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72 Cards in this Set
- Front
- Back
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what is the lifetime risk of spine, wrist and hip OP?
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20
12 18 |
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what are the three most common fracture sites in OP
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spine
hip wrist |
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by age 18, a woman has aquired how much of her skeletal mass
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85%
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how much bone loss occurs in the first 5-7 years PM and what is the annual average bone loss per year for the first five years PM
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20%
3-5% per year |
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is trabecular or cortical bone loss more prevelent
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trabecular
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what is the percentage of women with life long bone loss
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45 to 50%
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what is the cause of primary postmenopausal OP
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estrogen deficiency
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what are secondary causes of OP - most occur in men
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endocrine disease, metabolic disease
nutritional conditions medications |
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list some RF for OP or Fracture
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low bone density
age over 50 female caucasian or asian estrogen deficiency <45 years low testosterone in men parent with hip fracture personal history of fracture or OP low body weight history of low trauma fracture or agility fracture dementia low calcium or vitamin d frequent falls low activity ETOH >2 per day high caffiene |
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what medical conditions increase the risk of OP
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endocrine - increased PTH, synthroid, prolactin, low thyroid, gonadism, acromegaly
GI - IBS, celiac, malabsorption, bariatric Liver - ETOH, biliary sclerosing, autoimmune hepatitis dietary - anorexia, low vitamin d or calcium, high vitamin A, TPN Neuro - stroke, parkinson, MS, spinal cord injury Renal Disease Organ transplant |
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what medications are associated with reduced bone mass
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steroids
aromatase inhibitors - cancer GNRH - lupron immunosuppressents anticonvulsants cytotoxic agents depo lithium heparin PPI, SSRI, TZD |
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what are risk factors of OP for men
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low testosterone levels
steroid therapy smoking increased ETOH BMI <20 |
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what are major relative risk factors for OP
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age >70
menopause <45 hypogonadism fragility fracture hip fracture of parent glucocorticosteriods malabsorption anorexia low BMI immobilization renal failure transplant |
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moderate relative risk factors for OP
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estrogen deficiency
low calcium intake high PTH RA Anticonvulsants Hyperthyroidism DM Smoking ETOH |
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what are clinical consequences of vertebral fractures
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back pain
kyphosis respiratory or abdominal symptoms height loss loss of mobility and independence |
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what are some symptoms of a patient with vertebral fracture
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usually silent
sudden back pain, strain, bump or fall loss of height kyphosis chronic back pain abdominal pain, functional limitation |
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what are some physical exam tests for vertebral fractures
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stand against the wall, for thoracic - cannot put head against wall. for lumber place fingers around superior illiac crest, measure lower ribcage, if less than 2 fingers, increased RF for lumber fraction
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which fracture are the most serious consequence of OP
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hip
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BMD within one SD of a young adult is what
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normal
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BMD between -1 to -2.4 is what
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osteopenia
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BMD less than -2.5 is what
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osteoperosis
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what is a normal z score
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greater than -2, otherwise need to look at secondary causes
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what labs would you order to exclude secondary causes of OP
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CBC - cancer
BMP - DM, renal and liver TSH PTH if serum Calcium elevated Vitamin D Urinary excretion of calcium Free and total testosterone in men |
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at what age should you get a BMD test for women and men
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65 women
70 men |
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why would you order a BMD testing on somone under 65 years
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for one or more risk factors - other than being PM, Caucasian and female
those in PM transition or coming off HRT taking steroids on medications for OP |
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how often should you test BMD
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every 2 years
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when would you consider a VFA with a DEXA scan in PM women
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age over 70
historical ht loss 1.6in prospective ht loss 0.8 in self reported vertebral fracture or 2: age 60-69 years self report of non-vertebral fracture height loss 2 to 4 cm chronic systemic disease - COPD, arthritis, Crohns, RA |
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when would you order a VFA with a DEXA scan in Men
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age 80 years
historical ht loss - 2.4 inches self-reported vertebral fracture 2 of the following: age 70-79 years self reported non vertebral fracture historical ht loss 3-6cm on androgen deprivation therapy Chronic illness |
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what medication would cue you to order VFA with DEXA
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steroids >3months
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what is the FRAX score used for
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to calculate the 10 year probabilty of major OP fracture
if total >20% and hip >3% then treat |
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what are the WHO clinical risk factors for OP
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age
gender ethinicity weight height Previous low trauma fracture current cigarrette smoking family history of hip fracture sterods RA secondary OP high alcohol intake |
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when would you calculate a FRAX
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PM women over 50
to predict 10 year risk assessment must not be treated determine if you should treat the patient |
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do biochemical markers predict BMD scores
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no
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what are preventative measures for OP
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high calcium and vitamin d
weight bearing exercise avoid tobacco and ETOH, caffiene fall prevention and balance training |
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what is the recommended amount for vitamin d and calcium
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under 50 - 1g calcium
vitamin d 400-800iu over 50 - 1200 calcium vitamin d 800-1000iu |
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what is the goal of serum vitamin d
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30 ng/dl - if refactory assess celiac
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PM women and men over 50 years who present with what symptoms whould be treated for OP
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vertebral or hip fracture
DEXA t score less then -2.5 with excluded secondary causes other fractures - with low bone mass -1 to 2.4 Osteopenia and secondary causes identified osteopenia with FRAX over 20% and hip over 3% |
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what medication is only approved for prevention of OP
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HRT 24% overall reduction
34% reduction of vertebral and hip fracture slows bone loss |
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what are some risks of biphosphonates
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nausea
heart burn abdominal pain irritation or burning of the esophagus myalgia and arthralgia excreted through the kidney - no CKD dont give with low calcium work best with high vitamin D |
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how would you instruct a patient on the administration of taking biphosphanates
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8 oz with water
take nothing by mouth for at a half hour boniva - one hour before must stay upright for a half hour do not lay down |
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this biphosphonate medication is used for prevention and treatment and for all types of OP. Start at 5mg/day or 35mg/week for prevention and 70mg/week for treatment
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fosamax - alendronate sodium
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this biphosphanate medication is used for prevention and treatment, has less SE than fosamax, same dosing and used for all types of OP
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actonel - risedronate
enteric coated - Atelvia |
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this biphosphate can be given PO or IV 150mg monthly, used for treatment of vertebral fractures
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Boniva - ibandronate
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this medication is used for the prevention of OP given IV every 2 years of treatment every year IV, used for high risk fractures, pagets disease, must have high serum calcium and vitamin D
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reclast - zoledronic acid
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what are some adverse effects of Reclast
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headache
athralgia myalgia bone pain pyrexia flue symptoms acute symptoms - flu like symptoms are reported in 25% of patients - tylenol and motrin help symptoms |
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what is the most serious adverse effect of biphosphanages
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osteonecrosis of the jaw
increased with denal surgery, cancer patient prevention - good oral hygiene, let dentist know stop 2 months before and 2 months after dental procedure other SE - femur fractures - usually have bone/hip pain months before, with new onset bone pain, stop medication |
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what is the correlation with esophageal cancer and biphosphanates
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those with risk factors for esophageal cancer can still have IV form, or non-biphosphanate alternative, oral can increase risk
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This medication is approved for prevention and treatment of OP, it mimics estrogen in select tissue without stimulating breast or endometrial tissues
works on spine only |
Evista - Raloxifene
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What CHD benefits, side effects and dosing are for Evista
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benefits - decrease fibrinogen, cholesterol and LDL
SE - hot flashes, leg cramps, DVT risk and fluid retention - do not give in perimenopause 60mg/day |
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what is the correlation with breast cancer and Evista
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reduces risk of breast cancer by 72%, safter then tamoxifen
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this medication is approved for treatment only, produces analgesia effect on fractures, administered most common thru nasal spray
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calcitonin
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what is the dosage of nasal spray for calcitonin
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200iu/day
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this is a human parathyroid hormone, used only in treatment of PM OP or men with hypogonadism, used when other therapies do not work
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Forteo - teriparatide
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what is the dosage of Forteo
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20mcg SQ dial pen per day
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what are SE of Forteo
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nausea
transient hypotension hypercalcemia leg cramps dizziness |
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what labs do you have to monitor with Forteo
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vitamin D
PTH Calcium Phosphorus Creatnine |
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how long can a patient be on Forteo
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2 years
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what severe SE occurs with the use of Forteo
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osteosarcoma
caution with pagets elevated alk phos radiation pre-existing elevated calcium or PTH |
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this medication is used for developement of osteoclasts, decreasing bone reabsorption and increasing density. It reduces the incidence of all types of hip fractures in OP
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Prolia - denosumab
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what are the warnings of SQ Prolia
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skin infections, dermatitis
osteonecrosis of the jaw atypical femurs SE back pain and MS pain, high lipids and cystitis |
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what medications reduce non-vertebral fracture risk
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Fosamax
Actonel HRT Prolia Reclast Forteo |
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what medications prevent vertebral fractures
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Fosomax
Actonel HRT Forteo Boniva Evista Calcitonin Reclast Prolia |
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what medications are best for hip fracture prevention
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fosamax
actonel HRT Reclast Prolia |
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during annual follow ups on a patient with OP, what are you assessing?
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compliance of medications, side effects
physical therapy assess height kyphosis symptoms of vertebral fracture DJD acute back pain physical therapy vitamin d and calcium supplements |
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what is considered clinically significant on a DEXA scan, that shows medication is working
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no change or 5% increase in the spine
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dosage: 5mg/d or 35mg/week for prevention
10mg/d or 70mg/week for treatment |
fosamax, actonel
atelvia |
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150mg PO montly for treatment and prevention or 3mg IV every 3 months for treatment
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boniva
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this is IV 5mg/2years for prevention or yearly for treatment
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reclast
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60mg PO dialy for prevention and treatment
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evista
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this is 200IU nasal spray daily for treatment
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calcitonin
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this is 20mcg/d SQ for treatment
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forteo
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60mg SQ every 6 months for treatment
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Prolia
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