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Osteoporosis lecture
Endocrinology Osteoporosis
| Question | Answer |
|---|---|
| Osteoporosis definition | a skeletal disorder characterized by compromised bone strenth predisposing a person to an increased risk of fracture |
| Ratio of women to men | 4:1 F:M |
| Which races are most commonly affected? | Caucasians and Asians |
| __ in 10 Caucasian women over age 50 are expected to frature in their remaining lifetime | 4 |
| Define fragility fractures | Fragility (low trauma) fractures are defined as fracture resulting from a fall from a standing height of less, or fractures presenting in the absence of obvious trauma. |
| In measuring bone mineral density, what are the T and Z values? | T- how many standard deviations they are below their peak bone densityZ - how many standard deviations they are below the normal average |
| What is the best predictor of fracture? | BMD; bone mass accounts for 75-85% of the variance in vertebral compression strength and femur torsional fracture strength |
| What kind of fractures does BMD predict? | Any, commonly hip, spine, radius, hand, heel |
| What is a DEXA? | Dual energy x-ray absorptiometry for PA spine, lateral spine, hip, forearm, total body. |
| What is the role of Quantified CT | not used as often, higher amount of radiation |
| What is the relationship between previous and future fractures? | fractures predict fractures |
| What occurs before osteoporosis is diagnosed? | Osteopenia |
| Who should be evaluated for osteoporosis? | > or equal to 65 years old, <65 with risk factors, adults with a fracture, anyone considering therapy for OP, anyone with a disease, condition or medication associated with OP |
| Risk factors from guidelines | Prior Fracture, Secondary causes (hypogonadism, celiac dz), low body weight (<127lbs), Fracture in first degree relative, Use of glucocorticoid therapy, Cigarette smoking, advanced age |
| Physical Exam findings in Osteoporosis patients | heigh loss (greater than 2 inches), thoracic kyphosis, reduced rib to pelvis brim distance (1-3 fingerbreadths nl), wall to occiput distance (0 is nl), Other exam findings (goiter, blue sclerae, testicular atrophy, evidence of liver dz, Cushing's dz) |
| Diagnostic evaluation of Osteoporosis | serum calcium, creatinine, bicarb, LFTs, CBC,TSH, 24 hours urine calcium/creatinine25 OH D, BMD |
| Nutrition and Osteoporosis | 1500mg/day calcium (diet + supplements)400 IU Vitamin D in summer, 1000 IU D in winter or age >65. |
| When to initiate therapy for Osteoporosis | Depends on their T score, but usually around -1 or -2 |
| Pharmacologic tx of Osteoporosis | Calcium/Vit D, Bisphosphonates, estrogen, SERMs, Calcitonin. |
| How do Pharmacologic agents work in Osteoporosis? | Inhibit bone resorption, maintain/increase bone mass. Thus fracture risk is reduced. FORTEO increases bone formation and increases bone mass |
| How does FORTEO work? | Increases bone formation and bone mass |
| What is the concensus of HRT? | Risks exceed benefits |
| What is the MOA of Bisphosphonates? | Reduce osteoclast activity. This increases BMD by permitting "filling in" of existing remodeling space, and by more extensive mineralization of bone matrix. |
| What happened when fosamax was discontinued in patients who took it for 5 years? | It was incorporated into the bone and the patietns contintued to benefit from it. |
| What is the importance of Parathyroid hormone? | PTH is secreted by the parathyroid glands and is an important regulator of blood calcium concentrations. Synthesis and secretion of PTH are stimulated by a decrease in blood calcium. |
| Name the three functions of PTH | 1. Increases the release of calcium from the bone2. Reduces the renal clearance of calcium3. Stimulates the production of 1,25 OH D |
| The skeletal effects of PTH depend on what? | the pattern of systemic PTH exposure. Once-daily PTH stimulates new bone formation by prefering osteoblast formation over osteoclast action. This improves bone mass/strength. Continuous PTH results in more osteoclast action and bone resorption |
| An absoulte risk reduction of 10% using Forteo means | that you need to treat 11 people to prevent 1 hip fracture. |
| Definition of Osteomalacia | Defective bone matrix mineralization due to inadequate calcium or phosphorus, deficient mechanisms mineralization in presence of nl calcium and phosphorus levels |
| What is osteomalacia in childhood called | Rickets |
| Symptoms of osteomalacia | diffuse bone pain (esp. pelvis), waddling gait, muscular weakness, fractures, and pseudofractures (Looser's zones) of long bones, ribs and pelvis |
| Causes of Osteomalacia | Calciopenic Osteomalacia: Vit D deficiency, Calcium deficiencyPhophopenic OsteomalaciaNormal Mineral Osteomalacia |
| Treatment of Osteomalacia | Vitamin D, Calcium, Ergocalciferol, Calcitrol, |
| Paget's Disease | Localized disorder of bone remodeling. Initiating lesion is increased bone resorption (giant multicellular osteoclasts) |
| Is bone formation and mineralization normal in Paget's disease? | Yes, thought of irregular woven type |
| Where are the most common locations of Paget's? | Pelvis, Femur, Spine, Skull and Tibia |
| What is the hallmark sign of Paget's? | Elevated alkaling phosphatase |
| Treatment of Paget's disease | Inhibit osteoclast resorption/bone formation with bisphosphonates and calcitonin |
| Risedronate is an oral | bisphosphonate, effective, but take up to 6 months to start working |
| First line drugs for Osteoporosis? | bisphosphonates. |
| If a patient has multiple fractures, tx with | steroids, maybe forteo (injection) firstline |
| 2nd line tx for Osteoporosis | Aviasta. |
Created by:
ltm12