Osteoporosis

Question 1

contributors to osteo

Answer 1

hypogonadism
early menopause
hyperthyroidism
primary hyperparathyroidism

Question 2

drugs that may contribute to osteo

Answer 2

prednisone
glucocorticoids
phenytoin 
aromatse inhibitors 
PPI 
androgen deprivation therapy

Question 3

mechanism of glucocorticoid induced osteo

Answer 3

decreased bone formation , bone mass
increased bone resorption
2x more likely to get a fracture

Question 4

who is a BMD test indicated in on glucocorticoids

Answer 4

5-7.5mg prednisone equivalents for >3months

Question 5

what is the single strongest risk factor for fractures

Answer 5

falls —— should focus on prevention

Question 6

risk factors for falls

Answer 6

incontinence - get up at night
ice, dark 
loose carpet
hypotension dizzy 
alzeihmers meds, sedative, opioids
parkinsons, weak 
poor sight 
previous falls
advanced age
fear of falling
psychotropic meds
diabetes, arthritis, stroke, incontinence, dementia 
gait and balance problems

Question 7

whats a fragility fracture

Answer 7

fracture occurring spontaneously or following minor trauma such as a fall from standing height or less

Question 8

does low BMD diagnose OP

Answer 8

technically yes but just one of severeal risk factors for fractures

Question 9

what kind of exercise is recommended

does it decrease fractures

Answer 9

weight bearing and stability
aerobics, strength training, walking , tai chi
decreases falls and increase BMD but no decrease in fractures

Question 10

primary goal of therapy

Answer 10

decrease future risk of fracture

Question 11

whats clinical vertebral

Answer 11

brings a person in to say that theyre back hurts

in just vertebral the spinal fracture isnt identified

Question 12

whats a major osteoporotic fracture

Answer 12

proximal humerus
wrist
hip
clniical vertebral

Question 13

what is the benefit if vit d and calcium

Answer 13

minor decrease in fractures except for clinical vertebral

Question 14

what doses of vit d

Answer 14

600-800 IU

Question 15

dose of calcium

Answer 15

1200mg/day from ALL sources diet and supplement

Question 16

any harms of supplementation

Answer 16

not for vit D unless above 400iu/day

calcium - nausea, constipation, hypercalcemia, renal calculi, CV diseas?

Question 17

how much calcium in 250ml of milk, serving of yogurt, chunk of chees

Answer 17

300mg

Question 18

do we generally get lots of vitd naturally

Answer 18

no just supplement

Question 19

what does the BMD t score represent

Answer 19

number of standard deviations above or below the mean for a healthy 30 year old adult of same sex and ethnicity

Question 20

what does treatment depend on

Answer 20

patients risk of fracture 
efficacy 
patients goals
desire for specific harm avoidance
cormorbidities 
feasibility

Question 21

do we use teriparatide

Answer 21

no expensive and useless

Question 22

relative risk reduction of bisphosphonates

Answer 22

30-50%

Question 23

what do you do for someone with a low fracture risk of <10% 10 year fracture risk

Answer 23

unlikely to benefit from pharmacotherpay

reassess in 5years

Question 24

what do you do for someone with 10 year fracture risk 10-20%

Answer 24

offer medication
inform patient of the benefit and risks
and then make a decision to initiate therapy or reassess in a year

Question 25

what do you do with someone with a >20% 10 year fracture risk or prior fracture of hip or spine

Answer 25

pharmacology therapy should be offered

not the best evidence for this

Question 26

how should bisphosphonates be taken

Answer 26

once a week 
on empty stomach in morning 
with water 
while upright for 30 min 
30 min before taking other meds 
expect to take for 5 years

Question 27

side effects of bisphosphonates

Answer 27

abdominal problems
osteonecrosis of the jaw
bone breaks in femur
esophageal or gastric ulceration or erosion

Question 28

denosumab adverse events

Answer 28

rash
musculoskeletal pain
decreased calcium
infection

Question 29

what is osteonecrosis of the jaw and who is at risk

Answer 29

area of exposed alveolar bone that doesnt heal after 8 weeks

smokers, dental procedures, bad teeth, diabetes, chemo, radiation, glucocorticoids

Question 30

when do they recommend to repeat BMD

Answer 30

1-3 year

but no evidence and consumes health care resources

Question 31

when should you reassess BMD for patients on bisposphonates

Answer 31

5 years

Question 32

do you stay on bisphosphonates for ever

Answer 32

takes at least 3 years to see optimal benefit then in 5 years have a conversation with the patientabout stopping

Question 33

what was the difference between stopping bisphosphonate at 5 or 10 years

Answer 33

no different in non-vertebral
about 3% increase in vertebral
BMD remained still above levels before treatment although decreased a little bit

Question 34

no studies done in patients over 80, which people over 80 would we consider a bisphosphonate

Answer 34

decrease vertebral fractures in women >80 who had a previous vertebral fracture and we think will survive the 1-3 years necesssary to see an effect

Question 35

ARR of fractures that will result in pain for women >80 with previous fractures on bisphosphonate

Answer 35

2-2.5%

Question 36

what should we do for patients >80 in deciding on medication

Answer 36

educate on what exactly the treatment provides and does not instead of saying it is strongly recommended