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4 Cards in this Set

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Osteoporosis: Definition, Fragility Fractures, Factors Affecting Bone Strength, Fracture Risk Assessment, Treatment Thresholds
1. Definition: skeletal disorder of compromised bone strength that predisposes person to fractures
2. Fragility Fracture: caused by minimal trauma/fall from standing height that affects wrist/vertebra/hip>humerus/pelvis/ribs
3. Factors Affecting Bone Strength: bone quality (architecture,turnover,damage accumulation,mineralization), bone density (peak bone mass,age,genetics,lifesyle,illness)
4. Fracture Risk Assessment: Risk Factors [age, gender, lifestyle (diet,exercise,smoking,alcohol,caffeine), diseases/drugs, family history], CAROC (10yr risk based on DEXA and age, low/moderate/high risk), FRAX (10yr risk based on age,gender,risk factors)
5. Routine Investigations: CBC, creatinine, AST/ALT, calcium, magnesium, phosphate, albumin, ALP
6. Specific Investigations: serum protein electrophoresis (multiple myeloma), vitamin D, celiac screen, TSH, 24hr urine calcium, xrays (thoracolumbar, DEXA)
7. Treatment Thresholds: Calcium+Vit. D+lifestyle (low risk <10%), Calcium+Vit.D+lifestyle+pharmacologic intervention (high risk >20% all fractures, >3% hip fracture)
Factors that Increase Fracture Risk: Diseases, Drugs
1. Diseases: Hyperparathyroidism, hyperthyroidism, hypogonadism, malabsorption/malnutrition, rheumatoid arthritis
2. Drugs: glucocorticoids, anticonvulsants, heparin, anti-estrogens/androgens, SSRIs, PPIs
Osteoporosis Therapies: Lifestyle, Hip Pad, Calcium/VitD, Pharmacologic, Denosumab MOA
1. Lifestyle: wt loss, stop smoking, reduce alcohol, reduce caffeine, reduce carbonated drinks
2. Hip Pad: prevents fracture in small people
3. Calcium/VitD: 1200mg/day calcium, 800-2000U/day vitD
4. Pharmacologic: anti-resorptive (bisphosphonates, SERMs, hormone therapy, calcitonin, denosumab), anabolic therapy (teriparatide)
5. Denosumab MOA: blocks RANKL which is needed for osteoclast activity
Bisphosphonates: Examples, Indications, Contraindications
1. Examples: oral (etidronate,alendronate,risedronate), IV (zoledronate,pamidronate)
2. Indications: moderate and high 10 year fracture risk in women (also consider fragility fractures,glucocorticoid use, multiple fall risk factors, diseases/drugs), high 10 year fracture risk in men (also consider fragility fractures and glucocorticoid use)
3. Contraindications: inability to follow dosing, active upper GI disease, renal dysfunction, hypocalcemia, low vitD