Thompson 2

Question 1

Primary risk factors osteoporosis

Answer 1

• Women
• Less bone stock, smaller frames
• menopause
• liver longer
• increase with age

Question 2

Secondary causes

Answer 2

• Hypo gonadal

–> early menopause/late menarche

–> androgen insensitivity

–> over-training females

• Smoking
• Ethanol
• Sedentary lifestyle
• DIet (low Ca, low protein, SODA)
• MEDS (STEROIDS, seizure measure, Proton pump inhibitors, SSRI’s)
• GI = malabsorption
• Cancers, CHF, immobility, renal, liver disease,rheumatoid

Question 3

T and Z score

Answer 3

• T scores compares pts value to same sex healthy 30 y/o

–> SCORE THAT COUNTS

–> T score of 0 to -1.0 = NORMAL (20% hip fx in lifetime)

–> T score - 1.0 to - 2.5 = osteopenia (20-50% hip fx)

–> T score < -2.5 = osteoporosis; definitely tx

• Z score compres pt to person with same age, sex, race

Question 4

Prevention of osteoporosis

Answer 4

• Falls are a bigger risk than LOW BMD
• Gait training balance exercise, PT
• SMOKING CESSATION
• Moderate ETOH (small use)
• DIet at younger age
• Vit C and D foods, avoid soda, avoid caffeine, limit salt (push out Ca), too much soy/too much or too little protein

**EXERCISE benefits at all ages**

Question 5

treatment of osteoporosis

Answer 5

• Ca/Vit D

- Bisphosponates = first line treatment

• HRT and SERMS
• RANKL (biologic)
• Parathyroid

Question 6

Who needs testing?

Answer 6

• *ALL WOMEN 65 or OLDER**
• WOMEN under 65 whose 10 year risk factor of fracture is EQUAL to or greater than a 65 y/o

Question 7

WHo should be treated

Answer 7

• postmenopausla with hip fx
• T score < -2.5
• T score -1 to -2.5 and 10 yr probability of hip frature of 3% or risk of any major fracture 20%

Question 8

problems with bisphosphonates

Answer 8

• spendy (newer ones)
• GI/esophogitis issues
• very poor absorption so strict guidelines
• BONE PAIN

- JAW NECROSIS

• Poor compliance

- ATYPICAL FEMORAL FRACTURES