Osteoporosis Flashcards Preview

FAMILY MEDICINE > Osteoporosis > Flashcards

Flashcards in Osteoporosis Deck (26):
1

Z-score vs T-score

Z score - BMD compared to average healthy individual of SAME AGE
T score - BMD compared mean to 'young normal' adult"

2

Osteoporosis

2.5 standard deviations below T score for 'young normal' adult

T score

3

Osteopenia

Between -1 and -2.5 below T score

4

At 50 what does the NOF recommend for all men and women?

Start counseling on risk of fractures, checked for possible secondary causes of osteoporosis, have adequate calcium and vitd, perform regular weight bearing exercises

5

According to USPSTF, when to start screening?

all women aged greater than or equal to 65 and those less than 65 years with risk factors that are equal to or greater than the risk of a healthy 65 year old Caucasian woman should be screened for osteoporosis

cannot have had previous known fractures or secondary causes of osteoporosis

6

What about men?

Insufficient evidence to assess balance of benefits and harms of screening in men

7

Preferred screening modality

DEXA scan of femoral neck and lumbar spine

8

Secondary causes of osteoporosis

hyperthyroidism, primary hyperparathyroidism, vitD deficiency, amenorrheic conditions, chronic corticosteroid use

9

What substances can increase risk for osteoporosis?

alcohol and tobacco use

10

Standard lab workup in patient with osteoporosis

CBC, kidny and liver function tests, serum calcium, TSH, and 25-hydroxy vitD levels

consider estrogen/testosterone levels in hypogonadism

11

Criteria for treatment?

postmenopausal women and men aged 50 and older with...

-hip or vertebral fracture
- T score less than or equal to -2.5 after excluding secondary causes
-T score -1 to -2.5 if high risk for fracture (FRAX algorithm)

but also consider patient preference

12

What is a universal recomendation for postmenopausal women and patients with osteoporosis

calcium and vit D supplements

13

Treatment goal of 25-hydroxy vit D

serum level of greater than 30 ng/mL

14

First line treatment agents for osteoporosis

oral bisphosphonates (alendronate, riserdronate, ibandronate)

DRONATES

15

Special instructions for taking oral bisphosphonates

taken on empty stomach with full glass of water, must stay in uprightstanding for at least 30 minutes after dosing to avoid esophagitis

16

What to consider for prevention of osteoporosis in woen with significant menopausal vasomotor symptoms?

Estrogen replacement....but controversial due to risk of thrombosis and breast cancer

17

How to use estrogen replacement

lowest effective dose for shortest possible time

18

How to limit risk of endometrial cancer with estrogen replacement

If patient hasn't had hysterectomy, give progesterone to protect against endometrial cancer

19

FDA approved selective estrogen receptor modulator (SERM) for prevention and treatment of osteoporosis

raloxifene

20

Raloxifene side effects

=reduce risk of breast cancer
- increases vasomotor symptoms
- increases risk of DVT

21

Who should take raloxifene

postmenopausal women who do not tolerate bisphosphonates, hwo do not have vasomotor sypmtoms, and who have a high risk of developing breast cancer

22

Second line agent, nasal spray, can help prevent vertebral compression fractures

calcitonin

23

Teriparatide

recombinant human PTH that causes bone density growth by stimulating osteoblasts (DO NOT USE in patient risk for osteosarcoma like Paget's disease)

reserve if cannot tolerate bisphosphonates and if osteo is severe

24

Monoclonal antibody that prevents osteoclast differentiation and limits bone turnover

denosumab;

25

How to track treatment

BMD testing every two years

26

T/F: Inhaled corticosteroids represent significantly more risk for fracture than oral

FALSE...INHALED CORTICOSTEROIDS AREN'T A RISK FACTOR