Study sets, textbooks, questions
Upgrade to remove ads
Terms in this set (34)
what are the risk factors for osteoporosis?
-long term glucocorticoid therapy (more than 7.5 mg daily)
-personal hx of fragility fx
-low body weight (less than 127 lbs/58 kg)
-hamily hx of hip fracture ( 2x risk!)
-excess alcohol intake (>2 drinks/day)
-underlying inflammatory dz (SLE, RA)
-drugs (PPIs inhibit Ca absorption, anticonvulsants)
-vitamin D deficiency
what is the prevalence/epidemiology of osteoporosis?
30% of postmenopausal women have osteoporosis ( & 40% of this population will sustain one or more fragility fractures in their lifetime)
-1 in 2 caucasian women will fracture a bone due to osteoporosis in her lifetime
-over 50% of women and 30-45% of men over age 50 have osteopenia/osteoporosis
true or false: osteoporosis is asymptomatic until a fracture occurs
what is the prognosis of a hip fracture associated with osteoporosis?
-20% of women will die in subsequent year as an indirect result of the fracture
-30% will require long term nursing care
-only 1/3 will return to prior level of function
what is a T score (in the context of bone density/osteoporosis)?
standard deviation of the BMD from the average sex-matched 35 year old
what T score range signifies osteopenia?
t score less than -1.0 and greater than -2.5 (greater than -1.0 is normal)
what T score range signifies osteoporosis?
t score less than -2.5
what is the pathophysiology of osteoporosis?
-loss in total mineralized bone due to disruption of normal balance of bone breakdown and build up
-osteoclasts cause bone resorption, stimulated by PTH; osteoblasts cause mineralization & foration of bone
-slow down of bone buildup: osteoporosis seen in older women and men (men after age 70)
-accelerated bone breakdown (postmenopausal)- normal loss is .5% per year after peak bone density in 20s, may have up to 5% loss per year during first 5 years after menopause
what is the most common form of secondary osteoarthritis?
-glucocorticoid induced osteoporosis- risk factors include:
-long term use of oral glucocorticoids (more than 3 mos)
-high dose inhaled glucocorticoids (greater than 5 mg of prednisone)
-evaluate bone mineral density at hip & spine
-consider prescribing an osteoporosis med
what history is important in diagnosisng osteoporosis?
-family hx of osteoporosis/fx?
-personal fracture hx
-menarche & menopause, pregnancies? (no pregnancies & early menopause increases risk)
-steroid or seizure med use
-inflammatory bowel disease (poor vitamin absorption)
-fall risk? (neuro/gait disorders)
-weight bearing exercise? (helps increase bone density)
what physical exam findings are associated with osteoporosis?
-kyphosis (hunched over)
-comparison of current and max height, loss of greater than or equal to 2 inches indicates vertebral compression
what labs are used in the diagnosis of osteoporosis?
-25OH vitamin D
-PTH, ionized calcium
-TSH, free T4
-free & total testosterone in males (lower testosterone increaes risk)
what bone is usually involved in osteoporosis related hip fractures?
usually invovles femoral neck
how are osteoporosis related hip fractures treated?
requires surgical repair (ASAP)
-can pin femoral neck but risk of AVN
-total joint replacement
after fx/surgery, leg appears shortened & externally rotated
what compression fractures are associated with osteoporosis? how are they treated?
-acute compression of vertebrae, usually thoracic
-treat conservatively (pain meds, bracing, rest)
-once a patient has had one compression fx, risk for another is significantly increased- 505 of pts with one fracture will experience another w/in 3 years
-sometimes treat with kyphoplasty (inject plastic into fracture & heals instantly, for acute fx only)
-multiple fractures lead to severe kyphosis & chronic pain
what non-pharmalogic treatment is used for osteoporosis?
-risk factor modification: smoking cessation & ETOH reduction/cessation
-exercise: weight bearing exercise (walking) for at least 30 minutes 3x week, resistance training
-calcium plus vitamin D (1500 mg/day calcium in postmenopausal women/osteoporosis pts), 2000 IU vit D daily
what is the first line pharmacologic treatment for osteoporosis?
bisphosphonates widely used as first line tx, generally well tolerated
how do bisphosphonates work to treat osteoporosis?
inhibit osteoclast activity (aka anti-resorptives)
how should oral bisphosphonates be taken?
-take alone on an empty stomach 1st thing in morning w/ at least 8 oz water; no food/drink for 30 min after
what patients should avoid oral bisphosphanates?
-avoid in pts w/ active upper GI disease & discontinue in any pts who develop any sx of esophagitis (tough on GI tract, hard to take)
-cannot use bisphosphonates in pts w/ creatinine clearance less than 35
what forms of administration are bisphosphonates available in? which is more commonly used?
-IV treatment, only administered once/year so this is TOC! improves compliance & absorption & generic is now available
what are 2 rare compications of bisphosphonate therapy? how can they be avoided?
1. osteonecrosis of jaw (usually seen in pts w/ malignancy that are on bisphosphonates for bone mets or high dose IV bisphosphonates; have baseline oral exam & do any preventative dental work necessary before starting tx to help reduce risk)
2. atypical femoral fractures (directly correlates to length of time on bisphosphonates; after 5 years risk is much higher, so after 5 years, a "drug holiday" from bisphosphonates is recommended- switch to a dif class of drugs for a bit & do another DEXA scan in a year to assess for stability)
what drug is a good choice for treating osteoporosis in patients with renal disease?
how does Prolia (denosumab) work to treat osteoporosis? how is it administered?
-works by inhibiting RANKL, which prevents osteoclast formation & differentiation & reduces osteoclast longevity
-STOPS FORMATION of osteoclasts as opposed to blocking their activity like bisphosphonates
-administered as a SubQ injection 2 x year so high compliance & absorption
what is prolia (denosumab) indicated for?
reducing vertebral & non-vertebral fx in osteoporosis
what is the only osteoporosis treatment that increases bone density? how does this treatment accomplish that?
PTH therapy- teriparatide (Forteo)
-intermittent PTH causes improvement in bone density
-stimulates osteoblasts to build bone- builds both cortical & trabecular bone, significantly reducing fracture risk
what black box warning is associated with PTH therapy (Forteo)?
-risk of osteosarcoma if used for more than 2 years (daily subQ for 2 years)
what is the role of calcitonin (miacalcin nasal spray) in treatment of osteoporosis?
-less popular choice; used to be TOC in patients w/ renal dysfunction (can't use bisphosphonates), but now prolia can be used in this patients (so replaced calcitonin)
-has a relatively modest effect on BMD & weak anti-fx efficacy compared w/ other agents (this drug sucks & is old don't use anymore)f
what are selective estrogen receptor modulators (SERM) and what is their role in osteoporosis treatment?
-act like estrogen to decrease bone resorption
-decrease risk of breast cancer! (incidental finding)
-increase vasomotor sx associated w/ menopause
-not as effective as bisphosphonates or estrogen therapy
what is the role of estrogen therapy (HRT) in osteoporosis treatment? what are the risks associated with it?
-reduce hip and vertebral fracture risk but no longer a first line approach b/c increase the risk of breast cancer, stroke, venous thromboembolism, and coronary disease
what is the FRAX score?
-10 year probability based on BMD at femoral neck, age, weight, personal & family fx history, smoking hx, steroid use, alcohol use, & hx of RA
-tx recommended if 10-year probability of hip fx or other major osteoporotic fx is > 3.0 or > 20%
what recommendations should be made to postmenopausal women and men age 50 and older?
-counsel on risk of osteoporosis & fractures
-check for secondary causes (long term steroid use)
-advise on adequate calcium & vitamin D
-recommend regular exercise
-advise avoidance of excess ETOH & tobacco
when should pharmacologic treatment be used for osteoporosis?
-in postmenopausal women w/ established osteoporosis (T score less than -2.5) or past fragility fx (hip or vertebral) should be treated w/ pharmacological agent
-postmenopausal women w/ T score between -1.0 and -2.5 (osteopenia) should be treated if they have a 10 year probability of hip fx or combined major osteoporotic fracture of >3.0 or >20% (FRAX score showing high risk)
when should a bone density scan be recommended?
-in all women age 65+ and men age 70+
-in postmenopausal women & men age 50-69 recommend BMD based on risk factor profile
-recommend BMD testing to those who have had a fx, to determine degree of severity
Sets found in the same folder
Juvenile idiopathic arthritis (JIA)
Sets with similar terms
Other sets by this creator
ObGyn EOR Exam
local anesthetics & nerve blocks
newborn physical exam