3 typical characteristics of osteoporosis?
Low bone mass
Microarchitectural disruption
Skeletal fragility
Most common clinical manifestation of osteoporosis?
Vertebral Fx
3 clinical manifesttaions of osteoporosis in men?
Hypogonadism
Malabsorption
Hyperparathyroidism
In what circumstances could osteoporosis be made as a clinical Dx?
Fragility Fx (spine, hip, wrist, humerus, rib, pelvis)
T-score ? -2.5 SD upon BMD measurement by dual-energy x-ray absorptiometry (DXA)
BMD measurement if necessary in men in what circumstances?
Manifestations of low bone mass (osteopenia, Hx of low trauma Fx, loss of >1.5 inches in height)
Risk factors for Fx (long-term glucocorticoids, androgen deprivation therapy for prostate cancer, hypogonadism, primary hyperparathyroidism, intestinal disord
Fractures that occur from fall from a standing height or less, without major trauma
Fragility Fx
T-score by DXA = difference between:
Pts BMD and young-adult reference population BMD
Normal T-score
-1 SD of reference
A T-score of __________ = osteoporosis HIGH-RISK
<-2.5 SD of reference
A T-score of __________ = osteopenia
-1 to -2.5 SD of reference
Z-score = difference between:
Pts BMD and age-matched population BMD
Z-score of ______________ is considered below range for age
< -2
What BMD scoring criteria should be used for post-menopausal women and men >50 y.o.?
T-score criteria
When should T-score criteria NOT be used for BMD analysis?
Premenopausal women
Men <50 y.o.
What BMD scoring criteria should be used in children?
Z-scores
What 4 lab tests should be done on postmenopausal women?
BBCD
Biochemitry profile
BMD (if Dx determined by fragility Fx)
CBC
25-hydroxyvitamin D
What should be tested if lab tests in a woman show anemia, low vitamin D or low urinary Ca?
Test for celiac disease
What should be tested if lab tests in a woman show hypercalcemia?
Check for malignancy
What should be done to test Ca and creatinine if lab tests in a woman come back abnormal?
24-hr urine
What should be tested if lab tests in a woman show hypercalcemia, hypercalciuria, Hx of kidney stones or osteoopenia?
Serum PTH
The lab tests that should be done on men are the same 4 as women plus what additional?
Testosterone levels
If any of the lab testing comes back abnormal in men, markers of ________________ should be tested
Bone formation and resorption
What lab test should be done for a male presenting with hypogonadism?
Estradiol
What lab test should be done for a male presenting with systemic mastocytosis?
Serum tryptase
In the Tx of osteoporosis, optimal diet includes what 3 components?
Adequate intake of:
Calories
Ca
Vit D
Adequate Ca dietary intake in managing osteoporosis = ____________ mg/day
Inadequate intake needs ________________ mg/day supplement
How much vit D is needed?
1200
500-1000
800 IU/day
Which pts are candidates for medical Tx of osteoporosis?
Those at risk for Fx
- postmenopausal w/ Hx of Fx or OP
- high-risk (FRAX) post-menopausal w/ T-scores -1 to -2.5
- post-menopausal w/ osteopenia
Before medical Tx of OP, what should all pts have?
Normal serum Ca and Vit D levels
First-line therapy for medical Tx of OP?
Bisphosphonates - Alendronate/Risedronate
First-line therapy for medical Tx of SEVERE cases of OP?
Anabolic agent - PTH/PTHrP
- teriparatide first (2 yrs max) followed by denosumab
In monitoring the Tx of OP, how often should DXA be performed and where should it be performed?
DXA of hip and spine after 2 yrs
If BMD is stable/improved, then less often
In monitoring the Tx of OP, finding BMD decrease or a new Fx should trigger:
Additional evaluation
3 components that make up the Tx of OP in men?
Lifestyle modifications
Hormonal therapy
Pharmacotherapy
How do candidates for Tx and Tx guideline for OP differ in men vs. women?
They are the same
3 typical characteristics of osteoporosis?
Low bone mass
Microarchitectural disruption
Skeletal fragility
Most common clinical manifestation of osteoporosis?
Vertebral Fx
3 clinical manifesttaions of osteoporosis in men?
Hypogonadism
Malabsorption
Hyperparathyroidism
In what circumstances could osteoporosis be made as a clinical Dx?
Fragility Fx (spine, hip, wrist, humerus, rib, pelvis)
T-score ? -2.5 SD upon BMD measurement by dual-energy x-ray absorptiometry (DXA)
BMD measurement if necessary in men in what circumstances?
Manifestations of low bone mass (osteopenia, Hx of low trauma Fx, loss of >1.5 inches in height)
Risk factors for Fx (long-term glucocorticoids, androgen deprivation therapy for prostate cancer, hypogonadism, primary hyperparathyroidism, intestinal disord
Fractures that occur from fall from a standing height or less, without major trauma
Fragility Fx
T-score by DXA = difference between:
Pts BMD and young-adult reference population BMD
Normal T-score
-1 SD of reference
A T-score of __________ = osteoporosis HIGH-RISK
<-2.5 SD of reference
A T-score of __________ = osteopenia
-1 to -2.5 SD of reference
Z-score = difference between:
Pts BMD and age-matched population BMD
Z-score of ______________ is considered below range for age
< -2
What BMD scoring criteria should be used for post-menopausal women and men >50 y.o.?
T-score criteria
When should T-score criteria NOT be used for BMD analysis?
Premenopausal women
Men <50 y.o.
What BMD scoring criteria should be used in children?
Z-scores
What 4 lab tests should be done on postmenopausal women?
BBCD
Biochemitry profile
BMD (if Dx determined by fragility Fx)
CBC
25-hydroxyvitamin D
What should be tested if lab tests in a woman show anemia, low vitamin D or low urinary Ca?
Test for celiac disease
What should be tested if lab tests in a woman show hypercalcemia?
Check for malignancy
What should be done to test Ca and creatinine if lab tests in a woman come back abnormal?
24-hr urine
What should be tested if lab tests in a woman show hypercalcemia, hypercalciuria, Hx of kidney stones or osteoopenia?
Serum PTH
The lab tests that should be done on men are the same 4 as women plus what additional?
Testosterone levels
If any of the lab testing comes back abnormal in men, markers of ________________ should be tested
Bone formation and resorption
What lab test should be done for a male presenting with hypogonadism?
Estradiol
What lab test should be done for a male presenting with systemic mastocytosis?
Serum tryptase
In the Tx of osteoporosis, optimal diet includes what 3 components?
Adequate intake of:
Calories
Ca
Vit D
Adequate Ca dietary intake in managing osteoporosis = ____________ mg/day
Inadequate intake needs ________________ mg/day supplement
How much vit D is needed?
1200
500-1000
800 IU/day
Which pts are candidates for medical Tx of osteoporosis?
Those at risk for Fx
- postmenopausal w/ Hx of Fx or OP
- high-risk (FRAX) post-menopausal w/ T-scores -1 to -2.5
- post-menopausal w/ osteopenia
Before medical Tx of OP, what should all pts have?
Normal serum Ca and Vit D levels
First-line therapy for medical Tx of OP?
Bisphosphonates - Alendronate/Risedronate
First-line therapy for medical Tx of SEVERE cases of OP?
Anabolic agent - PTH/PTHrP
- teriparatide first (2 yrs max) followed by denosumab
In monitoring the Tx of OP, how often should DXA be performed and where should it be performed?
DXA of hip and spine after 2 yrs
If BMD is stable/improved, then less often
In monitoring the Tx of OP, finding BMD decrease or a new Fx should trigger:
Additional evaluation
3 components that make up the Tx of OP in men?
Lifestyle modifications
Hormonal therapy
Pharmacotherapy
How do candidates for Tx and Tx guideline for OP differ in men vs. women?
They are the same