Osteoporosis

Front 1

Calcitonin is secreted by ____.

It's function is to ___ (4)

Back 1

parafollicular C cells of the thyroid

- stimulates osteolysis by osteoclasts
- increases renal tubular reabsorption of calcium (and magnesium)
- decreases renal tubular reabsorption of phosphate
- increases synthesis of calcitriol in the kidney

Front 2

Parathyroid hormone is secreted by ___.

It's function is to ___ (4)

Back 2

parathyroid gland.

- inhibits bone resorption
- increases renal excretion of calcium and phosphate

Front 3

Calcitriol is ___ and its job is to ___.

Back 3

- activated vitamin D

- enhances intestinal absorption of calcium and phosphorus
- calcium mobilization in bone (with PTH)
- renal tubular reabsorption of calcium (with PTH)
- other physiological actions such as activating fast twitch muscle fibers (eg. in fall prevention)

Front 4

Osteoporosis - Following a hip fragility fracture, ___ % of women and ___ % of men die within 1 year.

Back 4

- 28%
- 37%

Front 5

Osteoporosis - Prevalence over 50 years old is 1 in ___ for women and 1 in ___ for men.

Back 5

- 4
- 8

Front 6

Osteoporosis - Both women and men begin to lose bone in their ___

Back 6

- mid 30s

Front 7

Osteoporosis - Pattern of bone loss is ____.

Back 7

- Biphasic (first phase is age dependent, second phase is post menopausal)

Front 8

Osteoporosis - Initial bone density is influenced by ___ (4).

Back 8

1. Race
2. Heredity (big vs small, heavy vs light)
3. Gender
4. Calcium intake during growth

Front 9

Osteoporosis - Races such as ___ (2) have thinner bones while ___ have thicker bones.

Back 9

- Caucasians and Asians

- Blacks

Front 10

Osteoporosis - Early menopause is before age ___

Back 10

45

Front 11

Osteoporosis - Secondary causes can be ___ (5)

Back 11

- primary hyperparathyroidism
- hyperthroidism
- Cushing's syndrome
- malabsorption syndrome
- chronic inflammatory diseases (eg RA)

Front 12

Osteoporosis - Drugs that can cause it are ___ (6)

Back 12

- glucocorticoids (~12% bone loss/yr on prednisone)
- anticonvulsants (AC affect vit D metabolism)
- thyroid hormone
- anticoagulants
- antineoplastics
- thiazolidinediones (glitazones)
- proton pump inhibitors (changes in gut function)
- vitamin D toxicity
- vitamin A excess

Front 13

Osteoporosis - When seeing synthroid ___ mcg, one should be concerned about osteoporosis in elderly.

Back 13

-100mcg

Front 14

Osteoporosis - Risk factors for low BMD, fractures and falls (8):

Back 14

- Prior fragility fractures
- High alcohol intake (≥3 units per day)
- Parental hip fracture
- Rheumatoid arthritis
- Glucocorticoid use
- Falls in the previous 12 months
- Current smoking
- Gait and balance

Front 15

Osteoporosis - Recommended lab tests

Back 15

Calcium, corrected for albumin Thyroid stimulating hormone (TSH)
Complete blood count
Creatinine
Alkaline phosphatase
Serum protein electrophoresis for patients with vertebral fractures
25-hydroxy vitamin D (25-OH-D)

Front 16

Osteoporosis - Optimum level of 25-OH Vit D is ___.

Back 16

75 nmol/L

Front 17

Osteoporosis - Prolonged glucocorticoid use for anyone is considered to be ____(amount) for over ____(time) in prior year.

Back 17

7.5mg prednisone equivalent daily

3 months

Front 18

Osteoporosis - The way to measure BMD is through ___. If that is not available another option is ___.

Back 18

- Dual x-ray absorptiometry (DXA)

- Heel ultrasound

Front 19

Osteoporosis - One Canadian risk assessment tool is the ___. It is based on ____(3).

Back 19

CAROC 10 year fracture risk tool.

Age, gender, and BMD at femoral neck.

Front 20

Osteoporosis - ___ will move an individual to the High risk category of CAROC automatically, irrespective of BMD.

Back 20

Hip or Vertebral hip fracture over age 50.

Front 21

Osteoporosis - ___ will move an individual to one higher up category of CAROC.

Back 21

Glucocorticoid therapy or non-hip/vertebra fragility fracture

Front 22

Osteoporosis - An alternative to CAROC designed by the WHO is ___. It involves BMD measurement at the ___.

Back 22

FRAX 10 year risk.

femoral neck

Front 23

Osteoporosis - Screening tool used for osteoporosis, it cannot be used for diagnosis: ___.

Back 23

Quantitative ultrasound

Front 24

Osteoporosis - Non pharmacologic choices (4)

Back 24

- Regular weight bearing exercise
- Reduce risk of falling: minimize hazards on way to bathroom, adequate lighting, assess drugs such as BZD and other psychotropics, wearing a hip protector
- Smoking cessation
- Adequate vit D and calcium
- Stop excessive alcohol (>2 drinks/day) and caffeine (>4 cups/day)

Front 25

Osteoporosis - Recommended calcium per day is ___.

Back 25

1200mg

Front 26

Osteoporosis - Recommended Vit D per day is ___.

Back 26

800-2000 IU.

Front 27

Osteoporosis - Bisphosphonates belong to ____ class.

Back 27

Anticatabolic

Front 28

Osteoporosis - Oral bisphosphanates are (3)

Back 28

ARC:
Alendronate
Risedronate
Cyclical Etidronate

Front 29

Osteoporosis - IV bisphosphanate is ___

Back 29

Zoledronic acid

Front 30

Osteoporosis - If one eats any kind of food during the day, intake of calcium is estimated to be ___ mg.

Back 30

300

Front 31

Osteoporosis - A cup of milk or yogurt, and a chunk of cheese has approximately ___ mg of calcium. Ice cream a cup has about ___ mg.

Back 31

300

160

Front 32

Osteoporosis - Instructions how to take oral bisphosphonates

Back 32

- Due to low absorption in GI, must be taken on empty stomach and only with water 30 minutes before 1st food of the day.
- Do not lie down or recline within 30 minutes of taking the medication.
- Do not take other vitamins or medications within half hour of taking bisphosphonate.

Front 33

Osteoporosis - Dose schedule of cyclical etidronate

Back 33

- 2 weeks every 3 months = etidronate
- The other 76 days is elemental calcium 500mg.

Front 34

Osteoporosis - Zoledronate is administered once every ___ by IV infusion.

Back 34

Year

Front 35

Osteoporosis - Side effects/Risks of bisphosphonate therapy

Back 35

NEATO:
- Nighttime leg cramps
- Esophageal ulceration
- Atypical fractures
- Taste is altered
- ONJ - osteonecrosis of the jaw (1-3%)

Front 36

Osteoporosis - Calcium carbonate is ___ % elemental calcium. (Should/Should not) take with food.

Back 36

40%

With food, as food will increase stomach acid (concern for ppi users).

Front 37

Osteoporosis - Calcium citrate is ___ % elemental calcium. (Should/Should not) take with food.

Back 37

21%

Doesn't matter because citrate is so soluble.

Front 38

Osteoporosis - Calcium side effects

Back 38

Constipation more of an issue with carbonate (brand specific)
Upset stomach

(brand specific)

Front 39

Osteoporosis - Calcium interaction with iron? (Yes/No).

Back 39

Yes. Calcium reduces iron absorption. Should space calcium apart from iron by 2 hours.

Front 40

Osteoporosis - Caclium interaction with levothyroxine? (Yes/No)

Back 40

Yes. Calcium reduces bioavailability of synthroid by one third. Space them out by 4 hours.

Front 41

Osteoporosis - Calcium DI with ___ (5)

Back 41

BC LIT:
- Bisphosphonates
- Ciprofloxacin
- Levothyroxine
- Iron
- Tetracycline

Front 42

Osteoporosis - first biologic agent approved for treatment of osteoporosis. What is it's category?

Back 42

Denosumab.

RANK ligand inhibitor. Blocks osteoclast activity.

Front 43

Osteoporosis - SERM example

Back 43

Raloxifine.

Estrogen antagonist in breast and uterine tissue but estrogen like activity in bone/lipid metabolism.

Front 44

Osteoporosis - Anabolic agents (2)

Back 44

- Teriparatide (PTH analog)
- Recombinant human PTH

Front 45

Osteoporosis - First line treatment for established osteoporosis (ie. fragility fracture and BMD in range)

Back 45

- Bisphosphonates
- Denosumab
- Estrogen
- Teriparatide