Osteoporosis

Question 1

Skeletal disease defined by compromised bone strength, increased risk of fracture

Answer 1

Osteoporosis

Question 2

Increased bone resorption and decreased bone formation causes

Answer 2

Osteoporosis

Question 3

These are the four phases of bone activity

Answer 3

Quiescent phase
Resorption phase
Formation phase
Quiescent phase after remodeling

Question 4

Measures areal bone mineral density in gm/cm2, compares patient’s BMD to normative data

Answer 4

Duel-energy X-ray absorptiometry (DXA)

Question 5

BMD score 0 to -1

Answer 5

normal

Question 6

SERM medication, binds estrogen receptor

Answer 6

Raloxifene

Question 7

Alendronate
Risendronate
Ibandronate
Zoledronic Acid

Answer 7

Bisphosphonates

Question 8

BMD score of -2.5

Answer 8

osteoporosis

Question 9

Hormones for osteoporosis

Answer 9

Calcitonin, Estrogen

Question 10

Standard deviation difference between patient’s BMD and mean BMD of age-matched reference population

Answer 10

Z-score

Question 11

Agonist, antagonist properties depending on target organ

Answer 11

Raloxifene

Question 12

BMD score -1 to -2.5

Answer 12

low bone density for age (“osteopenia”)

Question 13

Associated with estrogen use

Answer 13

breast cancer, cardiovascular

Question 14

Raloxifene is an estrogen ______ in bone

Answer 14

agonist

• -> inhibits osteoclasts
• -> improves BMD
• -> decreases fracture risk

Question 15

May be used for Paget’s disease of the bone

Answer 15

Calcitonin

Question 16

Standard deviation difference between patient’s BMD and mean BMD of young adult

Answer 16

T-score

Question 17

Anabolic osteoporosis medication

Answer 17

teriparatide

Question 18

Raloxifene is an estrogen ________ in breast tissue

Answer 18

antagonist

–> reduces risk of breast cancer

Question 19

disrupts protein prenylation –> cytoskeletal abnormalities in osteoclast –> detachment from bone –> reduced bone resorption

Answer 19

Bisphosphonates

Question 20

Induces differentiation and maturation of osteoblast precursors, increases preexisting osteoblast function, reduces osteoblast apoptosis: increases BMD and decreases fractures

Answer 20

teriparatide

Question 21

Risk factors for fracture

Answer 21

Prior fragility fracture,
parental history of hip fracture, glucocorticoid therapy, excess OH intake (>3/day), rheumatoid arthritis, cigarette smoking

Question 22

Menopause, Advanced Age, Familial predisposition

Answer 22

Primary causes of bone loss

Question 23

Side effects of Raloxifene

Answer 23

DVT, hot flashes

Question 24

Possible secondary causes of bone loss:

Answer 24

Medications (excess glucocorticoids)
Renal disease
Vitamin D, calcium deficiency
Hyperparathyroidism
Idiopathic hypercalciuria (renal wasting)
Hyperthyroidism
Premature menopause/hypogonadism
Multiple myeloma
Cushing's syndrome
Malabsorption (IBD, celiac) or malnutrition (anorexia)
Smoking/excess OH
Inflammatory diseases (RA)

Question 25

Impair osteoclast function, decrease differentiation, increase apoptosis --> increase BMD, decrease fracture

Answer 25

Bisphosphonates

Question 26

Non-pharm treatment for osteoporosis

Answer 26

Used for all patients Calcium (12-1500/day) Vitamin D (800/day)

Question 27

Action of bisphosphonates

Answer 27

Inhibit farnesyl pyrophosphate synthase enzyme in mevalonate pathway (cholesterol biosynthetic pathway)

Question 28

Who to treat for osteoporosis

Answer 28

T score less than -2.5 Low trauma fracture T score of -1 to -2.5 if other risk

Question 29

Side effects include: esophagitis, flu-like symptoms, bone/muscle pain, hypocalcemia, atypical subtrochanteric fractures, osteonecrosis

Answer 29

Bisphosphonates

Question 30

Biologic receptor activator of nuclear factor kappa-B ligand

Answer 30

Denosumab

Question 31

Increases BMD, decreases fractures

Answer 31

Denosumab

Question 32

Side effects include hypocalcemia, infections, concerns about neoplastic effects/subtrochanteric fractures/ONJ

Answer 32

Denosumab

Question 33

Use this for post-menopausal women, men over 50

Answer 33

T-score (compare to young population)

Question 34

Used for children, premenopausal women, men under 50

Answer 34

Z-score (compare to peers)

Question 35

Antiresorptive drugs

Answer 35

SERMs, Bisphosphonates, Biologic, Hormones

Question 36

Antiresorptives work by

Answer 36

Inhibiting osteoclasts, reestablish balance between osteoclasts/osteoblasts, stop bone loss (do not gain bone density)

Question 37

Neutral effect on cardiovascular system, endometrium

Answer 37

Raloxifene

Question 38

Avoid these if patient has upper GI disease, Barret's esophagus

Answer 38

Bisphosphonate oral drugs

Question 39

May have some effect on acute pain control

Answer 39

Calcitonin

Question 40

Where is the DXA scan measuring bone density?

Answer 40

hip, lumbar spine