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Endocrinology > Osteoporosis > Flashcards

Flashcards in Osteoporosis Deck (33):
1

What are two cardinal changes of osteoporosis?

Low BMD

Micro-architectural disruption-- "bone quality"

2

What are the rates of osteoporosis in women? In men?

Are certain racial groups more susceptible?

1 in 2 women
1 in 5 men

More common in caucasian/asian ancestry

3

Which fractures are most common? How do they present?

Vertebral fractures-- 2/3 are asymptomatic

Chronic pain, deformity and increase in morbidity and mortality can result

4

Which fracture is most concerning? What are mortality rates during first year?

Hip fractures are most serious

Mortality rates during first year:
30% in men
17% in women

5

What are the two main causes of low bone density?

Low peak bone mass "Modeling"
Excess bone loss later in life "remodeling" (i.e due to loss of estrogen in postmenopausal women)

6

What are primary causes of osteoporosis? Secondary causes? (list)

No known cause in postmenopausal women/aging men

Secondary osteoporosis causes include glucocorticoids or genetic diseases, lifestyle factors, endocrine disorders, GI disorders, hematological disorders, other medications, rheumatological disorders

7

Diagnosis of osteoporosis: DXA scan

What sites are used? What measurements are used, and for which populations?

Total hip, femoral neck, lumbar spine, forearm (if hyperparathyroidism, hip replacement pts)

T-score used for diagnosis-- compares to normal young adult control
Z-score used to predict propensity for developing osteoporsis--compares to age/race/gender-matched controls.

8

What are parameters for normal, low bone mass and osteoporosis on DXA scan?

Normal: T>-1
Low bone mass (osteopenia): T between -1 and -2.5
Osteoporosis: T

9

What is severe/established osteoporosis?

Patients with T

10

Interpretation of T-score in DXA scan-- which areas do you use? Which value do you use-- total or lowest observed?

Femoral neck and lumbar spine

Use lowest observed T-score

11

Who should be screened for osteoporosis?
Difference for clinical risk factors?

No clinical risk factor: Women>65, men>70

Risk factors: Younger postmenopausal women, men between 50 and 69

12

A decrease in one SD in BMD is associated with what increase in fracture risk?

The fracture risk doubles with every SD decrease in BMD

13

What are risk factors for osteoporosis that are considered in fracture risk assessment tool (FRAX)? (8)

Age, low BMI, previous facture, family history of hip fracture, current smoking, alcohol, glucocorticoids, secondary cause of osteoporosis (i.e RA)

14

What probabilities does FRAX give? Which values are high enough to warrant treatment?

FRAX measures risk for osteoporotic fracture and for hip fracture

Treat puts with
>20% for all osteoporotic fracture
>3% for hip fracture

15

In general what is criteria for treatment?

Postmenopausal women, men>50
T-score 20% osteoporotic fracture, >3% hip fracture

16

What is the mnemonic for non-pharmacological osteoporosis treatment?

CDEFGs
Calcium, vitamin D, exercise, prevent falls, good nutrition, smoking cessation

17

What pharmacological treatments are available for osteoporosis?

BCDE & T
Bisphosphonates, calcitonin, denosumab, estrogen/SERM

Teriparatide (rPTH)

18

How do BCDE pharmacological treatments for osteoporosis work?
AKA what is its MOA

Prevent RANKL binding to RANK.
This prevents differentiation to osteoclasts-- no bone resorption

19

What is first line therapy for osteoporosis?

Bisphosphonates

20

What is effect of bisphophonates on osteoclasts?

Inhibits osteoclast activity
Promotes osteoclast death

21

What are the AE for bisphosphonat?
Short term (3)
Long-term (2)

Short term: GI (difficulty swallowing, inflammation of esophagus, gastric ulcers), increase in creatinine, flu-like illness

Long term: Atypical femur fracture, osteonecrosis of jaw

22

What is denosumab? What is its MOA

A human monoclonal antibody that inhibits RANKL (like OPG)

23

Why is denosumab good for patients with renal problems?

It is NOT renally excreted

24

What are AE of denosumab? (3)

Hypocalcemia, infections, skin rxns

25

When do you prescribe tripartite/forteo?

Moderate-severe osteoporosis as a second line therapy

26

What is MOA of teriparatide?

Increase osteoblast activity

27

What is problem with teriparatide? How do you fix this?

Also stimulates RANKL-->Increased osteoclast differentiation and increased bone resorption

Also prescribe denosumab or bisphosphonates

28

What are AE for teriparatide? (

Nausea, headaches, leg cramps, hypercalcemia, orthostatic hypotension, palpitations
Osteosarcoma
CI: paget's disease, hypercalcemia, history of osteosarcoma

29

What is calcitonin? What is MOA?

Third line therapy for osteoporosis
Works by inhibiting osteoclast activity

30

What are AE for calcitonin? (5)

What are CI? (2)

Nausea, vomiting, injection site rxn, flushing, rhinitis

CI: hypertensive or hypocalcemic

31

Why use estrogen or raloxifen?

Prevention/treatment of osteoporosis

32

What are AE of estrogen/raloxifen? (5)

Headache, hot flashes, flushing, leg cramps, VTE

33

What are CI for estrogen/raloxifen? (2)

history of VTE, women of childbearing age