of age) slow progression, both cortical and trabecular bone

Question 13

what is secondary types of osteoporosis

Answer 13

sex hormone deficiency (hypogonadism, prolactinoma, orchiectomy (removal of testes) for prostate cancer)
hormone excess (hyperthroidism, hyperparathyroidism, corticosteroids)
Increased bone resorption/formation ration: immoblilization, space flight, long term heparin, cancer
multifactorial(renal failure, anorexia athletic amenorrhea, ETOH use

Question 14

what are risk factor for osteoporosis (non modifiable)

Answer 14

woman (postmenopausal)
white race
advanced age
personal history of fractures as adult
history of fractures in a first degree relative
dementia

Question 15

what are risk factors that are modifiable

Answer 15

Low body weight
current cigarette smoking
ETOH abuse
Low Calcium intake
Vitamin D deficiency
lack of physical activity

Question 16

what are chronic disease states that put people at risk for osteoporosis

Answer 16

rheumatologic and autoimmune
hypogonadal states, anorexia, DM, Cushings syndrome, hyperthyroidism
Celiac, gastric bypass, chrohn’s, malabsorption
Multipe Myeloma, Lymphoma, leukemia
Epilepsy, Muscular sclerosis, Dementia, parkinsons, poor eye sight

Question 17

what medications will put you at risk

Answer 17

most common is glucocorticoids

anticonvulsants, immunosuppressants, aromatase inhibitors, heparin lithium, hormone therapies, PPI, ICS in elderly

Question 18

What is the pathophysiology for normal bone growth?

Answer 18

skeleton increases in size by linear growth and by apposition of new bone tissue on the outer surface of the cortex which is known as modeling. the modeling allows the long bones to adapt and shape to the stress placed on them
Puberty require increased sex hormone production which is required for maturation

Question 19

What happens to bone mass in adulthood

Answer 19

bone mass remain constant after peak bone mass is achieve in adulthood- equal balance

Question 20

what are the two primary functions of bone remodeling?

Answer 20

repair microdamage with in skeleton to maintain strength

to supply calcium from the skeleton to maintain normal serum calcium

Question 21

what regulated bone remodeling

Answer 21

estrogen, androgen, vitamin D, PTH,

Question 22

what happens to bone remodeling at ages 30-40

Answer 22

resorption exceeds formation
due to menopause
or increase osteoclast activity or decrease osteoblast activity

Question 23

what are the signs and symptoms of osteoporosis

Answer 23

usually painless unless the patient sustains a fracture
height loss
increased kyphosis of thoracic spine with a secondary protuberant abdomen
bone pain or deformities from fractures

Question 24

how is osteoporosis diagnosed

Answer 24

made clinically in the setting of a fragility fracture regardless of T-score

Question 25

how is osteoporosis diagnosed in men and women

Answer 25

post menopausal women and men greater than 50years old with no fragility fracture diagnosed by bone density testing

Question 26

What labs are ordered to rule out secondary causes of osteoporosis?

Answer 26

``` CBC Calcium if elevated hyperPTH low Vit D def or GI malabsorption phosphorus level Cratinine TSH ```

Question 27

what is the gold standard in diagnosis a person with osteoporosis?

Answer 27

DEXA scan

Question 28

what does a DEXA scan measure?

Answer 28

measure bone density w/minimal radiation exposure | focuses mainly on the spine and hip

Question 29

how are DEXA scan values reported

Answer 29

T-scores | it compares the values of the individual results to those of a healthy 30 year old of the same race and

Question 30

what is a t-score of less than -2.5 in the lumbar, spine, femoral neck or total hip

Answer 30

this is classified at osteoporosis

Question 31

what is the t-score less than -1.0 but greater than -2.5 is considered

Answer 31

osteopenia

Question 32

what are the approved testing guidelines for osteoporosis

Answer 32

for postmenopausal women and men>50years old | measure height annually

Question 33

What are the requirements for a dexa scan

Answer 33

``` all women>65yr all men>70 post menopausal women7.5mg of prednisone or duration of tx>3months primary hyperPTH monitoring osteoporosis meds ```

Question 34

what is the treatment for hop fractures

Answer 34

require open reduction and internal fixation with rehab and pain mgmt

Question 35

what is the treatment for vertebral fx

Answer 35

acute pain mgmt if symptomatic | vertoplast/kypoplasty

Question 36

what is the treatment for wrist fractures

Answer 36

may or may not require pinning, ORIF or manual reduction, acute pain mgmt

Question 37

what is the treatment for osteoporosis by reducing underlying modifiable risk factors

Answer 37

``` d/c meds smoking cessation alcohol abuse treatment environmental safety in the home( eliminate throw rugs, move wires, remove tripping hzds) treat vision impairment specialized care for pts with dementia ```

Question 38

what was can you treat osteoporosis?

Answer 38

improve nutrition calcium supplements Vitamin D weight bearing exercise ( do not increase bone mass but prevents bones loss)

Question 39

how is exercise a good treatment for osteoporosis

Answer 39

prevents bone loss, but does not increase bone mass improves coordination, strength, and balance needs to be at least 3x/week

Question 40

what are the normal values for calcium levels

Answer 40

8.5-10.5

Question 41

what is 1st line treatment for osteoporosis what are additional treatments

Answer 41

``` bisphosphonates SEMS selective estrogen receptor modulators calcitonin PHT Testosterone ```

Question 42

what is the MOA of bisphophonates

Answer 42

inhibit osteoclast-induced bone resorption increases bone density and reduce incidence of both vertebral and nonvertebral fx prevents corticosteroid osteoporosis

Question 43

when should oral agents for osteoporosis be taken

Answer 43

in the am w/ 8oz of water and 40 min prior to consuming anything else, need to remain upright to prevent esophagitis

Question 44

what are side effects of bisphosphonates

Answer 44

osteonecrosis of jaw, esophagitis, esophageal cancer

Question 45

how long is the treatment for bisphophonates?

Answer 45

1/2 life is 10 yrs there fore it is now recommended to d/c after 5 years of tx

Question 46

how does estrogen work to fight osteoporosis

Answer 46

reduces bone turnover, prevents bone loss and causes small increases in bone mass of the spine, hip, and total body

Question 47

what are some long term side effects of estrogen therapy

Answer 47

increased risk of CV events, breast cancer, storkes, endometrial hyperplassia, DVT, PE

Question 48

how do serms work to prevent osteoporosis

Answer 48

used in postmenopausal women | prevents bone loss and reduces bone turn over

Question 49

how does PTH work for people with osteoporosis

Answer 49

works on osteoblasts | favors bone formation over resorption, produces increase in bone tissue and restores the micoarchitecture

Question 50

what is an example of PTH medication

Answer 50

teriparatide given sub q daily for 2 years not as effective as with pts who used bisphosphonates best as mono therapy

Question 51

when is testosterone use for treatment

Answer 51

in hypogonadal men