R/O - Metabolic bone disease

Question 1

definition: osteoporosis

Answer 1

bone deterioration with:

• reduced bone mass
• disruption of micro architecture of bone

Question 2

what is the T score cut off for osteoporosis?

Answer 2

-2.5 (-2.5 or less means osteoporosis diagnosis)

Question 3

what type of fracture has the highest mortality?

Answer 3

hip fracture

Question 4

what is the most common reason for nursing home admittance?

Answer 4

hip fractures

Question 5

what is the gold standard screening for diagnosing and monitoring osteoporosis?

Answer 5

DXA

Question 6

what is a Z score?

Answer 6

age matched control

Question 7

low bone density (osteopenia) is a T score in what range?

Answer 7

• 1.0 down to -2.5

Question 8

what is a normal T score?

Answer 8

-1.0 to 1.0

Question 9

anyone with a fragility fracture by definition has:

Answer 9

osteoporosis

Question 10

when should a T score be used?

Answer 10

• comparing BMD to a person of same age
• younger than peak bone mass
• pre-menopausal women
• men under 50 yo
• evaluating for secondary causes of osteoporosis

Question 11

recommend BMD testing in women over ____ and men over ____

Answer 11

• women: 65

- men: 75

Question 12

in postmenopausal women and men 50-70, recommend BMD testing when there is concern based on ______________________

Answer 12

risk factor profile

Question 13

the WHO FRAX algorithm was developed to calculate:

Answer 13

• 10 yr probability of a hip fracture

- 10 yr probability of any major osteoporotic fracture (defined as hip, forearm, humerus)

Question 14

consider initiating treatment in postmenopausal women and men over 50 with T score of ______ AND _________

Answer 14

• 1 to -2.5

- 10 yr hip fracture probability 3% or more

Question 15

how often is BMD testing recommended?

Answer 15

every 2 years

Question 16

what are limitations of FRAX?

Answer 16

• patients naive to treatment

- only uses T score from hip and does not accomodate peripheral sites or spine T score

Question 17

what are the anticatabolic drug therapies for osteoporosis?

Answer 17

• bisphosphonates
• SERM
• denosumab

Question 18

what is the anabolic drug therapy for osteoporosis?

Answer 18

teriparitide

Question 19

what is the MOA of bisphosphonates?

Answer 19

• bind to bone mineral
• concentrate at sites of bone resorption
• release and intracellular uptake during resorption
• loss of resorptive function

Question 20

bisphosphonate action depend on what two factors?

Answer 20

• mineral binding

- effects of osteoclasts

Question 21

what is the MOA of denosumab?

Answer 21

• binds RANK-L and inhibits osteoclast-mediated bone destruction
• osteoclast formation, function, and survival inhibited
• bone resorption inhibited

Question 22

what factors determine PTH effects on bone?

Answer 22

• administration

- dose

Question 23

high dose (continuous) PTH has what effect on bone?

Answer 23

catabolic

Question 24

low dose (daily) PTH has what effect on bone?

Answer 24

anabolic

Question 25

paget disease of bone is characterized by abnormalities of the ______________ (cell type) and there is _______________ (accelerated / decreased) bone turnover and abnormal bone remodeling

Answer 25

- osteoclast | - accelerated

Question 26

what is the inheritance of PDB?

Answer 26

AD

Question 27

what are the labs in PDB?

Answer 27

- increased alk phos (bone specific AP) - bone turnover markers increased - calcium and phosphate typically NORMAL

Question 28

what test should be done in patients with PDB?

Answer 28

baseline bone scan

Question 29

what do you monitor in PDB?

Answer 29

alk phos

Question 30

what is the medication of choice for PDB?

Answer 30

- bisphosphonates (zoledronic acid)

Question 31

definition: rickets

Answer 31

deficient mineralization at the growth plate, as well as architectural disruption of this structure

Question 32

definition: osteomalacia

Answer 32

impaired mineralization of the bone matrix

Question 33

rickets and osteomalacia occur together as long as:

Answer 33

growth plates are open (only osteomalacia occurs once the growth plates close)

Question 34

calcipenic rickets is usually caused by:

Answer 34

dietary deficiency of vitamin D and/or calcium (most common form)

Question 35

phosphopenic rickets in children and adolescents is almost always caused by:

Answer 35

- renal phosphate wasting (usually isolated) - generalized tubular disorder (e.g. Fanconi) - inadequate dietary phosphate / intestinal malabsorption (rare)

Question 36

- delayed closure of fontanelles - parietal and frontal bossing - enlargment of costochondral junction - widening of wrist - lateral bowing of femur and tibia

Answer 36

rickets

Question 37

- elevated alk phos - reduced serum calcium and phosphorus - low urinary calcium - low 25-OH vitamin D - elevated PTH

Answer 37

osteomalacia