14 terms

Osteoporosis

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What is the definition of osteoporosis on DEXA scan?

T score <-2.5

What is the clinical diagnosis of osteoporosis?

Fragility (low-trauma) fracture

What is the definition of osteopenia on DEXA scan?

T score -1 to -2.5

What does shattered stand for?

S: steroids (second most common cause)
H: hyperthyroidism, hyperparathyroidism
A: alcohol and tobacco use
T: thin (BMI<22)
T: testosterone ↓ (e.g. anti-androgen prostate cancer treatment)
E: estrogen decrease
R: renal or liver failure
E: erosive and/or inflammatory bone disease (e.g. RA or myeloma)
D: dietary Ca2+ ↓/malabsorption; DM type 1

What is the initial laboratory evaluation of secondary osteoporosis causes?

FBE
CMP
Vitamin D
LFTs
TFTs
UECs

What investigates do you run for secondary causes of osteoporosis, beyond the basic screen?

24 hour urine calcium
Multiple myeloma screen
PTH level
Coeliac serology
Urinary cortisol
Serum testosterone

What lifestyle measures can help with osteoporosis?

Quit smoking and reduce alcohol consumption
Exercises
Intensity of exercise does not seem to matter
Balance exercises such as tai chi
Home based falls prevention program
Calcium and vitamin D (fish) rich diet

How long post-fracture should you wait to give bisphosphonates (official recommendation)?

6 weeks

Which pt group would you consider denosumab in?

Pts w renal failure

Who should get raloxifene?

Pts that require breast cancer prevention and osteoporosis therapy

What is teriparatide?

Recombinant PTH
Intermittent use maximizes bone formation rather than resorption

Why do you need to stop teriparatide after 24 months?

Risk of osteosarcoma

4 things to think about when a pt has a poor response to osteoporosis therapy

Poor compliance
Inadequate GI absorption
Inadequate calcium and vit D
Secondary cause of osteoporosis