FRAX tool
The age range accepted for the FRAX calculator
What is 40-90?
-officially designed and validated for postmenopausal women and men age 50 and olde.
Alendronate
-trade name
-class of drug
-route of adminstration
What is Fosamax, bisphosphonate and oral once a week?
-binds to bone and stops osteoclasts from working and ultimately apoptosis
Women who are this age or older should get screening.
What is 65 and older?
The definition of osteopenia.
What is a T-score between -1.0 and -2.5 on BMD testing.
This agent needs to be continued indefinitely or upon another medication needs to be started immediately due to rapid bone loss once discontinued
denosumab (Prolia)
The only family history item on the FRAX calculator.
What is a parent with a hip fracture?
Trade name?
Class of drug?
Route of administration?
What is Prolia, RANK ligand inhibitor, subcu injection every 6 months?
-a monoclonal antibody that binds to and blocks a protein called RANKL, which normally activates osteoclasts-therefore decreasing bone breakdown
Women who in this state, younger than 65, and have 1 or more risk factor for osteoporosis should be screend.
What is postmenopausal?
This type of fracture occurs after minor trauma such as a fall from standing or sitting.
A fragility fracture. Most common are vertebral compression fractures, hip and wrist fractures. Does not include skull, c-spine or hands/feet)
The only IV bisphosphonate.
Zolendronic acid
The only named disease on the FRAX calculator.
What is RA?
rheumatoid arthritis
Raloxifene
Trade name?
Class of med?
Route of admin?
What is Evista, SERM (selective estrogen receptor modulator) and 60 mg PO Q D?
-only reduces risk of which type of fracture?
-inhibits bone resorption
Some experts recommend screening all men for osteoporosis starting at this age and older.
What is 70 or older?
BMD <= t score of -2.5
hx of a fragility fracture
High risk 10 year FRAX score
Once you have completed the course of this class of medications used to treat osteoporosis you need to start a different agent to prevent loss of the gains in BMD.
Anabolic agents: romosozumab, teriparatide, abaloparatide
After initial therapy with an anabolic agent is discontinued, patients should be treated with an antiresorptive agent (typically a bisphosphonate) to preserve the gains in BMD from anabolic therapy. For individuals who are unable to tolerate oral or intravenous bisphosphonates, alternatives may include denosumab or raloxifene.
Two lifestyle factors that appear on the FRAX tool.
What are
-current smoker and Alcohol use (3 or more per day)?
Calcitonin
Trade name?
Class of med?
Route of admin?
What is Miacalcin, hormone, intranasal (subcu or IM)
1 spray intranasal once daily
May be used to reduce pain associated with acute osteoporotic vertebral fractures; switch to a more effective agent (eg, a bisphosphonate) once pain has abated
Name 3 clinical risk factors for osteoporosis besides age and secondary causes.
What are:
-Previous fracture during adulthood
●High fall risk
●Impaired mobility
●Chronic glucocorticoid therapy (eg, ≥3 months)
●Low body weight (<58 kg [127 lb])
●Parental history of hip fracture
●Current cigarette smoking
●Excess alcohol intake
●Height loss (>3.8 cm [1.5 inches]) and/or kyphosis, suggesting prior vertebral fractures
This is what DXA or DEXA stands for.
What is dual-energy x-ray absorptiometry?
Most fractures occur in patients in this bone density catergory.
Osteopenia (more patients in this category) but patients in osteoporosis have higher risk for fracture.
Incidence of fracture and mortality vary widely by this, which is why you must enter it into the FRAX tool.
What is the country you live in?
Teriparatide
Trade name?
Class of med?
Route of admin?
What is
Forteo or Bonsity
PTH analog
subcu 20 mcg Q D
Name 3 medical conditions that are secondary causes of osteoporosis.
What are:
rheumatoid arthritis, hyperthyroidism, primary hyperparathyroidism, hypogonadal states, gastrointestinal diseases, malabsorptive states, hypercalciuria, malignancy, spinal cord injury-see larger list
This FRAX score makes you High risk in the US
A 10-year probability of
Hip fracture risk of 3 % or higher
or
Major osteoporotic fracture risk of 20% or higher
In the year 2000 this many osteoporotic fractures occured worldwide.
9 million
In systematic reviews, the worldwide annual hip fracture rate in women ranged from <100 to nearly 600 per 100,000 and vertebral fracture rate from <100 to almost 1400 per 100,000, depending on the region . The highest rates of hip fracture occurred in Scandinavian countries, whereas the highest rates of vertebral fracture occurred in South Korea and the United States. As the global population ages, the estimated annual number of hip fractures is expected to double between 2018 and 2050. The prevalence of vertebral or hip fracture in older men is approximately one-third that in women (5 to 6 percent versus 16 to 18 percent), and Colles' fracture one-sixth as common (2.5 versus 16 percent).