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Flashcards in Osteoporosis Deck (58):
1

What are the symptoms of uncomplicated osteoporosis?

none --> silent disease

2

Osteoporosis

silent systemic disease of bone --> low bone mass/density, microarchitectural disruption of bone quality --> increased risk of fx

3

Osteoporosis affects ____ # of americans

10 million

4

T/F osteoporosis prevalence decreases with age

F --> increases

5

T/F osteoporosis affects both sexes equally

F --> F>M

6

1 out of ____ women will experience an osteoporosis related fx

2

7

1 out of ____ men will experience an osteoporosis related fx

5

8

Which races have an especially higher risk of osteoporosis

asians and caucasians

9

T/F 2/3 of vertebral fx are symptomatic

F --> 2/3 are asymptomatic

10

____% of people do not regain pre- hip fracture level of independence

40%

11

T/F vertebral fx complications are worse than hip fx complications

F --> hip is worse: mortality is greatest during first year after hip fracture

12

Colles fracture

distal radius fx

13

T/F a greater proportion of women will die in the first year after hip fx than men

F --> 30% of men with hip fx and 17% of women will die in first year

14

T/F diagnosis of osteoporosis depends on both bone quality and bone density

F --> both are important pathophysiological factors but we only dx based on density

15

Low bone density pathophysiology

low peak bone mass: modeling
or
excess bone loss later in life: remodeling

16

Primary osteoporosis

no known cause in postmenopausal women and aging men

17

secondary osteoporosis

due to glucocorticoids or diseases like hypogonadism (low T/E)

18

Pathophysiology in both primary and secondary osteoporosis has to do wiwth more _____than _____

bone resorption than construction

19

Lifestyle factors that influence osteoporosis

low calcium intake, Vitamin D insufficiency, 3+ alcohol drinks/day, low BMI

20

T/F family hx increases hip fracture rixk

T

21

T/F idiopathic hypercalciuria can increase hip fracture risk

T

22

Endocrine disorders that increase osteoporosis

hypothalamic amenorrhea, thyrotoxicosis, hyperparathyroidism, cushing, androgen insensitivty, hyperprolactinemia, diabetes mellitus

23

GI disorders that increase osteoporosis

celiac disease, cystic fibrosis, short gut, ibd, etc.

24

Hematological disorders that can increase osteoporosis

multiple myeloma, hemophilia, thalassemia, etc.

25

T/F RA can increase risk of osteoporosis

T

26

Medications that can increase osteoporosis

Anticonvulsants, PPIs, aromatase inhibitors, glucocorticoids, depo, tzd, lithium, gnrh analogs, etc.

27

T score

# of SD below normal young adult control in bone mineral density --> used for diagnosis

28

Z score

# of SD below age-matched control subjects in bone mineral density

29

Which people can have a dx of osteoporosis?

postmenopausal women and men>50

30

T score cutoff

-2.5

31

DXA scan

dual energy xray absorptiometry of hip, femoral neck, and lumbar spine (+/- forearm)

32

T score >-1.0

normal

33

T score between -1.0 and -2.5

low bone mass: osteopenia

34

T/F patients who have had one or more osteoporosis fractures are deemed to have normal osteoporosis

F --> severe or established osteoporosis

35

T/F can dx osteoporosis without DXA

T --> if history of fragility low trauma fracture

36

Osteoporosis screening

no risk factors or hx: all women >65, men>70
clinical risk factor: younger post menopausal women and men 50-69

37

T/F Fracture risk doubles with every sd decrease in bmd

T

38

T/F most fx occur among those with osteopenia

T

39

Risk factors for bone quality

previous fx, age, family hx, low bmi, alcohol, glucocorticoids, current smoking

40

FRAX

fracture risk assessment tool

41

People to treat for osteoporosis

T score20% for all fx, >3% for hip)

42

Tx that stimulate osteoblast activity

teriparatide/rPTH

43

Non pharm tx of ostoeporosis

modify risk factors, supplements, exercise, fall prevention

44

Tx that inhibit osteoclast activity

biphosphonates, denosumab, calcitonin, SERM, estrogen

45

Osteoclast activity is increased by _____ ligand from the ____ cell

RANKL from preosteoblast

46

Osteoblasts secret ____ which blocks RANKL action on osteoclasts

OPG

47

Bisphosphonates MOA

first line tx (prevention and tx) --> antiresorptive by inhibiting osteoclasts and promoting their death

48

Adverse effects of bisophosphonates

GI, increase in creatinine, flue like illness, atypical fracture of femur, osteonecrosis of jaw

49

Denosumab MOA

monoclonal Ab that acts like OPG by inhibiting RANKL --> antiresoptive (not renally excreted)

50

Adverse effects of denosumab

hypocalcemia, infections, skin reactions

51

Teriparatide MOA

second line tx, anabolically increases osteoblast activity

52

Why is teriparatide followed by an osteoclast inhibitor

anabolic window: induces bone formation but also increases bone resorption --> but first two years have more bone production than resorption --> then have to prevent it from being broken down

53

Adverse effects of teriparatide

nausea, headache, leg cramps, hypercalcemia, osteosarcoma, avoid in paget's disease/high alk phos, hypercalcemia, h/o of skeltal malignancy radiation or mets

54

Calcitonin MOA

third line therapy --> inhibits osteoclasts, acute fx or pain setting

55

Adverse effects of calcitonin

nausea, vomiting, etc --> avoid if hypersensitive or hypocalcemic

56

SERM MOA

ER agonist on bone and antagonist on breast/uterus (raloxifene) -

57

adverse effects of raloxifene

headache, hot flushes, leg crams, thromboembolism

58

ERT MOA

decrease osteoclast activity --> increase breast cancer risk and thromboembolism