pathophys
At what age is maximum bone density achieved
What is age 18-25
Describe the standard age to begin screening and the frequency per USPFTF
What is age 65 in women and every 2 years or greater?
The length of treatment time with bisphosphonates in low risk patients
What is 5 years?
Describe alendronate dosing options and correct administration
Available as once weekly (70 mg) or 10 mg daily
Administer: give with water 30 minutes before first food and avoid lying down for 30 minutes (avoids GERD adv. effect)
Name 3 modifiable lifestyle risk factors
What are stop smoking, drink less alcohol and exercise more, eat more calcium containing foods
Which gender has greater mortality from hip fracture
What is male?
Describe the USPSTF bone density screening recommendation for males?
What is I (Insufficient evidence to recommend) screening men over 70 with risk factors?
What percent of people with hip fractures will die within a year
What is 30% (credit for +/- 5%)
This treatment involves twice yearly injections and has this contraindication found on BMP
What is denosumab (prolix) with the contraindication of hypocalcemia?
Two home modifications that are useful are:
What are decrease throw rugs and increase handrails
A severe deficiency in Vitamin D that leads to osteoporosis is known as a. in children b. in adults (pls give 2 answers)
What are rickets and osteomalacia?
Please give the definition and significance of the T score on the DEXA report
What is the bone density compared to a young adult when compared to women and men (over age 50)
Osteoporosis T score <-2.5
Osteopenia T score -1.0 - -2.5
What is the screening interval for DEXA scan while patients are on treatment
What is no screening?
Which drugs decrease fracture risk at hip, vertebral and non-vertebral areas. Name 4
What are:
Bisphosphonates: alendronates, risendronate, zolendrinic acid
Denosumab and teriparatide
Explain calcium intake recommendations
What is get 1000-1200 mg calcium in your diet, but no supplements (and this is an uncertain recommendation based on available evidence)
The typical posture of someone with osteoporosis and its cause
What is kyphosis due to anterior vertebral compression fractures
What are the 2 recommendations of the FRAX score and describe their significance
What is commence treatment if >3% risk of fracture at hip and >20% risk of fracture at other sites
This medication decreases vertebral fractures, but not hip fractures
What is ibandronate (Boniva)?
Which drug improves vertebral fracture risk reduction but not hip fracture risk reduction and is associated with thromboembolism and is no longer recommended for treatment?
What is the SERM raloxifine (was used for breast cancer prevention)
Explain Vitamin D intake recommendations
What is taking supplements in the 800-1000 IU range (another uncertain recommendation)
Describe the pathophysiology of osteoporosis with respect to bone remodeling and the cells involved
What is when bone resorption (osteoclast cells) outpaces bone formation (osteoblast cells) resulting in decreased bone density?
please describe there defintion and significance of the Z score on the DEXA report
What is bone density compared to age matched norms. A score of >-2.0 indicates osteoporosis in people age 50 and under.
Name 4 diseases and 3 meds that are associated with secondary osteoporosis
epilepsy, parkinson's, copd, endocrine d/o - hyper: parathyr, thyroid, prolactinemia, cushings, GI disorders with malabsorption: ibd, celiac, sickle cell, multiple myeloma, nutritional disorders, CKD, RA, SLE
AED, chemo, glucocorticoids, depo provera, heparin, lithium, PPI, tamoxifen
This treatment for osteoporosis involves daily injections and a specific contraindication found on the BMP
What is teriparatide (recombinant human parathyroid hormone) FORTEO - 20 mug SQ daily for up to 2 years. Contraindication is hypercalcemia
The lifestyle recommendation that is the most worthwhile for osteoporosis prevention
What is weight bearing exercise?