Osteoporosis

Question 1

What % of elderly who have a hip fracture die within one year?

Answer 1

20%

Question 2

What is the gold standard for diagnosing osteoporosis?

Answer 2

DEXA scan

Question 3

What is a T-score?

Answer 3

comparison of bone density compared to young adults

Question 4

what is a Z-score?

Answer 4

comparison of bone density to age-matched adults

Question 5

Which score is used to diagnose osteoporosis?

Answer 5

T-score <= -2.5

Question 6

what is normal T-score?

Answer 6

-1 to +1

Question 7

what T-score range is considered osteopenia?

Answer 7

-1 to -2.5

Question 8

What population should you not use T-scores for?

Answer 8

never use in children

doesn’t apply to pre-menopausal women, or men <50y/o

Question 9

When should you use a Z-score?

Answer 9

• pre-menopausal women
• men <50y/o
• when evaluating for secondary causes of osteoporosis

Question 10

How much Calcium and Vitamin D should you get per day?

Answer 10

Ca2+ = 1200mg

Vit D= 1000 IU

Question 11

What are the screening guidelines for osteoporosis?

Answer 11

• women > 65y/o and men >70 y/o
• for postmenopausal women & men btwn 50-70y/o, testing is recommended based on risk factor profile
• those who have suffered a fracture

Question 12

what is the FRAX model?

Answer 12

risk-assessment model for osteoporosis developed by WHO that calculates the 10 yr probability of a hip fracture and any other major osteoporotic fx

Question 13

the FRAX model uses Bone marrow densit from which part of the body to assess risk for osteoporosis?

Answer 13

-femoral neck BMD

Question 14

what risk factors are included in the FRAX model?

Answer 14

current age
gender
personal hx of fracture
femoral neck BMD
low BMI
use of glucocorticoid tehrapy
secondary osteoporosis/ RA
parental history of hip fx
current smoking
alcohol intake of 3+ drinks/day

Question 15

what are the treatment guidelines for treating osteoporosis?

Answer 15

postmenopausal women & men >50y/o with a T-score of -1 to -2.5 AND 10yr hip fx prob >3% or 10yr major osteoporosis related fx prob >20% based on FRAX model

Question 16

how often is BMD testing recommended?

Answer 16

every 2 years for patients on pharmacotherapy

Question 17

what is the MOA of bisphosphonates?

Answer 17

inhibit resorption (but does not stimulate higher level of synthesis)

Question 18

what is the MOA for teriparatide-forteo?

Answer 18

is an anabolic drug that stimulates both building and resorption (but more so in favor of building) so net effect is that bone mass and strength increase

Question 19

which drug is a fully human monoclonal ab that inhibits bone resorption by neutralizing RANKL?

Answer 19

Denosumab

Question 20

What is the function of RANKL?

Answer 20

key mediator of osteoclast differentiation, activation, and survival

Question 21

what is the effect of PTH on bone?

Answer 21

continuous (high dose) PTH –> catabolic effect

daily (low dose) PTH –> anabolic effect

Question 22

what is osteonecrosis of the jaw?

Answer 22

presence of exposed bone in the maxillofacial region that does not heal within 8 weeks after identification

Question 23

osteonecrosis of the jaw is an AE of which therapeutic drug?

Answer 23

bisphosphonates