Osteoporosis Day 1

Question 1

What is the big picture of osteoporosis?

Answer 1

Fragile bones break

Question 2

What are the 2 types of bones?

Answer 2

Trabecular and Corical

Question 3

What is trabecular bone?

Answer 3

forms the interior structures in honeycombed fashion. It has a large surface area. It is more metabolically active. It has close contact with marrow cells

Question 4

What is cortical?

Answer 4

dense bone that forms the outer shell of the skeleton. Ot is formed in layers and is highly calcified. It is metabollically protective

Question 5

What are the bone components?

Answer 5

collagen, minerals, bone cells

Question 6

What are the type of bone cells?

Answer 6

osteoblasts- bone formation
osteoclasts- breaks bone (respiration)
osteocytes- mature bone cells

Question 7

What is bone Remodeling?

Answer 7

bone mass develops rapidly during childhood and even more rapidly during adolecense. It is the balance of bone breakdown and buildup with a majority replaced every 7-10 years during peak growth

Question 8

When do you reach peak bone mass?

Answer 8

age 20

Question 9

What is calcium’s role in osteoporosis?

Answer 9

taken up by osteoblasts to build bone. It undergoes strict homeostatis.

Question 10

What does PTH do in osteoporosis?

Answer 10

increases blood calcium through reabsorption or distal renal tubular calcium reabsorption. It also stimulates calcitriol production andn RANKL release

Question 11

What is calcitonin’s role in osteoporosis?

Answer 11

Decreases blood calcium through stopping bone resorption and increasing bone formation. it inhibits RANKL release

Question 12

What is Vitamin D’s role in osteoporosis?

Answer 12

It is syntheized in the skin. It is also consumed in the diet. The active form is 1,25 dihydroxyl Vitamin D. Increases serum calcium and phosphorus. It binds to Vitamin D receptor on parathyroid gland and supresses PTH secretion and stimulates RANKL release

Question 13

What is estrogen’s role in osteroporosis?

Answer 13

Suppresses proliferation and differentiation of osteoclases. It increases osteoclast apoptosis but decreases RANKL produciton

Question 14

What is testosterone’s role in osteoporosis?

Answer 14

Suppresses proliferation and differentiation of osteoclases. It increases osteoclast apoptosis but decreases RANKL produciton. It also increases osteoblast proliferaiton and differentiation

Question 15

When you have low blood calcium what is secreted?

Answer 15

PTH

Question 16

When you have high blood calcium what is secreted?

Answer 16

calcitonin

Question 17

What is the process of bone loss?

Answer 17

corticol bone gradually decreases yearlt from peak bone mass. It is accelerated in menopause because of decrease in estrediol

Question 18

What are the reasons for primary osteoporosis?

Answer 18

postmenopausal and age related

Question 19

when and where in postmenopausal women have osteoporosis?

Answer 19

3-4 years after and in vertebral and distal radial fractures

Question 20

Whar are the factors with age related osteoporosis?

Answer 20

femals >males
corticol and trabecular bone loss proportional
hips, vertebral and wrist seen

Question 21

What aer the causes of secondary osteoporosis?

Answer 21

due to various meds or presence of particular states

can occur ar any age and equal in males and females

Question 22

What medical conditions cause secondary osteoporosis?

Answer 22

endocrine
gastrointestinal 
inflammatory disease
chronic disease
immobility 
genetic

Question 23

What medications cause secondary osteoporosis?

Answer 23

anticonvolsants
glucocorticosteroids
Thiazolidinediones
excess thyroid hormones
excess Vitamin A

Question 24

What causes Childhood Osteoporosis?

Answer 24

geneftic defects- cystic fibrosis
endocrine disorders- growth hormone deficiency
nutritional disease- celiac disease
malignancies- leukemia
chonic disease- juvinille RA
conditions associated with disuse- paralysis, muscular dystrophy

Question 25

What causes pre-menoposal osteoporosis?

Answer 25

relationship between low BMD and fracture risk not well established most have identifiable secondary causes some hace low BMD as a normal varation of BMD routine bone marrow testing is not cost effective

Question 26

What happens in glucorticoid induced osteoporosis?

Answer 26

most common cause of secondary third most common overall most that take glucocorticoids chonicly will get they decrease bone formation through enhanced apoptosis of osteoblasrs, decreasing calcium absorption and increasing urinary calcium excretion

Question 27

What are the 3 components of WHO classification

Answer 27

BMD T score Z score

Question 28

What is BMD?

Answer 28

grams of bone mineral per square centimeter of bone cross section

Question 29

What is T score?

Answer 29

compared to mean BMD of sex matched young adults at there peak bone mass

Question 30

What is Z score?

Answer 30

compares amount of bone loss with the expected loss for individuals of the same age and sex

Question 31

What are the 3 things that you need to look for in the assessment of OP?

Answer 31

risk factors look for secondary causes DXA

Question 32

What is DXA?

Answer 32

dual energy x ray absorptiometry should not be given more than every 2 years unless caused by steroids screening starts at age 65 for women and 70 for men if thery are at high risk

Question 33

What are the modifiable risk factors in OP?

Answer 33

``` tabacco use low calcium intake low Vit D or sun exposure sedentary life style low body wt stress excessive alcohol high caffinee intake ```

Question 34

What are the non modifiable risk factors in OP?

Answer 34

``` advanced age female caucasian or asian FH of it personal history of fragility fracture lactose intolerence post menopausal premature menopause ```

Question 35

What are the risk factors for fractures?

Answer 35

``` low BMD prior fragility facture FH recent fall cognitive or visual impairment ```

Question 36

What can the use of tobacco cause?

Answer 36

``` early menopause decreasef body wt enhanced estrogen metabolism increased PTH concentration decreased Vitamin D concentration ```

Question 37

Where do the majority of wrist and hip fractures occur form?

Answer 37

falls

Question 38

What does FRAX help predict?

Answer 38

fracture risk in pts who do not have access to DXA.It gives clinical guidence for treatment decisions. It predicts risk in 10 years. It can be done with or without BMD