Osteoporosis Flashcards
(11 cards)
A 76 yo female presents for her annual physical. You find out that a few months ago she fell and fractured her hip. Since then she’s been much less active than she used to be. On exam you notice that she has a low body weight and has shrunk a couple cm since last year. What disease is this pt most at risk for? What is the most likely cause of her disease?
Osteoporosis
Due to reduced bone strength, most likely Type I primary osteoporosis b/c she is post-menopausal (although Type II primary osteoporosis d/t dementia is possible)
A 64 yo woman presents complaining of arm pain. She tripped earlier today and caught herself on the palm of her hand. Shortly after the pain started. What is the most likely underlying cause of this woman’s fracture? What lab tests are you going to run?
Colle’s fracture d/t osteoporosis
X-Ray her arm
DEXA scan for osteoporosis
Alternatives are CT or U/S
A 65 yo woman comes in for her annual check up. What should you do? What findings would you expect to see in a normal, healthy pt?
DEXA scan to look for osteoporosis
Normal is > -1
Osteopenia is -1 - -2.5
Osteoporosis is < -2.5
When should DEXA scans be started to check for osteoporosis in otherwise healthy men?
After age 75
After age 65 in women
A 58 yo female comes in for her annual check-up. From her history you discover that she fractured her T3 vertebrae a couple months ago, that she smokes a pack per day, and she drinks 3-4 glasses of wine every night. You send her to get a DEXA scan and some blood work. Her results come back below. What treatment options do you recommend for this pt?
DEXA = -3.0
Ca is low
Vitamin D is low
Smoking cessation
Decreased alcohol consumption
Improve nutrition (dietary changes or supplemental Ca & Vitamin D)
Do weight-bearing exercise
Pain management for her fracture if needed
Start her on a bisphosphonate - Alendronate (preferred b/c it’s 1 of 2 drugs FDA recommended to Tx osteoporosis (Ibandronate is the other), and it’s been shown to be the most effective bisphosphonate for in women with vertebral Fx’s)
Raloxifene (an SERM) could also be used since it reduces the risk of vertebral fractures and it a first line Tx
A 59 yo female presented for her annual physical. From her history you found that she had a sedentary lifestyle, she is on a long-term glucocorticoid and her mother was diagnosed with osteoporosis when she was 74. On exam you found that she was 1.5 cm shorter than last year, and last year she was 1 cm shorter than the year before. You sent her to get a DEXA scan, which came back at -2.7. What treatment recommendations should you make for this pt?
Reduce her underlying risk factors - begin daily weight-bearing exercise, switch off of the glucocorticoid if possible
Improve her nutrition (dietary or supplemental Ca and Vitamin D)
Consider starting her on a bisphosphonate (1st line), estrogen, SERM (Raloxifene), or PTH (Teripratide)
What are the 1st line Tx options for a pt with osteoporosis?
Bisphosphonate (preferred): Alendronate, Risendronate, Ibandronate, Zoledronic, Pamidronate
SERM: Raloxifene
An 80 yo pt of your has osteoporosis and she has been on Alendronate for 5 years with noticeable effects. Should you make any adjustments to this pt’s Tx?
Yes - bisphosphonates must be discontinued after 5 yrs d/t their risk of osteonecrosis, esophagitis, and esophageal CA
Change her to Raloxifene (an SERM)
What are the 2 types of osteoporosis? What are the underlying causes of each?
Primary Osteoporosis
Type I occurs post menopause
Type II occurs in senile pts (slow progression)
Secondary Osteoporosis d/t (1) sex hormone deficiency, (2) hormone excess, (3) increased bone resporption/formation, and/or (4) multifactoral
What are the 2 bisphosphonates FDA approved for the treatment of osteoporosis
Alendronate
Ibandronate
What is the SERM that is approved to treat osteoporosis?
Raloxifene
