Osteoporosis Patho

Question 1

Which calcium salt is acid dependent?

Answer 1

Calcium carbonate

Question 2

Which calcium salt is acid INDEPENDENT

Answer 2

Calcium citrate

Question 3

At what amount is calcium best absorbed?

Answer 3

500-600 mg or less

Question 4

What are some ADR of calcium supplementation?

Answer 4

-gas
-bloating
-constipation

Question 5

Which drugs interact with calcium?

Answer 5

-FQs
-tetracyclines
-bisphosphonates
-levothyroxine

Question 6

What is the recommended vitamin D intake for adults >50?

Answer 6

1000 IU/day

Question 7

What is the optimal level for Vitamin D?

Answer 7

25 (OH) Vit D ≥ 30 ng/ml

Question 8

What level of vit D is considered deficient?

Answer 8

<20 ng/ml

Question 9

What is the treatment for vit D deficiency?

Answer 9

-5,000 IU QD x 8-12 weeks, then 1000-2000 IU QD
OR
-50,000 IU QW x 8-12 weeks, then 1000-2000 IU QD

Question 10

What is the safe upper limit of vit D for the general adult population?

Answer 10

4000 IU/day

Question 11

What are the two main components of bone?

Answer 11

1. collagen
2. mineral

Question 12

What is the role of collagen?

Answer 12

provides flexibility, absorbs energy

Question 13

What part of the bone is the cortical bone?

Answer 13

-long bones
-outside shell

Question 14

What is trabecular bone?

Answer 14

-inside bone
-in vertebrae and ends of long bones

Question 15

When is peak bone mass achieved?

Answer 15

18-25 years old

Question 16

What is RANKL?

Answer 16

-regulates osteoclast differentiation, activation, and function
-binds to RANK on osteoclast precursor cells to initiate differentiation into osteoclasts

Question 17

What is osteoprotegerin?

Answer 17

-protein produced by osteoblasts/osteocytes
-natural inhibitors of RANKL
-prevents osteoclast activation

Question 18

Which factors favor osteoclast activity?

Answer 18

RANKL stimulation:
-inflammatory cytokines
-prolongs high levels of PTH
-Sclerostin
-Glucocorticoids

Question 19

Which factors favor osteoblast activity?

Answer 19

-RANKL inhibition: estrogen and calcitonin
-Osteoprotegerin
-Vitamin D

Question 20

What defines a fracture as an osteoporotic fracture?

Answer 20

fracture from a fall from a height of less

Question 21

Which type of fractures are more common in post-menopausal osteoporosis?

Answer 21

compression fractures of vertebrae

Question 22

What are the clinical presentations of osteoporosis?

Answer 22

-lordosis/kyphosis
-fractures
-pain
-anxiety
-depression

Question 23

Which drug therapies inhibit bone resorption?

Answer 23

-bisphosphonates
-estrogen
-RANKLi
-calcitonin
-Sclerostin MoAb

Question 24

Which drug therapies increase bone formation?

Answer 24

-PTH analogue
-Sclerostin

Question 25

What are risk factors for osteoporosis included in FRAX (WHO Fracture risk assessment)?

Answer 25

-low BMD -female -race/ethnicity -advanged age -smoking -high alcohol intake

Question 26

Which medical conditions are included in FRAX (WHO Fracture Risk Assessment)?

Answer 26

RA

Question 27

Which medications are associated with osteoporosis?

Answer 27

-glucocorticoids -antiseizure meds -aromatase inhibitors -heparin (UF>LMWH) -depot medroxyprogesterone -PPIs -TZD, SGLT2i