Osteoporosis

Osteoporosis How is osteoporosis characterized - Low bone density In which population is osteoporosis seen in - Postmenopausal women What is the most common complication of low bone density - Fractures Which areas of the body are prone to fracture - Spine - vertebrae Hip - proximal femur Wrist - distal forearm What is significant about spinal fracture - They can occur without falling and are initially painless, therefore, in many cases people don't know they have a fracture until they begin to lose height What is significant about hip fractures - They are the most devastating type due to higher disability and mortality as compared to other types of fractures What is significant about wrist fractures - They are more common in younger people and an early indicator of poor bone health RF for osteoporosis - Page 670 How is osteoporosis dx - By assessing bone health How is bone health examined - By evaluating BMD via DEXA/DXA scan (the gold standard) Or ultrasound but it is not preferred What does the DXA scan measure - It measures BMD and calculates a T-score or Z-score What does a T-score do - It compares the BMD of the patient to that of a younger, health, white person of the same gender A T-score at or above -1 means - The bones are stronger (denser) and less likely to fracture T-Score: Normal, osteopenia, osteoporosis - Normal: -1 and higher (towards positive numbers) Osteopenia: -1 to -2.4 Osteoporosis: -2.5 and lower When should people start getting a DEXA scan - Women 65+ Men 60 + What is a FRAX score - A tool used to estimate the risk of osteoporosis-related fracture within the next 10 years What factors are considered using a FRAX - Age Sex Height/ Weight Previous fractures Parental hip fractures Femoral neck BMD Smoking status Steroid use Alcohol intake Disorders related to osteoporosis Rheumatoid arthritis What disorders are associated with osteoporosis - T1D Chronic liver disease Premature menopause Which medications are associated with falling - Sedatives Those that cause orthostasis What is orthostasis - Light-headedness upon rising What drugs cause orthostasis - Antihypertensives Hypnotics Narcotics Psychotropics What conditions are associated with falling - Those that cause physical instability: PD + STK Impaired vision or hearing Urinary and fecal urgency What LSM can be made to increase bone density - Weight-bearing exercises (jogging, walking, tai chi) Strength training (lifting and yoga) In which populations is Ca critical - Children Pregnancy Years before menopause What can vitamin D deficiency lead to - Rickets (children) Osteomalacia (adults) What is osteomalacia - Softening of the bone What is the recommended daily dose of calcium - mg / day but not to exceed more than 500-600 mg of Ca per dose (divide the doses) What types of Ca can the patient take - Calcium carbonate or calcium citrate Calcium carbonate - TUMs Os-Cal Maalox Calcium Citrate - Cal-Citrate Citracal What is significant about calcium carbonate - It has more elemental Ca Requires an acidic environment for absorption - do not use PPI Must be taken with meals What is significant about calcium citrate - It has better absorption with an increased gastric pH Can be taken with or without food How much elemental Ca is in each type of calcium - Carbonate = 40% Citrate = 21% Calcium SE - Constipation 1g of each is equivalent to how much elemental Ca - Carbonate 400 mg Citrate 210 mg How do you know if the patient have Vitamin D deficiency - Serum Vitamin D < 30 Types of vitamin D - D2 (ergocalciferol) D3 (cholecalciferol) Vitamin D dose - D2 (ergocalciferol) - 1250 mcg (50,000IU) weekly D3 (cholecalciferol) - 125-175 mcg (IU) daily How long are patients treated with HD vitamin D - 8-12 weeks Which medications are used to Tx and Px osteoporosis - Px: Bisphosphanate (exc IV ibandronate), estrogen therapies, raloxifene and Duavee Tx: Bisphosphanate, denosumab, parathyroid hormone, and calcitonin What is the rule of thumb regarding treating osteoporosis - Treatment must include adequate Ca and Vit D How do you know when a patient should be treated - If they have osteoporosis or if they osteopenia and high risk What is the criteria for osteoporosis - T-Score </ = -2.5 in the spine, femoral neck, total hip or 1/3 radium OR The presence of a fragility fracture regardless of BMD What is a fragility fracture - A fall from standing height or lower that results in a fracture What is the criteria for osteopenia if high risk - Low BMD (T score -1 to -2.5) AND FRAX score that indicates a 10-year probability of a major fracture >20% or a 10-year probability of a hip fracture > 3%