Osteoporosis and Osteosarcoma

When is the peak adult bone mass get reached?

Early 20’s to 30/35

When is the greatest amount of bone mass decline?

Immediately after menopause

What is osteopenia?

A bone condition characterized by bone loss that is not as severe as in osteoporosis

What is the definition of osteoporosis?

Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, resulting in decreased bone strength and increased risk of fracture

What is osteoporosis known as in the medical field?

Silent disease

When are symptoms first shown for osteoporosis?

First fracture

What is the rate of bone formation and bone resorption for osteoporosis?

Bone formation is normal and bone resorption is increased

What happens to the bone and structural integrity from osteoporosis?

Incapable of maintaining structural integrity of the skeleton due to depleted bone integrity

Name the four most common fractures from most to least frequent

Vertebral compression fracture, distal radial fracture, hip fracture, and pelvic fracture

What is the main cause distal radial fractures (Abbreviation)?

FOOSH

What does FOOSH stand for?

Fall on an outstretched hand

What kind of fracture is the most life changing?

Hip fracture

What gender is most susceptible to Osteoporosis?

Women

What is a pathologic fracture?

Fragility fracture

How much trauma is needed for a fragility fracture?

Minor trauma

What is used to treat fractures?

ORIF

What does ORIF stand for?

Open reduction and internal fixation

What is primary osteoporosis?

Bone loss that occurs during the normal human aging process

What is secondary osteoporosis?

Bone loss that results from specific, well-defined clinical disorders

What are the most common risk factors for osteoporosis (the four things he listed)?

Aging, taking corticosteroid, alcohol, and post menopausal

What is the main cause of secondary osteoporosis?

Taking corticosteroids

What medications increase your chance of osteoporosis?

Steroids, thyroid medications, hormone suppressants (Lupron), and cancer treatment

What medical conditions increase your chance of osteoporosis (One of my answerers are different than the packet, he misspelled something)?

Rheumatoid arthritis, eating disorder, hyperthyroidism, hyperparathyroidism, and osteogenesis imperfecta

What are all the symptoms of osteoporosis?

Asymptomatic

What is the quote from Rosen and Drezner about symptoms?

Osteoporosis has no clinical manifestation until there is a fracture. This is an important fact because many patients without symptoms incorrectly assume that they must not have osteoporosis.

What is the first kind of diagnosis for osteoporosis (diagnosis A)?

Fragility fracture, particularly at the spine, hip, wrist, humerus, rib, and pelvis

What is the second kind of diagnosis for osteoporosis (diagnosis B)?

T-score -2.5 or higher standard deviations at any site based upon bone mineral density measurement by DXA scan

When can a clinical diagnosis of osteoporosis?

If there is a elevated rick for fracture

Give me all the classifications and the T-score involved (classification T-score, classification T-score, …).

Normal -1.0 or greater, Osteopenia between -1.0 and -2.5, osteoporosis -2.5 or less, and severe osteoporosis -2.5 or less with fragility fracture

Give me to T-scores and when to repeat a DXA scan (T-score frequency, T-score frequency, …).

-1.0 to -1.5 every 5 years, -1.5 to -2.0 every 3-5 years, and under -2.0 every 1-2 years

What population is a T-score based on?

Young adult

What population is a Z-score based on?

Age-matched population

What is T-score and Z-score based on (from the patient, and no abbreviation)

Bone mineral density

What Z-score should prompt careful scrutiny for coexisting problems?

-2 or lower

What does DXA stand for?

Dual-energy x-ray absorptiometry

What is the gold standard for evaluation of bone density?

DXA scan

What are DXA scans used to determine the density of?

Lumbar spine and hip

What does a DXA scan deliver?

Negligible radiation with an accuracy that is considerate

What lifestyle factors contribute to bone loss?

Smoking, excessive alcohol, physical inactivity, and poor nutrition

Most of the conditions can causing osteoporosis can be excluded with a what?

Careful history and physical examination

What should be measured in a physical examination for osteoporosis?

Height and weight

What does FRAX stand for?

Fracture risk assessment tool

What does FRAX estimate?

10-year probability of hip fracture and major osteoporotic fractures for untreated patients between ages 40 and 90

X-rays are ___________ to the detection of osteoporosis unless very severe or if there is an acute fracture?

Very insensitive

What are the baseline laboratory tests that are performed to judge the risk of osteoporosis?

Thyroid function, vitamin D assessment, serum protein electrophoresis, 24-hour urine calcium, testosterone level, and LH and FSH

Where do we get vitamin D

Sun

What is vitamin D good for when dealing with osteoporosis?

Calcium absorption

Where do we absorb calcium for vitamin D?

Small intestine

Write the quote from the International Osteoporosis Foundation (I learned he likes to use names just like the way I worded this question, so make sure you know who wrote the thing, so you know what to write)

Osteoporosis, which literally means porous bone, (porous bone matrix) is a disease in which the density and quality of bone are reduced (bones are brittle, porous, and prone to fracture). As bones become more porous and fragile, the risk of fracture is greatly increased. The loss of bone occurs silently and progressively. Often there are no symptoms until the first fracture occurs.

What is the quote from Rosen and Drezner from UpToDate about diagnosis (I heard we need to know quotes, which they got one of last year, this one, and a few others are important due to boldness and highlighting)?

Early diagnosis and quantification of bone loss and fracture risk are important because of the availability of therapies that can slow or even reverse the progression of osteoporosis

What are the signs of a hip fracture?

One leg shorter and externally rotated

What is this?

Normal

What is this?

Colles fracture

What kind of fracture would this lead to?

Colles fracture

What is this?

Colles fracture

What is this?

Smith fracture

What is this?

Smith fracture

What is this?

Smith fracture

What does this show?

Vertebral compression fracture

What is this?

Growth plates

What is this?

Cast treatment

What is this?

External fixation

What is it called when you fix a distal radial fracture without opening the skin?

Closed reduction

What are the nutritional and lifestyle modifications that can be done to prevent osteoporosis?

Diet should be adequate in protein, total calories, calcium, and vitamin D, corticosteroid doses should be reduced or discontinued if possible, high impact physical activity (jogging) significantly increases bone density in both men and women, stair climbing increases bone density in women, weight training (increase muscle strength as well as bone density), and fall avoidance

List 5 high calcium foods (he asked this question as if it’s going to be an exam question, and you can remember this or other things if you find it easier).

Milk, yogurt, cheese, sardines, and salmon

What is the most important preventative lifestyle change for osteoporosis?

Fall avoidance

What are some things you can remove or be watchful for to decrease your chance of falling?

Loose rugs, cluttered floors, pets underfoot, wet or cracked paving, ice, and snow

What are things you can install and use to decrease your chance of falling?

Handrails on stairs, handholds in bathroom, and use of cane or walker

What are things you can do to decrease your chance of falling?

Balance exercises and avoiding smoking and alcohol

What increases your chance of falling?

Impaired vision (cataracts) and footwear with slipper soles or high heels

How long could an elderly patient fall down for until someone finds them?

Hours

What should you be concerned about when someone has fallen and laid down for hours?

Rhabdomyolysis

What is Rhabdomyolysis

Breakdown of damaged skeletal muscle

In rhabdomyolysis, what does the skeletal muscle breakdown cause?

Release of myoglobin into the bloodstream

In rhabdomyolysis why is too much myoglobin in the blood bad?

It can cause kidney damage

What does myoglobin do?

Stores oxygen in your muscles

What are three signs of rhabdomyolysis?

Dark or tea colored urine, increase BUN/Cr, and EKG changes

When should pharmacologic intervention happen in postmenopausal women and men 50 years and older?

History of hip or vertebral fracture, T-score of -2.5 or less at the femoral neck or spine (after appropriate evaluation to exclude secondary causes), and a T-score between -1 and -2.5 at the femoral neck or spine with a 10-year probability of hip fracture of 3% or higher or a 10-year probability of any major osteoporosis-related fracture of 20% or higher.

What is the first line of therapy for osteoporosis?

Bisphosphonates

Who is indicated for Bisphosphonates?

Patients with DXA of -2.5 or higher in spine, hip, or femoral neck or fracture of spine or hip

What is the MOA for bisphosphonates?

Inhibit osteoclast-induced bone resorption

What do bisphosphonates do for the person?

Increase bone density significantly and reduce the incidence of both vertebral and non-vertebral fractures

To ensure intestinal absorption when and how should bisphosphonates be taken?

In the morning with at least 8 ounces of water and at least 40 minutes before consumption of anything else

What are the three bisphosphonates?

Alendronate (Fosamax), Risedronate (Actonel), and Ibandronate sodium (Boniva)

What is the strength and frequency of Alendronate (Fosamax)?

70mg once weekly

What is the strength and frequency of Risedronate (Actonel)?

35mg once weekly

What is the strength and frequency of Ibandronate Sodium (Boniva)?

150mg once monthly

What route do bisphosphonates get taken?

Oral

What are the side effects of bisphosphonates?

Abdominal pain, heartburn, irritation of esophagus, anemia, and joint and muscle pain

What is Bisphosphonates helpful in preventing?

Corticosteroid induced Osteoporosis

What are all the pharmacological therapies for osteoporosis?

Bisphosphonates, vitamin D and calcium, calcitonin, SERMs, and estrogen/progestin therapy

Sun exposure and vitamin D supplementation are useful in preventing and treating what?

Osteomalacia

What must be added to vitamin D uptake to prevent and treat osteoporosis?

Calcium

What is the advised amount of vitamin D and calcium daily?

800mg of vitamin D and 1200mg of elemental calcium

How do you get vitamin D?

Synthesized in skin on exposure to sunlight and in foods

What are some foods that good for vitamin D uptake?

Egg yolks, fish, liver, cereals, milk, and OJ

What does vitamin D do to deal with Osteoporosis?

Absorbs calcium in the GI tract

Supplementation for calcium is recommended for what groups?

Those with low dietary intake of calcium, high risk for osteoporosis, and those with osteoporosis

What is calcitonin?

Antiresorptive medication

What does calcitonin do for people?

Reduces risk of vertebral body fractures