Term
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Definition
Age
White or Asian
Less than 126 lb
Family history
Menopause
Smoke and ETOH
Sedentary and diet deficiency
Medication: thyroid, steroid |
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Term
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Definition
| DEXA T-score (standard deviation difference between patient’s BMD and that of a young-adult, reference population) is -2.5 or lower at hip, femoral neck and L1-L4 spine |
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Term
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Definition
Use Z score for young women and men (SD difference between patient’s BMD and that of an age and ethnicity matched reference data)
Clinical diagnosis if history of fragility fracture without DEXA (vertebral fx) |
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Term
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Definition
Women > or equal 65 and men >70
Younger postmenopausal women and men 50-69 who has risk factors (fm hx, smoke, fx)
Women in menopausal transition with clinical risk factors (low weight, previous fracture, high med use)
Adults with condition, RA or hyperthyroid problem or taking prednisone more than 3 months |
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Term
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Definition
Hip or vertebral fracture
T score < -2.5 at femoral neck total hip or lumbar spine
Low bone mass (T score -1.0 and -2.5 at femoral neck or lumbar) and 10 year probability of hip fracture >3% based on WHO algorithm |
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Term
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Definition
WHO Fracture Risk Algorithm to calculate 10-yr probability of hip and major osteoporotic fracture
Fracture risk doubles for every SD decrease in BMD and every decade advance in age, as well as presence of fragility fracture
Expressed as relative risk, risk ratio compared to reference population
Absolute risk better estimate, fracture probability over defined period |
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Term
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Definition
Estrogen (prevention, not for Rx) Ht
Alendronate (Fosamax), Bisphos
Risedronate (Actonel), Bisphos
Ibandronate (Boniva), Bisphos
Zoledronate (Reclast),Bisphos
Denosumab (Prolia), RANK
Raloxifene(Evista), Estrogen agonist
Calcitonin (Fortical) – outdated but some still use
Terparatide (Forteo), parathyroid; use for pts who recently had a fracture |
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Term
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Definition
Osteonecrosis of jaw (ONJ)
Increase spontaneous femoral fracture
More common with high dose with IV bisphosphonate rx with cancer
Risk for ONJ in Osteoporosis tx is unknown
Very small for up to 5 years; more than that, give a drug holiday or switch to a different type of med (inj.)
Increase with duration of rx |
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Term
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Definition
Stability or increase in BMD
Increase total BMD 4%
Fracture risk decrease by 50%
Drug holiday
Use of alternative therapy other than bisphosphonates after 3 to 5 years
MAXIMUM increase of BMD is 10-15%
You don’t see the benefit until they fall
Just because you do not see an increase in BMD, doesn’t mean the patient is not benefitting from the medication
Make sure they don’t deteriorate |
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