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Flashcards in Rheum - Osteoporosis Deck (13):

Biphosphonates – names? mechanism of action? Adverse effect?

Alendronate, risedronate, ibandronate

Synthetic carbon phosphate compounds that bind to pyrophosphate and inhibit osteoclastic bone resorption

Severe esophagitis (caution in patients with gastric reflux)


Osteopenia definition?

T score between -1.0 and -2.5 standard deviations below the mean of young healthy adults

T score More than -2.5 standard deviations below the mean of young healthy adults


Risk factors for osteoporosis?

1. Low peak skeletal density
2. Increasing age
3. Loss of steroid hormone production (menopause or hypogonadism)
4. Smoking
5. Nutritional deficiencies


Most common cause of secondary osteoporosis?

Glucocorticoid excess (from treatment for diseases like rheumatoid arthritis)


Endocrine Pathologies that will lead to osteoporosis?

1. Gonadal deficiency (female athletes or anorexics)
2. Hyperprolactinemia
3. Hyperparathyroidism
4. Hyperthyroidism


Medications that accelerate bone loss?

Cyclosporine, antiepileptics, heparin, GnRH inhibitors


When are women recommended to undergo bone mineral density (BMD) testing?

1. All Women >65 years
2. women <65 years who have sustained a fracture


DEXA scan: Z score versus T score

Compares bone density to patient of the same age versus young healthy adult



Vitamin D or phosphate deficiency that results in an accumulation of unmineralized osteoid


Pagent disease?

Disorganize bone remodeling with high alk phos


Treatment of osteoporosis?

1. 1000 to 1200 mg of calcium daily
2. 400 to 800 IU of vitamin D
3. Biphosphonates
4. estrogen (depending)
5. Weight-bearing activity
6. Raloxifene - SERM that decreases breast cancer risk and LDL
7. Teriparatide - parathyroid analogue that stimulates bone matrix formation


Effect of biphosphonates on incidence of fractures?

Decreases incidence of hip fractures by 30 to 50%


Bisphosphonates are rarely associated with what complication?

Osteonecrosis of the jaw

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