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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
What do you do if a pt has a poor response to oral bisphosphonate therapy?
Trial zolendronic acid
Trial teriparatide