Term
| The most common bone diseases are... |
|
Definition
| Osteoporosis and hyperparathyroidism |
|
|
Term
| At what age do you start to lose bone? |
|
Definition
|
|
Term
| Why is osteoporosis more common in women than men? |
|
Definition
| Men lose bone less rapidly and lay down more bone early on |
|
|
Term
| Why do black women have a higher risk of mortality than white women when presenting with a fracture? |
|
Definition
| Black female presents 10yrs later, is more likely to be older, and has more comorbidities than white females |
|
|
Term
| What bone is most metabolically active? |
|
Definition
| Spine. First to fracture, first to heal. |
|
|
Term
| How does physical activity build more bone? (2) |
|
Definition
| More pressure causes more bone to be laid down. Pulling on tendon causes undifferentiated cells to differentiate into osteoblasts. |
|
|
Term
| What protein inhibits RANKL? |
|
Definition
|
|
Term
| How is estrogen protective against bone loss? |
|
Definition
| Estrogen inhibits RANKL, inhibits cytokine oroduction that would recruit osteoclasts |
|
|
Term
| Why are post menopausal women at a higher risk for osteoporosis? |
|
Definition
| Less estrogen. Skin changes causes less absorption of sunlight and decreased vitamin D production |
|
|
Term
| Risk factors for osteoporosis |
|
Definition
| Post menopausal white female, smoking, no sunlight, no activity, poor diet (no calcium, high salt), alcohol, coffee, nulliparity, thin, family hx, personal hx |
|
|
Term
| At the same bone density, Asians are [more/less] likely than white women to get a fracture? Why? |
|
Definition
| Less likely bc bone length is shorter in Asian women |
|
|
Term
| Secondary causes of osteoporosis |
|
Definition
| Steroids, disease, hyperhyroidism, hypogonadism, hyperparathyroidism, hypopituitarism |
|
|
Term
|
Definition
| Provides strength, specifically resorbed by osteoblasts, restored by calcitonin |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| # of standard deviations below or above leak bone mass in young adults |
|
|
Term
| If T score goes down by 1, then your risk of fracture... |
|
Definition
|
|
Term
|
Definition
| # of standard deviations above or below the peak bone mass of a peer |
|
|
Term
| If a post menopausal pt presents with a Z score of -2, what do you suspect? |
|
Definition
| Secondary cause of osteoporosis |
|
|
Term
| Where does a spinal fracture occur? |
|
Definition
|
|
Term
| Where is a fracture likely to occur in the first decade post menopause? 2nd decade? 3rd decade? |
|
Definition
| Thoracic spine, upper lumbar spine, lower lumbar spine |
|
|
Term
| 82yo female presents with a fracture. Where is this most likely located and what are her co-presentations? |
|
Definition
| Anterior wedge fracture in lower lumbar spine, loss of height, kyphosis |
|
|
Term
|
Definition
|
|
Term
| How do you screen women for osteoporosis? |
|
Definition
| Measure BMD of proximal femur every 2yrs starting at 65yo or earlier if pt has a risk factor |
|
|
Term
| What tests do you use to rule out secondary causes of osteoporosis? |
|
Definition
| CBC, serum Ca, serum phosphate, creatinine, alkaline phosphatase, TSH, LFTs |
|
|
Term
| What test do you order if you suspect hyperparathyroidism? |
|
Definition
|
|
Term
| What test do you order if you suspect multiple myeloma? Cushing's? Vitamin D deficiency? |
|
Definition
| Protein electrophoresis, plasma free cortisol, 25-OH vitamin D |
|
|
Term
| MOA and efficacy of raloxifene |
|
Definition
| Selective estrogen receptor modulator, estrogen analogue, may be breast cancer protective, reduces risk of vertebral fractures but not hip fractures |
|
|
Term
| MOA and efficacy of calcitonin |
|
Definition
| Increases horizontal trabecular, does not increase BMD, decreases risk of vertebral fractures only |
|
|
Term
| MOA, indications, and pharmacokinetics for bisphosphonates |
|
Definition
| Inhibit resorption by inhibiting osteoclasts. For post menopausal women. Poor absorption, must be ingested without food and sitting up, stored in bone long term. |
|
|
Term
|
Definition
|
|
Term
| Teraparatide MOA and efficacy |
|
Definition
| Increases BMD, inhibits mineralization, decreases risk of vertebral fractures only |
|
|
Term
|
Definition
|
|
Term
| What is used to estimate 10y probability of a hip fracture? |
|
Definition
|
|
Term
| 35yo premenopausal female presents with a fracture. She has a hx of easy bruising, peptic ulcer disease, hypertensionm and diabetes type 2. Dx? Workup? |
|
Definition
| Cushing's. Urine free cortisol. |
|
|
