Osteoporosis

Medication Risk factors

Corticosteroids, Loop diuretics (hypocalcemia), Proton Pump Inhibitors (decreased Ca2+ absorption), Methotrexate

Used to measure Bone mass density

Dual Energy X-ray Absorptiometery DEXA

What value does DEXA provide?

T score

Normal BMD T score values

- 1.0 or above

Abnormal BMD T score

- 1.0 to - 2.5

T value for Osteroporosis

Less than - 2.5

Non-medication risk factors for Osteoporosis

Past bone fractures

Low body weight

Osteopenia (Precursor)

Women (especially over 50)

Postmenopause

Common bone fracture sites (why?)

Hip/Pelvis, Spine (Weight baring bones)

Pathophysiology of osteoporosis

Excessive Osteoclast activity ovewhelming Osteoblast activity

Difference between Osteoporosis and Paget’s diseae

Pagest has both hyper osteoclast (resorption) and Osteoblast (absorption) activity leading to weaker bones. Wherease Osteoporosis, osteoblast cannot (and doesn’t try to) keep up with osteoclast

Predicts 10 year score of having a fracture

FRAX (Fracture Risk Assessment Tool)

Other than BMD what else determines osteoporosis diagnosis

Fracture (not from traumtic accident) T score -1.0 to -2.5 plus a FRAX of > 3%

How does estrogen stabilize osteoclast?

Stabilizes HIF-1

Menopause leads to decreased ovary sensitivity to…

Decreased sensitivity to FSH and LH

What do z scores measure

Risk of premenopausal men and women for osteoporosis treatment without diagnosis

At what z score would you consider treatment for premenopause.

Less and or equal to -2.0

Recommended daily calcium intake

1200 mg

Elemental Carbon for Calcium Carbonate

40%

Elemental Carbon for Calcium citrate

21%

Vitamin D Supplement Possible Adverse Effects

Hypercalcemia, Kidney Stones, Calcification