Highway to the
danger zone
danger zone
Who screens
the screeners?
the screeners?
Cross your T's and
dot your Z's
dot your Z's
An ounce of prevention and a pound of treatment
100
These are three modifiable risk factors for developing osteoporosis
100
All adults with fractures after this age should be screened for osteoporosis
What is 50?
100
These are the T-score cutoffs to diagnose osteopenia and osteoporosis, respectively
What are -1.0 and -2.5?
100
These are the recommended daily calcium and vitamin D intake amounts for adults 50 and older
What are 1200mg and 800 IU?
200
This amount of glucocorticoid treatment increases risk for osteoporosis
What is >=5mg/day for >=3 months?
200
These are the recommended ages to screen in women and men, respectively
What are 65 and 70? (Note that USPSTF does not make any recommendations for screening in men)
200
The Z-score is used to categorize bone mineral density in patients younger than this age.
What is 50? (A Z-score of -2.0 or worse with evidence of skeletal fragility such as a low trauma fracture is categorized as osteoporosis in a young individual.)
200
These are two recommendations for patients taking oral bisphosphonates to optimize absorption.
What are take first thing in the morning on an empty stomach, with at least 8 ounces of plain water; remain upright (to avoid the pill transiting back into the esophagus) and wait at least 30 minutes (with alendronate, risedronate) or 60 minutes (with ibandronate) before consuming any other pills, food, or beverage?
300
These are three medications from different classes other than corticosteroids that increase osteoporosis risk.
300
This is the traditional screening interval after initial DXA.
What is 2 years? (Note that normal or close to normal DXA, especially in younger patients, warrant consideration for a longer interval between scans.)
300
These FRAX score cutoffs are used as indications for treatment in patients with osteopenia.
What are 10-year hip fracture risk or >3% or total fracture risk of >20%?
300
These are two adverse effects of bisphosphonates.
What are GI side effects, hypocalcemia, jaw osteonecrosis, and atypical femoral shaft fractures?
400
A 56-year-old woman with RA is being treated with prednisone 10mg daily for the past 4 months. You obtain a DXA and calculate a FRAX risk of 12%. You treat her with this class of medications.
What are bisphosphonates?
400
These are three labs you might order to evaluate for secondary causes in a patient newly diagnosed with osteoporosis.
What are calcium, phosphorus, and alkaline phosphatase, with consideration of TSH, intact PTH, 24-hour urine calcium, and 25-OH vitamin D level, since the patient has osteoporosis?
400
This is an indication to perform DXA of the forearm in addition to the L-spine, femoral neck, and hip.
What is primary hyperparathyroidism? (preferentially affects loss of cortical bone, and the forearm is approximately 99% cortical bone)
400
This drug has an anabolic, rather than anti-absorptive, mechanism of action.
What are abaloparatide, teriparatide, and romosozumab?
