Term
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Definition
| bone density + bone quality |
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Term
| What is the precursor for an osteoblast? |
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Definition
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Term
| What is the precursor for an osteoclast? |
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Definition
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Term
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Definition
| a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture |
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Term
| Respectively approximately what percentages of men and women > 50 years of age will suffer at least 1 osteoporatic bone fracture in their lifetimes? |
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Definition
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Term
| Over _____ fractures each year in men and women > 50 years old. |
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Definition
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Term
| What non - medical conditions are risk factors for an osteoporatic fracture? |
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Definition
| Stunt Men (not) have a Proud HISTORY of being PAID FELLERs - (Small, thin frame), Smoking, Men < women, Postmenopausal, HISTORIES (personal HISTORY of osteoporosis, personal HISTORY of fractures as an adult, family HISTORY of low trauma fracture), Poor health, Advancing Age, Impaired I-sight despite correction, Dementia, Frequent Falls, Estrogen deficiency at an Early age (<45 years), Lifelong Low calcium intake, Low physical activity, Excessive alcohol intake, Race (caucasian or asian) |
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Term
| What medical conditions increase risk for an osteoporatic fracture? |
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Definition
| GOLDEN RAd - GI diseases, Organ transplantation, Liver diseases, Dietary disorders, Endocrine disorders, Neurological disorders, Renal disease, Autoimmune connective tissue disorders |
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Term
| What are the predominant secondary causes of osteoporosis in men? |
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Definition
| HAGGISH - Hypogonadism, Alcoholism, Glucocorticoid excess, GI disorders, Immobilization, Smoking, Hypercalciuria |
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Term
| What medications are associated with reduced bone mass? |
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Definition
| "HIDden GLACIEr" rated PG - long term Heparin use, Immunosuppressants, Depo-provera, Glucocorticoids (oral and high dose inhaled), Lithium, Aromatase inhibitors, Cytotoxic drugs, (Intravenous food) TPN use, Epilepsy drugs - anticonvulsants, PPIs, GNRH inhibitors (leuprolide) |
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Term
| How is glucocorticoid induced osteoporosis manifested? |
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Definition
| decreased osteoblast activity, increased osteoclast activity, decreased calcium absorption, increased calcium excretion, suppressed sex steroid production |
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Term
Women can lose up to ___% of their bone mass during the first 5-7 years following menopause
Researchers have shown that an average bone loss of ___-___% per year occurs during the first ___ years after menopause compared to almost no bone loss during postmenopausal years ___-___ |
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Definition
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Term
Prior Vertebral Fracture -
Increases vertebral fracture risk ___-fold
increase hip fracture risk ___-fold |
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Definition
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Term
Up to ___ of patients with a prior vertebral fracture will repeat a fracture within 3 years
Mortality is ___ after a fracture |
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Definition
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Term
Hip fracture - Most _____ consequence of osteoporosis
___-___% mortality rate during the year following a fracture - higher in _____
___% require nursing home care
After 6 months - only ___% can walk unaided
< ___% of hospitalized patients regain their pre-fracture confidence in activities |
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Definition
| serious, 10-24, men, 30, 15, 20 |
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Term
| What are the T-scores for normal BMD? |
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Definition
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Term
| What are the T-scores for low BMD or osteopenia? |
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Definition
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Term
| What are the T-scores for osteoporosis? |
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Definition
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Term
| What are the T-scores for severe osteoporosis? |
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Definition
| T-score <= -2.5 and a fracture |
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Term
| Which BMD is the best predictor of fracture risk? |
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Definition
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Term
| Who should have BMD testing done? |
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Definition
All women ages 65 and older
Younger postmenopausal women with one or more risk factors other than race, postmenopausal and female
Postmenopausal women who present with fractures
Anyone who is being treated for bone loss to monitor for efficacy |
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Term
| What are the markers of bone resorption? |
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Definition
| NTX, CTX, DPD, TRAP, OH-PRO |
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Term
| What are the markers fo bone formation? |
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Definition
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Term
| Who should look at bone turnover markers? |
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Definition
Patients with borderline treatment criteria
Starting drug therapy (baseline)
Monitoring for response of drug therapy (efficacy)
Patients with difficult to interpret BMD |
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Term
| Concerning osteopososis what are the treatment / prevention guidelines for everyone? |
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Definition
Counsel all patients on risk reduction
Instruct all patients on adequate daily intake of calcium and vit D
Provide guidelines for regular participation in weight-bearing exercise and muscle strengthening exercises
Provide strategies for fall prevention
Avoid smoking and excessive ALOH intake |
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Term
| What are the recommended daily allowances for calcium? |
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Definition
| 1-3 yo --> 500mg, 4-8 yo --> 800mg, 9-18 yo --> 1300mg, 19-49 yo --> 1000mg, >49 yo --> 1200mg (pregnant of lactating follow same age recommendations) |
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Term
| What is the approximate calcium in the following items: 8 oz. yogurt, 3 oz. sardines, 1.5 oz. cheddar cheese, 8 oz. milk, 6 oz. calcium fortified OJ? |
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Definition
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Term
| What is the approximate calcium in the following items: 1/2 cup turnip greens, 1/3 cup vanilla ice cream? |
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Definition
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Term
| What is the calcium range for fortified cereal? |
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Definition
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Term
| What is the calcium range for 8 oz. soy beverage? |
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Definition
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Term
| What are the recommended daily allowances for Vitamin D? |
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Definition
< 50 yo --> 400 - 800 IU
> 50 yo --> 800 - 1000 IU |
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Term
| What is the biologically active form of vitamin D? |
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Definition
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Term
| What serum concentration of biologically active vitamin D to promote asorption of calcium? |
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Definition
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Term
| Why is excercise recommended for bone health / fracture prevention? |
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Definition
Decrease risk of falling
Improve bone mass and strength
Enhance muscle strength
Improve balance and flexibility
Improve posture |
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Term
| What general exercise categories are recommended for bone health / fracture prevention? |
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Definition
| weight-training and resistance-training excercises |
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Term
| What are the excercise guidelines for those who already have osteoporosis? |
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Definition
Avoid exercises involving forward flexion of the spine
Avoid exercises that twist or jerk the spine
Keep one foot on the floor at all times
Balance training is essential |
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Term
| What are the drug categories used in osteoporosis treatment? |
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Definition
| HRT, SERM / raloxifene, calcitonin, parathyroid hormone, bisphosphonates |
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Term
| Estrogen is FDA approved for (prevention, treatment, both) of osteoporosis. |
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Definition
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Term
| What are the general objectives in osteoporosis prevention / treatment? |
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Definition
| inhibition of calcium resorption and stimulation of bone formation |
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Term
| Estrogen's primary effect on bone is (antiresorptive, proformation) activity. |
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Definition
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Term
| What are some important risks to consider when balancing risk / benefit of taking estrogens for osteoporosis? |
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Definition
4 Cs - Cancer of endometrium, breasts, ovaries
May cause increased cardiovascular problems
(clot throwing) thromboembolic disorders
Cholelithiasis (gall stones) |
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Term
FDA statement on estrogens for osteoporosis -
When prescribing medication to prevent osteoporosis, you should consider all _____ preparations first
When prescribing HRT, you should prescribe the _____ dose for the _____ time to achieve treatment goals
You should prescribe HRT products only when the benefits are believed to _____ the risks |
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Definition
| non-estrogen, smallest, shortest, outweigh |
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Term
| What does SERM stand for? |
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Definition
| Selective Estrogen Receptor Modulator |
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Term
| What is the only SERM that is FDA approved for postmenopausal osteoporosis? |
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Definition
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Term
| Where is raloxifene an agonist to estrogen receptors? |
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Definition
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Term
| Where is raloxifene an antagonist to estrogen receptors? |
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Definition
| endometrium, breast tissue |
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Term
| What is the frequency and dosing for raloxifene in osteoporosis? |
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Definition
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Term
| Raloxifene's primary effect on bone is (antiresorptive, proformation) activity. |
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Definition
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Term
| What are the primary adverse effects of raloxifene? |
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Definition
| increased risk of throboembolic disease and increased hot flashes |
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Term
| What are raloxifene's contraindications? |
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Definition
| pregnant or may become pregnant, active or past history of venous thromboembolic disease, hepatic dysfunction may need a dosage adjustment |
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Term
| (MIACALCIN) Calcitonin's primary effect on bone is (antiresorptive, proformation) activity. |
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Definition
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Term
Calcitonin acts directly on ____ to decrease bone _____ primarily from _____ sites.
Most effective on _____ spine. May increase BMD by 1-3% of trabecular bone but little effect on cortical bone
Decreases fractures of _____, but not _____ area. Effectiveness decreases after 1-2 years. |
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Definition
| osteoclasts, resorption, vertebral, lumbar, trabecular, cortical, spine, hip, 1-2 |
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Term
| What is the dosing and frequency for calcitonin in osteoporosis? |
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Definition
SQ or IM 100 IU QD
Intranasal 200 IU QD |
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Term
| Name the bisphosphonates (generic and brand). |
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Definition
Alendronate (Fosamax)
Risedronate (Actonel)
Ibandronate (Boniva)
Zoledronic Acid (Reclast) |
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Term
| Bisphosphonates are FDA approved for (prevention, treatment, both) of osteoporosis. |
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Definition
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Term
| t ½ of bisphosphonates may be ___-___ years |
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Definition
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Term
| Bisphosphonates' primary effect on bone is (antiresorptive, proformation) activity. |
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Definition
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Term
| What are the adverse effects of all bisphosphonates? |
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Definition
| tOUGH - Osteonecrosis of the jaw, Ulcer (esophageal and/or gastric), GI (pain, reflux, nausea, gastritis), Hypocalcemia |
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Term
| What should be done to minimize GI symptoms of bisphosphonates? |
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Definition
| Use PPI the night before the dose |
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Term
| Bisphosphonate patient education - Take at least ___ minutes before breakfast, Take with a full glass of _____ (Not with orange juice, coffee, mineral water or _____ products), Don’t lie down for at least ___ minutes, Do not take with _____ or _____, Report any _____, _____ or _____ problems, Missed doses : Daily - _____, Weekly – Next _____, Monthly – minimum of ___ day between doses |
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Definition
| 30, water, dairy, 60, calcium, minerals, esophageal, stomach, bowel, skip, morning, 7 |
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Term
| Bisphosphonates are (renally, hepatically) cleared. |
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Definition
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Term
| Which bisphosphonates have a formulation with supplemental vitamin D? |
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Definition
| only alendronate has a formulation with 5600 IU vitamin D QW |
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Term
| Which bisphosphonates have a QD dosing formulation? |
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Definition
| alendronate and risedronate (5mg PO) |
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Term
| Which bisphosphonates have a QW dosing formulation? |
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Definition
| alendronate and risedronate (PO) |
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Term
| Which bisphosphonates have a QM dosing fomulation? |
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Definition
| ibandronate and risedronate (PO) |
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Term
| Which bisphosphonates have a QY dosing fomulation? |
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Definition
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Term
| Which bisphosphonates have a formulation with supplemental calcium? |
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Definition
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Term
| What are the CrCl limits for the bisphosphonates? |
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Definition
| Alendronate avoid use with CrCl < 35, all others avoid use with CrCl < 30 |
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Term
| What special instructions are there for ibandronate QM and zoledronic acid QY? |
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Definition
| Ibandronate should be taken 60 minutes before meal, patient should be well hydrated before administering IV zoledronic acid |
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Term
| What side effects are we worried about specific to zoledronic acid? |
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Definition
| increased risk of serious atrial fibrilation, arrhythmias, chills, nausea, bone pain, back pain, and infusion related SE |
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Term
| What are the generic and brand names for prescription parathyroid hormone? |
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Definition
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Term
| Parathyroid hormone's primary effect on bone is (antiresorptive, proformation) activity. |
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Definition
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Term
| How is parathyroid hormone administered? |
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Definition
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Term
| Parathyroid hormone: Decreases the risk of vertebral fractures and non-vertebral fractures (during / after) ___ months of use, Indicated for men and _____ women with _____ and a _____ risk of _____ |
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Definition
| after, 18, postmenopausal, osteoporosis, high, fracture |
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Term
| What condition put you at "high" risk for fracture that wuold qualify a patient for indication of parathyroid hormone use? |
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Definition
Previous osteoporotic fracture
Multiple risk factors for fracture
Extremely low BMD (T score –3 and below)
Unresponsive or intolerant to other therapies |
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Term
| What is the mechanism of action for parathyroid hormone? |
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Definition
| decreases apoptosis of osteoblasts, stimulates differentiation of bone lining cells and preosteoblasts to osteoblasts resulting in a net increase in the number and action of bone forming osteoblasts |
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Term
| Continuous (high dose) PTH is associated with (anabolic / catabolic) effects. |
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Definition
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Term
| Daily (low dose) PTH is associated with (anabolic / catabolic) effects. |
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Definition
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