NURS 5462 Metabolic Bone Dz New Exam 100% Verified 2025
Postmenopausal Osteoporosis (OP) - ANSWER Menopause → ↓ Estrogen • 𝖳 osteoclast
activity → "high turnover" bone loss • 𝖳 calciumexcretion • ↓ calcium gut absorption
Bone loss accelerates 2-3 years prior to last menses and continues to accelerate until
3-4 years after menopause • Lose bone mass 2%/year initially for several years • Total
bone loss due to menopause → 7.7%
osteoclast-breakdown bone
Prevalence of Osteoporosis - ANSWER • 9.9 million Americans estimated to have OP •
55% of people aged 50 years and older • 43.1 million Americans estimated to have
osteopenia (low bone mass[LBM]) • 7% of women aged 50-59 years have OP • 35% of
women aged 80 years and older haveOP
Impact of Osteoporosis - ANSWER • 50% of women 50 years and older will break a bone
due to OP, • After a hip fracture • 12%-20% of women die in the following 2 years • >50%
of women are unable to return to independentliving • 20% require permanent nursing
home placement data even worse for men
Screening - ANSWER • Perform risk assessment (i.e., FRAX) starting at age 50 years, •
Bone density testing (dual-energy x-ray absorptiometry, DEXA) • In ALL women aged
≥65 years • In postmenopausal women aged <65 years who are at increased risk as
determined by a formal clinical risk assessment too
Imaging of the vertebrae in postmenopausal women and men aged ≥50 years with: -
ANSWER • Low trauma fracture since adulthood (aged ≥50 years) • Historical height
loss of ≥1.5 inches • Prospective height loss of ≥0.8 inches • Recent or ongoing
long-term glucocorticoid treatment
Risk Factors for Osteoporosis - ANSWER • Low BMD (not required to estimate risk),
Past/present glucocorticoid use • ≥3 months of prednisone 5 mg daily or equivalent
dose, • Alcohol intake of ≥3 drinks per day • Rheumatoid arthritis, • Low body mass
index
,Others not listed on FRAX: • - ANSWER Recent falls • Early menopause, ≤ age 45 • Low
dietary calcium intake • Vitamin D insufficiency or deficiency • Low physical
activity/immobilization • Neurologic impairment • Poor eyesight
Medications that Cause/Contribute to Osteoporosis - ANSWER • PPIs • SSRIs •
Glucocorticoids • Thiazolidinediones (pioglitazone) • Heparin • Tamoxifen
(premenopausal) • Lithium • Aluminum (antacids) • Aromatase inhibitors • Cyclosporine •
Depo-medroxyprogesterone • Tacrolimus • Barbiturates • Methotrexate • Cancer
chemotherapy • GnRH agonists (leuprolide, goserelin) • Thyroid hormones (in excess)
Atypical Femoral Fractures (AFFs) ANSWER • Documented with bisphosphonates,
denosumab, romosozumab and not on any treatment, risk is extremely low, • Treating
1000 women with OP with bisphosphonates for 3 years associated with 0.08 AFF cases
while preventing 100 fractures, • Managing risk • Patient to report prodromal thigh or hip
pain
Osteonecrosis of the Jaw (ONJ) - ANSWER Incidence 0.001% to 0.01% (similar to
general population), Most cases have been reported in patients with cancer who receive
high doses of intravenous (IV) bisphosphonates for the prevention of skeletal
complications of cancer: Risk factors •Treatment longer than 3 years •Maxillary or
mandibular bone surgery while on treatment •Poor oral hygiene •Poor fitting of dental
appliances •Diabetes •Glucocorticoid
Prevention in Women - ANSWER Ca19-50 1000 mg 2000 mg ≥51 1200 mg, Vit D<50
400-800 units 4000 units ≥50 800-1000 units-assuming Nl Vit D Lvl~35
Prevention - ANSWER • Regular weight-bearing and muscle-strengthening exercise •
Balance training • Assessment of fall risk—and offer appropriate modifications •
Smoking cessation and alcohol moderation (as applicable)
Diagnosis & Treatment—Postmenopausal Women - ANSWER T-score ≥ -1 (SD) Normal
No RX, T-score -1 to -2.5 (SD) Osteopenia (LBM) Yes, if FRAX score: • ≥3% at hip • ≥20%
for major OP-related fracture, T-score ≤ -2.5 (SD) OP Yes rx-NO dexa
, Bisphosphonates - ANSWER • Antiresorptive; binds to bone hydroxyapatite and inhibits
osteoclastmediated bone resorption
• Oral: take ≥30 minutes before food, medications, or beverage with full glass of water
(60 minutes for ibandronate boniva) • Remain upright for ≥30 minutes after dose (60
minutes for ibandronate)
• Renal dose cutoff • CrCl ≥30 mL/min: risedronate and ibandronate • CrCl ≥35 mL/min:
alendronate and zoledronic acid
Bisphosphonates • AEs - ANSWER Oral: abdominal pain, acid regurgitation,
constipation, diarrhea, dyspepsia, nausea, MSK pain • IV: flu-like symptoms 25% (usually
only after first infusion) consider pretreatment APAP
• Contraindications - ANSWER • Hypocalcemia • Hypersensitivity to any component •
Oral: abnormality of the esophagus which delays emptying (eg, stricture or achalasia) •
Not specifically mentioned as contraindication for risedronate • Oral: inability to
stand/sit upright for ≥30 minutes (60 minutes with ibandronate) • Oral: risk of aspiration
(alendronate oral solution/effervescent tablets)
Denosumab—Prolia, Xgeva - ANSWER • Antiresorptive; prevents RANK ligand from
binding to RANK receptors on osteoclasts, which inhibits formation, function, and
survival of osteoclasts and their precursors, • Correct Ca prior to denosumab use • If
advanced CKD or predisposition to hypocalcemia: check Ca, Mg, and P within 14 days
after injection, Important to give every 6 months
Denosumab—Prolia, Xgeva 1 - ANSWER • Drug holidays are not recommended • BMD
gains are rapidly lost with cessation—should not stop without subsequent treatment •
BMD returns to pretreatment levels within 24 months • Renal consideration • can give
with less renal function Stage 4 CKD (eGFR 15-29): 𝖳 BMD, no effect on fracture rates, 𝖳
risk of hypocalcemia • AEs • Hypocalcemia, infections (not statistically significant vs
placebo)
Parathyroid Hormone (PTH) - ANSWER Continuous elevation 𝖳 bone 𝖳 serum resorption
calcium
Pulsed/Daily elevation 𝖳 osteoblast proliferation, differentiation and survival 𝖳 BMD
Postmenopausal Osteoporosis (OP) - ANSWER Menopause → ↓ Estrogen • 𝖳 osteoclast
activity → "high turnover" bone loss • 𝖳 calciumexcretion • ↓ calcium gut absorption
Bone loss accelerates 2-3 years prior to last menses and continues to accelerate until
3-4 years after menopause • Lose bone mass 2%/year initially for several years • Total
bone loss due to menopause → 7.7%
osteoclast-breakdown bone
Prevalence of Osteoporosis - ANSWER • 9.9 million Americans estimated to have OP •
55% of people aged 50 years and older • 43.1 million Americans estimated to have
osteopenia (low bone mass[LBM]) • 7% of women aged 50-59 years have OP • 35% of
women aged 80 years and older haveOP
Impact of Osteoporosis - ANSWER • 50% of women 50 years and older will break a bone
due to OP, • After a hip fracture • 12%-20% of women die in the following 2 years • >50%
of women are unable to return to independentliving • 20% require permanent nursing
home placement data even worse for men
Screening - ANSWER • Perform risk assessment (i.e., FRAX) starting at age 50 years, •
Bone density testing (dual-energy x-ray absorptiometry, DEXA) • In ALL women aged
≥65 years • In postmenopausal women aged <65 years who are at increased risk as
determined by a formal clinical risk assessment too
Imaging of the vertebrae in postmenopausal women and men aged ≥50 years with: -
ANSWER • Low trauma fracture since adulthood (aged ≥50 years) • Historical height
loss of ≥1.5 inches • Prospective height loss of ≥0.8 inches • Recent or ongoing
long-term glucocorticoid treatment
Risk Factors for Osteoporosis - ANSWER • Low BMD (not required to estimate risk),
Past/present glucocorticoid use • ≥3 months of prednisone 5 mg daily or equivalent
dose, • Alcohol intake of ≥3 drinks per day • Rheumatoid arthritis, • Low body mass
index
,Others not listed on FRAX: • - ANSWER Recent falls • Early menopause, ≤ age 45 • Low
dietary calcium intake • Vitamin D insufficiency or deficiency • Low physical
activity/immobilization • Neurologic impairment • Poor eyesight
Medications that Cause/Contribute to Osteoporosis - ANSWER • PPIs • SSRIs •
Glucocorticoids • Thiazolidinediones (pioglitazone) • Heparin • Tamoxifen
(premenopausal) • Lithium • Aluminum (antacids) • Aromatase inhibitors • Cyclosporine •
Depo-medroxyprogesterone • Tacrolimus • Barbiturates • Methotrexate • Cancer
chemotherapy • GnRH agonists (leuprolide, goserelin) • Thyroid hormones (in excess)
Atypical Femoral Fractures (AFFs) ANSWER • Documented with bisphosphonates,
denosumab, romosozumab and not on any treatment, risk is extremely low, • Treating
1000 women with OP with bisphosphonates for 3 years associated with 0.08 AFF cases
while preventing 100 fractures, • Managing risk • Patient to report prodromal thigh or hip
pain
Osteonecrosis of the Jaw (ONJ) - ANSWER Incidence 0.001% to 0.01% (similar to
general population), Most cases have been reported in patients with cancer who receive
high doses of intravenous (IV) bisphosphonates for the prevention of skeletal
complications of cancer: Risk factors •Treatment longer than 3 years •Maxillary or
mandibular bone surgery while on treatment •Poor oral hygiene •Poor fitting of dental
appliances •Diabetes •Glucocorticoid
Prevention in Women - ANSWER Ca19-50 1000 mg 2000 mg ≥51 1200 mg, Vit D<50
400-800 units 4000 units ≥50 800-1000 units-assuming Nl Vit D Lvl~35
Prevention - ANSWER • Regular weight-bearing and muscle-strengthening exercise •
Balance training • Assessment of fall risk—and offer appropriate modifications •
Smoking cessation and alcohol moderation (as applicable)
Diagnosis & Treatment—Postmenopausal Women - ANSWER T-score ≥ -1 (SD) Normal
No RX, T-score -1 to -2.5 (SD) Osteopenia (LBM) Yes, if FRAX score: • ≥3% at hip • ≥20%
for major OP-related fracture, T-score ≤ -2.5 (SD) OP Yes rx-NO dexa
, Bisphosphonates - ANSWER • Antiresorptive; binds to bone hydroxyapatite and inhibits
osteoclastmediated bone resorption
• Oral: take ≥30 minutes before food, medications, or beverage with full glass of water
(60 minutes for ibandronate boniva) • Remain upright for ≥30 minutes after dose (60
minutes for ibandronate)
• Renal dose cutoff • CrCl ≥30 mL/min: risedronate and ibandronate • CrCl ≥35 mL/min:
alendronate and zoledronic acid
Bisphosphonates • AEs - ANSWER Oral: abdominal pain, acid regurgitation,
constipation, diarrhea, dyspepsia, nausea, MSK pain • IV: flu-like symptoms 25% (usually
only after first infusion) consider pretreatment APAP
• Contraindications - ANSWER • Hypocalcemia • Hypersensitivity to any component •
Oral: abnormality of the esophagus which delays emptying (eg, stricture or achalasia) •
Not specifically mentioned as contraindication for risedronate • Oral: inability to
stand/sit upright for ≥30 minutes (60 minutes with ibandronate) • Oral: risk of aspiration
(alendronate oral solution/effervescent tablets)
Denosumab—Prolia, Xgeva - ANSWER • Antiresorptive; prevents RANK ligand from
binding to RANK receptors on osteoclasts, which inhibits formation, function, and
survival of osteoclasts and their precursors, • Correct Ca prior to denosumab use • If
advanced CKD or predisposition to hypocalcemia: check Ca, Mg, and P within 14 days
after injection, Important to give every 6 months
Denosumab—Prolia, Xgeva 1 - ANSWER • Drug holidays are not recommended • BMD
gains are rapidly lost with cessation—should not stop without subsequent treatment •
BMD returns to pretreatment levels within 24 months • Renal consideration • can give
with less renal function Stage 4 CKD (eGFR 15-29): 𝖳 BMD, no effect on fracture rates, 𝖳
risk of hypocalcemia • AEs • Hypocalcemia, infections (not statistically significant vs
placebo)
Parathyroid Hormone (PTH) - ANSWER Continuous elevation 𝖳 bone 𝖳 serum resorption
calcium
Pulsed/Daily elevation 𝖳 osteoblast proliferation, differentiation and survival 𝖳 BMD
