Term
| Osteoporosis is a metabolic bone disease with __ __ __ and ___ __ of bone tissue, leading to enhanced bone __ and increased __ ___. |
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Definition
- low bone mass
- microarchitectural deterioration
- fragility
- fracture risk |
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Term
| Primpary osteoporosis is bone mass loss that is NOT associated with any other __. It is merely related to __ and loss of __ __ in women and the __ __ in men. |
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Definition
- NOT associated with any other illness
- aging and loss of gonadal function in women
- aging in men |
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Term
| Secondary osteoporosis is the result of various __ __ that significantly contribute to bone mineral loss. Secondary osteopororis may also be due __ or ___ ___. |
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Definition
- chronic conditions
- medical or nutritional deficiencies |
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Term
| According to WHO criteria, osteoporosis is a T-score less than ___. |
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Definition
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Term
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Definition
| T score < -2.5 + a fracture |
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Term
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Definition
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Term
| For diagnosis of osteopenia, the T-score is between __ and __. |
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Definition
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Term
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Definition
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Term
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Definition
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Term
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Definition
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Term
| __ standard deviation below normal T score leads to increase in spinal fractures by 2.-2.4 times normal. |
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Definition
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Term
| With osteopororis the bone matrix is ___. With osteopenia the bone matrix is __. With both conditions the bone density is ___. |
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Definition
- decreased
- intact
- decreased |
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Term
| 3 most common osteoporotic fractures: |
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Definition
hip, wrist, vertebrae
With osteoporosis, its not really about falling and breaking. Its breaking then falling. |
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Term
| 1 in 2 Caucasian women and 1 in 4-5 men, will have an osteoporosis-related fracture in his/her lifetime. |
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Definition
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Term
| The annual incidence of osteoporosis-related fractures in women is greater than the incidence of MI, CVA, and breast cancer combined. |
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Definition
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Term
Hip Fracture: Facts About Risk
The lifetime risk of hip fracture for a 50-year-old white woman in the United States is 18%. Many factors, skeletal and extraskeletal, increase hip fracture risk.1
Prior hip fracture increases the likelihood of the occurrence of a second hip fracture.2 |
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Definition
| THE POINT WHERE IT BREAKS ACTUALLY BECOMES STRONGER AFTER HEALING, BUT STILL INCREASED RISK OF BREAKING HIP AGAIN, THE SECOND TIME IT WILL BREAK AROUND THE AREAS OF THE FIRST BREAK BUT NOT AT SAME SPOT |
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Term
| In the US, __% of postmenopausal women have osteoporosis. |
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Definition
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Term
| Osteoporosis usually asymptomatic. May have ___ and height loss due to __ __. |
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Definition
- backache
- wedge factors> kyphosis |
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Term
| With osteoporosis, labs will show ___ calcium, phosphorous, and PTH. ___ ___ will be normal or slightly elevated. ____ is commonly decreased. |
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Definition
- normal calcium, phosphate, and PTH
- alkaline phosphatase
- 25-hydroxyvitamin D commonly decreased |
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Term
| 25-hydroxyvitamin D less than __ng/mL= frank Vitamin D deficiency. __ to __ng/mL increases risk hip fracture. |
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Definition
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Term
| With primary osteoporosis, __, __, and __ are normal. If these are not __, its probably secondary osteoporosis, and there is something else you can treat. |
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Definition
- calcium, phosphorous, and vitamin D
- normal |
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Term
| Bone densitometry aka __ __ determines bone density of the __ __ and ___. |
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Definition
- DEXA scan
- lumbar spine and hip |
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Term
| DXA scan results are reported as __ __ based on the __ __ from a normal young adult. |
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Definition
- T-scores
- standard deviation |
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Term
T-score is about __ ___ from __ __ adult.
Z-scores are about risk associated with specific __ __. |
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Definition
- standard deviations from normal young adult
- age group |
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Term
| Normal T-score, but abnormal Z-score means you have an __ risk for osteoporosis. |
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Definition
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Term
| YOU CAN USE THIS TEST ON AN ANNUAL BASIS TO DETERMINE IF TMT IS SUFFICIENT OR IF NEED TO ADD SOMETHING ELSE. |
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Definition
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Term
| 3 scenarios when a DEXA scan should be ordered: |
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Definition
- all patients at risk for osteoporosis
- all patients with a pathological fracture (non-traumatic)
- patients with radiological evidence of diminished bone density |
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Term
| 2 main causes of pathological fractures: |
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Definition
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Term
| Risk factors for osteoporosis that cannot be changed: |
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Definition
- female
- advancing age (50+)
- Caucasian/Asian
- Late menarche
- Early menopause |
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Term
| Modifiable risk factors for osteoporosis: |
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Definition
- diet: calcium and vitamin D
- exercise: weight bearing (walking)
- smoking
- excessive alcohol
- estrogen deficiency
- Medications: GnRH analoges, anti-convulsants, too much thyroid hormone |
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Term
| Women can lose __ of their bone mass in the first 5 years after menopause. |
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Definition
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Term
| Causes of secondary osteoporosis: |
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Definition
- genetic
- hypogonadal
- endocrine
- gastrointestinal
- hematologic
- rheumatic disease
- nutritional
- chronic systemic disease
- iatrogenic |
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Term
| specific causes of secondary osteoporosis: |
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Definition
- Low estrogen states
- Glucocorticoids
- Thyroid hormone excess
- Anticonvulsants
- Heavy alcohol use |
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Term
| Causes of Secondary osteoporosis in men: |
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Definition
- Hypogonadism (maybe had testicular cancer)
- Glucocorticoids
- Alcohol |
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Term
| Osteoporosis associated disease states: |
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Definition
Anorexia nervosa
Chronic liver disease
Chronic renal insufficiency
Cushing’s syndrome
Ehlers-Danlos syndrome
Gastric Bypass Surgery
Hemochromatosis
Homocystinuria
Hypercalcuria
Hyperparathyroidism
Hyperthyroidism
Inflammatory bowel dz.
Marfan syndrome
Mastocytosis
Multiple myeloma
Renal tubular acidosis |
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Term
| Medications that can cause osteoporosis: |
|
Definition
- STEROIDS: Prednisone (>5mg/d for >3months)
- Pheonothiazines
- Phenytoin
- Heparin: long term
- Aromatase inhibitors
- Antiretrovirals
- Chemo drugs: Cyclosporine, Platinum, Methotrexate
- Cyclosporine
- GnRH agonists
- Lithium |
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Term
| 25% of osteoporosis cases are caused by __. |
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Definition
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Term
| With 6 months of glucocorticoid use, bone mineral density decreases by up to __. |
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Definition
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Term
| With corticosteroid doses of 7.5mg/day, there is __% increase in fractures. What is the safe dose. |
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Definition
400% increase in fractures
NO SAFE DOSE |
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Term
10 million Americans have Osteoporosis
Another 34 million have Osteopenia.
1.5 – 2 million osteoporotic fractures occur in the US every year.
40% lifetime fracture rate for women 50 and older with osteoporosis
Wrist – 50’s , Vertebral – 70’s, Hip – 80’s |
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Definition
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Term
| Secondary osteoporosis laboratory testing: |
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Definition
- CBC
- CMP
- TSH
- ESR or CRP
- 24 hr. urine calcium
- PTH
- SPEP/UPEP
- Testosterone
- 25-OH Vitamin D |
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Term
| Most important determinant of long term skeletal bone health: |
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Definition
| bone mass attained early in life |
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Term
| From ages 1-3 y/o, you need __ mg calcium/day. From ages 4-8 you need __mg calcium/day. From ages 9-18, you need __mg calcium/day. |
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Definition
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Term
| 1 glass of milk is __ mg calcium. |
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Definition
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Term
| what % of children meet dietary recommendations for calcium? |
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Definition
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Term
| For adults under the age of 50, you need __ mg calcium/day. Adults over the age of 50 need ___ mg calcium/day. |
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Definition
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Term
| For adults under the age of 50, __ IU of Vitamin D are needed per day. For adults over the age of 50 ,___ IU of Vitamin D are needed per day. |
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Definition
- 400-800 IU/day
- 800-1000 IU/day |
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Term
| FRAX is an online fracture risk calculator created by WHO. It gives a __ __ __of __ fracture and of __ __ __. Treatment recommended for __ patients with a 10-year hip fracture risk of __ or more or major osteoporotic fracture risk of __ or more. |
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Definition
- 10 year probability of hip fracture
- major osteoporotic fracture
- osteopenic patients
- 3% or more
- 20% or more |
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Term
|
Definition
Osteoporosis
Osteopenia with
-history of fracture
-secondary causes that increase risk
-10 year probability of hip fracture 3+% or
10 year probability of major osteoporotic
fracture 20+% based on FRAX |
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Term
| Surgery (vetebroplasty or kyphoplasty) is for __. |
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Definition
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Term
| Drugs for management of Osteoporosis: |
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Definition
- calcium
- vitamin D
- bisphosphonates
- HRT
- Raloxifene
- Calcitonin
- N 1-34 PTH (Teriparatide, Forteo) |
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Term
| What drugs can be given for prevention? |
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Definition
- Raloxifene (Evista)
- Alendronate (Fosamax)
- Risendronate (Actonel)
- Ibandronate (Evista)
(all except calcitonin and PTH) |
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Term
| 2 main drug treatments for men with osteoporosis: |
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Definition
Alendronate (Fosamax)
Risedronate (Actonel) |
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Term
| 2 drugs that can be given with glucocorticoids for prevention: |
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Definition
- Alendronate (Fosamax)
- Risendronate (Actonel) |
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Term
| Name the 4 bisphosphonates: |
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Definition
- Risendronate (Actonel): daily, weekly every 2 weeks, or monthly
- Ibandronate (Boniva): daily or monthly
- Alendronate (Fosamax): weekly
- Zolendronic (Reclast): 5mg IV annually |
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Term
| What do we know about long term use of bisphosphonates in osteoporosis? figure this out |
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Definition
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Term
| Bisphosphonates side effects: |
|
Definition
- GI side effects- po dosing must sit upright for 30 minutes
- Arthralgias/bone pain
- infusion reaction
- osteonecrosis of jaw
- arrhythmias
- atypical fractures |
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Term
| Zolendronate (Reclast) is given ___ 5mg infusion IV over greater than 15 minutes. This reduces spine fractures by __ and hip fractures by __ over 3 years. |
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Definition
- yearly
- 70%
- 41%
Infusion reactions in 32% of patients with the first dose, 7% with the second dose, 3% with the third dose |
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Term
| Calcitonin meds include __ and __. __ is a nasal spray taken daily. __ can be a daily nasal spray or a SC or IM injection every other day. |
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Definition
- Fortical and Miacalcin
- Fortical- daily nasal spray
- Miacalcin- daily nasal spray, or IM or SC infection every other day |
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Term
| Raloxifene (Evista) is a __ __ __ __. It can be given for osteoporis __mg po __. |
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Definition
- Selective Estrogen Receptor Modulator (SERM)
- 60 mg po daily |
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Term
| Teriparatide (Forteo) is __ __. It can be given to female postmenopausal osteoporotic patients with high fracture risk. It can also be given to males with __ or __ ___ with a __ fracture risk. It decreases spine fractures by __ and non-spine fractures by ___ after 18 months. |
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Definition
- parathyroid hormone
- primary or hypogonadal osteoporosis with a high fracture risk
- 65%
- 53% |
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Term
| BLACK BOX WARNING FOR TERIPARATIDE (FORTEO): |
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Definition
|
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Term
| Contraindications to Teraparatide (Forteo): |
|
Definition
- Paget's disease
- pregnancy/nursing
- pediatrics/young adults
- prior radiation therapy
- bone metastasis
- skeletal malignancies
- hypercalcemia |
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Term
| Sequencing with bisphosphonates is a concern with ___. __ can only be given 2 years and costs 500-1000 dollars/month. |
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Definition
Teraparatide (forteo)
Teraparatide (forteo) |
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Term
| Denosumab (Prolia, Xgeva) is a human __ __ against ___ (calcium metabolism modifier). This is indicated for ___ women with __ and __ ___ __. It is a __ mcg subcu injection every __ __ (administered by healthcare professional only). |
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Definition
- monoclonal antibody
- RANKL
- post-menopausal
- osteoporosis
- high fracture risk
- 60 mcg subcu injection every 6 months |
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Term
| Denosumab (Prolia, Xgeva) have possible adverse effects similar to ___ plus signinfant increased risk for ___, ___, ___, and perhaps ___. |
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Definition
- bisphosphonates
- rash, hypercholesterolemia, infections, and perhaps malignancy |
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Term
| Screen all women __ and older for osteoporosis and all men __ and older. |
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Definition
65
70
(earlier if risk factors especially if pt on steroids) |
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Term
| Evaluate pts for secondary causes, __ Z scores are a red flag. |
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Definition
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Term
| Osteomalacia is defective ____ of growing skeleton in childhood that causes permanent bone deformities, like __. |
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Definition
- mineralization
- Rickets |
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Term
| Osteomalacia can also be in adults and is still defective mineralization of the bone. It can be caused by any condition that results in __ __ or __ mineralization of the bone osteoid. |
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Definition
| - inadquate calcium or phosphate |
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Term
| Most common cause of osteomalacia: |
|
Definition
Vitamin D deficiency
serum 25[OH]D <50 nmol/L or 20 ng/mL
24.3% postmenopausal women
60% institutionalized women
Causes of Vit D deficiency
Inadequate sun exposure
Malnutrition
Malabsorption
Pancratic insufficiency, cholestatic liver dz, sprue, IBD, jejunoileal bypass, Billroth II gastrectomy, Nephrotic syndrome
Meds - anticonvulsants
Genetics – rare autosomal recessive disorder |
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Term
| Other possible causes of osteomalacia: |
|
Definition
Deficient Calcium intake
Ca absorption decreases with age
Phosphate deficiency – genetic, oncogenic osteomalacia
Aluminum toxicity – renal dialysis, TUMS
Hypophosphatasia - rare
Fibrogenesis imperfecta ossium – very rare |
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Term
| Osteomalacia is initially ___, but then __ __, __ __ and __ __ occur. |
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Definition
- asymptomatic
- bone pain
- muscle weakness
- pathological fractures |
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Term
| With osteomalacia you will see a ___ appearance on radiographs. |
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Definition
|
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Term
| With osteomalacia calcium and phosphorous will be ___ and alkaline phosphatase will be ___. Also 25-hydroxy vitamin D will be ___. |
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Definition
- calcium and phosphorous will be decreased
- alkaline phosphatase will be increased
- 25-hydroxy vit D will be decreased |
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Term
| Osteomalacia prevention and treatment: |
|
Definition
SUNSHINE!
No sunscreen, 15 minutes, 2 X weekly
Natural Vit D – salmon, tuna in oil
Vitamin D supplementation (1000iu daily for sun deprived individuals)
Vit D deficiency -Tx with ergocalciferol (D2) 50,000 iu po weekly for 6-12 mo, then 1000iu daily.
Calcium for pts with malabsorption. |
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Term
| Osteomalacia prevention and treatment: |
|
Definition
SUNSHINE!
No sunscreen, 15 minutes, 2 X weekly
Natural Vit D – salmon, tuna in oil
Vitamin D supplementation (1000iu daily for sun deprived individuals)
Vit D deficiency -Tx with ergocalciferol (D2) 50,000 iu po weekly for 6-12 mo, then 1000iu daily.
Calcium for pts with malabsorption. |
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