Term
| metabolic bone disease with low bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and increased fracture risk |
|
Definition
|
|
Term
|
Definition
bone mass loss unassociated with any other illness
related to aging and loss of gonadal function in women and aging process in men |
|
|
Term
|
Definition
| result of various chronic conditions that significantly contribute to bone mineral loss of results from effects of medical and nutritional deficiencies |
|
|
Term
| What is the WHO criteria for osteoporosis? |
|
Definition
| bone density that is 2 standard deviations or more below young adult mean values |
|
|
Term
| What T score gives a diagnosis of osteoporosis? |
|
Definition
|
|
Term
| What gives a diagnosis of severe osteoporosis? |
|
Definition
| T score < -2.5 with a fracture |
|
|
Term
| What T score gives a diagnosis of osteopenia? |
|
Definition
|
|
Term
| What is a normal T score? |
|
Definition
|
|
Term
| What does 1 standard deviation below normal lead to? |
|
Definition
| increase in spinal fractures by 2-2.4 times normal |
|
|
Term
| What is the difference between osteoporosis and osteopenia? |
|
Definition
osteoporosis--bone matrix decreased; T score < -2.5
osteopenia--bone matrix intact; T score -1 to -2.5 |
|
|
Term
| What do osteoporosis and osteopenia have in common? |
|
Definition
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|
Term
| What is often true about osteoporosis and falls? |
|
Definition
| It is often the broken bone that causes the fall--not the fall that causes the broken bone. |
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|
Term
| What is the likelihood for a woman to have an osteoporosis-related fracture in her lifetime? |
|
Definition
|
|
Term
| What is the likelihood of a man having an osteoporosis-related fracture in his lifetime? |
|
Definition
|
|
Term
| What are the most common fracture sites related to osteoporosis? |
|
Definition
|
|
Term
| The annual incidence of osteoporosis-related fractures in women is greater than the incidence of ____, ____, and ____ combined. |
|
Definition
|
|
Term
| What increases the risk of a second hip fracture? |
|
Definition
|
|
Term
| Do second hip fractures usually occur in the same place as the first? |
|
Definition
| no, because the body's repair makes that site stronger with osteoblasts |
|
|
Term
| Why might someone be likely to develop a second hip fracture in the same bone at a different site? |
|
Definition
| scared to walk so they change their gait or shift their weight to the good side, putting more stress on that hip and causing it to break |
|
|
Term
| What percentage of postmenopausal women have osteoporosis in the US? |
|
Definition
|
|
Term
| What is the usual presenting symptom of osteoporosis? |
|
Definition
|
|
Term
| If symptomatic, what might a pt. with osteoporosis complain of? |
|
Definition
backache (due to vertebral fracture)
loss of height |
|
|
Term
| What causes kyphosis in a pt. with osteoporosis? |
|
Definition
| vertebral wedge fractures |
|
|
Term
| What labs are normal in primary osteoporosis? |
|
Definition
|
|
Term
| What would you expect to see with the alkaline phosphatase level in a patient with primary osteoporosis? |
|
Definition
| normal or slightly elevated |
|
|
Term
| What would you expect to see with the 25-hydroxyvitamin D level in a patient with primary osteoporosis? |
|
Definition
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|
Term
| What level of 25-hydroxyvitamin D leads to a diagnosis of frank vitamin D deficiency? |
|
Definition
|
|
Term
| What level of 25-hydroxyvitamin D indicates an increased risk of hip fracture? |
|
Definition
|
|
Term
| What can be suspected if all labs are abnormal? |
|
Definition
| secondary cause of osteoporosis |
|
|
Term
| A DXA scan determines bone density of the ________ _________ and _________. |
|
Definition
|
|
Term
| If a pt. has a normal T score but an abnormal Z score, what does that mean? |
|
Definition
| they are at risk for osteoporosis |
|
|
Term
| When should you order at DEXA scan? |
|
Definition
-all pts. at risk for osteoporosis
-all pts. with a pathologic fracture
-pts. with radiologic evidence of diminished bone density |
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|
Term
| What is a pathologic fracture? |
|
Definition
fracture due to a disease process rather than trauma
main causes include osteoporosis and bone cancer |
|
|
Term
| What are risk factors for osteoporosis that cannot be changed? |
|
Definition
female
advancing age (50+)
genetics (family hx)
ethnicity (Caucasian, Asian)
late menarche
early menopause |
|
|
Term
| What are the modifiable risk factors associated with osteoporosis? |
|
Definition
diet (calcium, vitamin D)
exercise (weight bearing)
smoking
excessive EtOH
estrogen deficiency
medications |
|
|
Term
| Women can lose ___% of their bone mass in the first 5 years after menopause. |
|
Definition
|
|
Term
| What are the main causes of secondary osteoporosis in women? |
|
Definition
low estrogen states
glucocorticoids
thyroid hormone excess
anticonvulsasnts
heavy alcohol use |
|
|
Term
| What are the main causes of secondary osteoporosis in men? |
|
Definition
hypogonadism
glucocorticoids
alcohol |
|
|
Term
| What disease states are associated with secondary osteoporosis? |
|
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 disease
Marfan syndrome
mastocytosis
multiple myeloma
renal tubular acidosis |
|
|
Term
| What medications are associated with secondary osteoporosis? |
|
Definition
steroids
pheonothizines
phenytoin
heparin
aromatase inhibitors
antiretrovirals
chemo drugs
cyclosporine
GnRH agonists
lithium |
|
|
Term
| What dose of prednisone is associated with secondary osteoporosis? |
|
Definition
|
|
Term
| What chemo drugs are associated with secondary osteoporosis? |
|
Definition
cyclosporine
platinum
methotrexate |
|
|
Term
| A pt. can have up to ___% decrease in bone mineral density after 6 months of oral glucocorticoid use. |
|
Definition
|
|
Term
| A pt. taking oral glucocorticoids has a ___% increased risk for fractures at a dosage of 7.5 mg/day. |
|
Definition
|
|
Term
| What is a safe dose of oral glucocorticoids in avoiding secondary osteoporosis? |
|
Definition
|
|
Term
| What is the lifetime fracture rate for women 50 and older with osteoporosis? |
|
Definition
|
|
Term
| What is the most common osteoporosis-related fracture during the 50's? |
|
Definition
|
|
Term
| What is the most common osteoporosis-related fracture during the 70's? |
|
Definition
|
|
Term
| What is the most common osteoporosis-related fracture during the 80's? |
|
Definition
|
|
Term
| What lab tests might you order when trying to determine the cause of secondary osteoporosis? |
|
Definition
CBC
CMP
TSH
ESR or CRP
24 hr urinary calcium
PTH
SPEP/UPEP
testosterone
25OH-vitamin D |
|
|
Term
| What is the most important determinant of life-long skeletal health? |
|
Definition
| bone mass attained early in life |
|
|
Term
| What is the dietary recommendation for calcium for ages 1-3? |
|
Definition
|
|
Term
| What is the dietary recommendation for calcium for ages 4-8? |
|
Definition
|
|
Term
| What is the dietary recommendation for calcium for ages 9-18? |
|
Definition
|
|
Term
| What percentage of children meet dietary recommendations? |
|
Definition
|
|
Term
| What is the dietary recommendation for calcium for adults under age 50? |
|
Definition
|
|
Term
| What is the dietary recommendation for calcium for adults 50 or older? |
|
Definition
|
|
Term
| What is the dietary recommendation for vitamin D for adults under 50? |
|
Definition
|
|
Term
| What is the dietary recommendation for vitamin D for adults 50 and older? |
|
Definition
|
|
Term
|
Definition
online fracture risk calculator developed by WHO
gives 10-year probability of hip fracture and of major osteoporotic fracture |
|
|
Term
| When is treatment recommended based on FRAX? |
|
Definition
| osteopenic pts. with 10-year hip fracture risk 3%+ or major osteoporotic fracture risk 20%+ |
|
|
Term
| What patients with osteoporosis should be treated? |
|
Definition
|
|
Term
| What patients with osteopenia should be treated? |
|
Definition
-hx of fracture
-secondary causes that increase risk
-10-year probability of hip fracture 3%+ or major osteoporotic fracture 20%+ based on FRAX |
|
|
Term
| What modifiable factors can be corrected to reduce the risk of osteoporosis and fractures? |
|
Definition
smoking
alcohol
nutrition
medications
vision
fitness
cognition
hazards |
|
|
Term
| What non-pharmacologic management can be done to prevent fractures and help treat osteoporosis? |
|
Definition
physical therapy
home safety evaluation |
|
|
Term
| What surgical interventions are often used for treatment of osteoporosis? |
|
Definition
vertebroplasty
kyphoplasty
hip surgery |
|
|
Term
| How does a vertebroplasty and kyphoplasty relieve pain? |
|
Definition
| takes the pressure off of the nerves that have been compressed by the fracture |
|
|
Term
| What drug does not help in preventing osteoporosis? |
|
Definition
|
|
Term
| What drugs are used to treat osteoporosis in men? |
|
Definition
alendronate (Fosomax)
risedronate (Actonel) |
|
|
Term
| Which drugs used to treat osteoporosis require daily dosing? |
|
Definition
calcitonin
raloxifene (Evista) |
|
|
Term
| What drugs used to treat osteoporosis require weekly dosing? |
|
Definition
alendronate (Fosamax)
risedronate (Actonel) |
|
|
Term
| What drug used to treat osteoporosis only requires monthly dosing? |
|
Definition
|
|
Term
| What drugs are used in the treatment of secondary osteoporosis caused by glucocorticoid use? |
|
Definition
alendronate (Fosamax)
risedronate (Actonel) |
|
|
Term
| What is the dosage for zolendronic (Reclast)? |
|
Definition
5 mg IV annually
given over >15 min |
|
|
Term
| What are the bisphosphonates used for the treatment of osteoporosis? |
|
Definition
risendronate (Actonel)
ibandronate (Boniva)
alendronate (Fosamax)
zolendronic (Reclast) |
|
|
Term
| How do bisphosphonates work? |
|
Definition
| inhibit osteoclast activity, reducing bone resorption and turnover |
|
|
Term
| What are the concerns and issues associated with bisphosphonates? |
|
Definition
GI side effects
arthralgias/bone pain
infusion reactions
osteonecrosis of the jaw
arrhythmias
atypical fractures |
|
|
Term
| What is important to tell the pt. when prescribing an oral bisphosphonate? |
|
Definition
| must sit upright for 30 min after taking |
|
|
Term
| Zoledronate (Reclast) reduced spine fractures by ___% and hip fractures by ___% over 3 years. |
|
Definition
|
|
Term
| What are the 2 forms of calcitonin? |
|
Definition
Fortical (nasal spray daily)
Miacalcin (nasal spray daily or injection every other day) |
|
|
Term
| What SERM is used in the treatment of osteoporosis? |
|
Definition
|
|
Term
| What is the dosage for raloxifene (Evista)? |
|
Definition
|
|
Term
| What drug is a PTH antagonist used for treatment of osteoporosis? |
|
Definition
|
|
Term
| When is teriparatide (Forteo) used in a female? |
|
Definition
| postmenopausal osteoporosis with high fracture risk |
|
|
Term
| When is teriparatide (Forteo) used in a male? |
|
Definition
| primary or hypogonadal osteoporosis with high fracture risk |
|
|
Term
| Teriparatide (Forteo) decreased spine fractures by ___% and non-spine fractures by ___% after 18 months. |
|
Definition
|
|
Term
| What is the black box warning for teriparatide (Forteo)? |
|
Definition
|
|
Term
| What are the contraindications for teriparatide (Forteo)? |
|
Definition
Paget's disease
pregnant/nursing
pediatrics/young adults
prior radiation therapy
bone mets
skeletal malignancies
hypercalcemia |
|
|
Term
| How long can a pt. be on teriparatide (Forteo)? |
|
Definition
|
|
Term
| denosumab (Prolia, Xgeva) |
|
Definition
| human monoclonal antibody against RANKL (calcium metabolism modifier) |
|
|
Term
| Who is denosumab (Prolia, Xgeva) indicated for? |
|
Definition
| postmenopausal women with osteoporosis and high fracture risk |
|
|
Term
| What is the dosage for denosumab (Prolia, Xgeva)? |
|
Definition
|
|
Term
| What is the adverse effect profile for denosumab (Prolia, Xgeva)? |
|
Definition
similar to bisphosphonates
significant increased risk for rash, hypercholesterolemia, infections, perhaps malignancy |
|
|
Term
| What is the main goal of exercise early in life with regard to osteoporosis? |
|
Definition
|
|
Term
| What is the main goal of exercise later in life with regard to osteoporosis? |
|
Definition
|
|
Term
| When should women be screened for osteoporosis? |
|
Definition
65 and older
earlier if fractures or other risk factors (esp. pts. on steroids) |
|
|
Term
| When should men be screened for osteoporosis? |
|
Definition
70 and older
earlier if fractures or other risk factors (esp. pts. on steroids) |
|
|
Term
| What is a red flag for secondary causes of osteoporosis? |
|
Definition
|
|
Term
|
Definition
| defective mineralization of the growing skeleton in childhood that causes permanent bone deformities |
|
|
Term
|
Definition
| defective skeletal mineralization in adults caused by any condition that results in inadequate calcium or phosphate mineralization of bone osteoid |
|
|
Term
| What is the most common cause of osteomalacia? |
|
Definition
|
|
Term
| What serum 25OH-vitamin D level gives you a diagnosis of vitamin D deficiency? |
|
Definition
|
|
Term
| What are the potential causes of vitamin D deficiency? |
|
Definition
inadequate sun exposure
malnutrition
malabsorption
meds (anticonvulsants)
genetics (rare autosomal recessive d/o) |
|
|
Term
| What other conditions, besides vitamin D deficiency, can cause osteomalacia? |
|
Definition
deficient calcium intake
phosphate deficiency
aluminum toxicity
hypophosphatasia
fibrogenesis imperfecta ossium |
|
|
Term
| ___________ absorption decreases with age. |
|
Definition
|
|
Term
| What can cause aluminum toxicity? |
|
Definition
|
|
Term
| What can cause phosphate deficiency? |
|
Definition
genetic
oncogenic osteomalacia |
|
|
Term
| What is the symptom progression associated with osteomalacia? |
|
Definition
| asymptomatic first, then develop bone pain, muscle weakness, and pathologic fractures |
|
|
Term
| What is the characteristic appearance of bones on radiographs in a pt. with osteomalacia? |
|
Definition
|
|
Term
| What lab findings are consistent with osteomalacia? |
|
Definition
elevated serum alkaline phosphatase
decreased calcium and phosphorus
decreased 25OH-vitamin D |
|
|
Term
| What is the non-pharmacological treatment for osteomalacia? |
|
Definition
| sunshine (no sunscreen, 15 min, 2 times weekly) |
|
|
Term
| What supplementation is needed in a pt. with osteomalacia? |
|
Definition
natural vitamin D (salmon, tuna in oil)
vitamin D supplement (1000 IU/day for sun-deprived individuals)
calcium for pts. with malabsorption |
|
|
Term
| How do you treat vitamin D deficiency? |
|
Definition
| ergocalciferol (D2) 50,000 IU po weekly for 6-12 months, then 1000 IU daily |
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