What happens to excess calcium that is not absorbed into the bone?
excreted through the kidneys
what are the 3 cells of the bone?
1.) osteocytes
2.) osteoblasts
3.) osteoclasts
what are Osteoblasts?
bone-producing cells
What cell is responsible for bone remodeling?
osteoclasts
What bone cell has multi-nucleated cells that contain and secrete calcium-dissolving acids?
osteoclasts
What are the 2 major types of bone?
cortical
trabecular
what is cortical bone
dense, tightly aligned
compresses in a limited number of directions (ex. skull and femur shaft)
where is trabecular bone found?
locations that receive either low mechanical stresses or multi-directional stresses (femoral head, calcaneus)
what are 3 ways to characterize bone for DXA?
1 weight bearing/ non weight bearing
2 axial/ appendicular
3 central/ peripheral
Which bones are weight bearing?
spine and lower extremities (including calcanious)
which bones are part of the axial skeleton?
skull, ribs, sternum and spine
which bones are part of the appendicular skeleton?
all extremeties
What part of the skeleton is a central site?
thoracic and lumbar spines
proximal femure
what is included in the peripheral skeleton sites?
calaneus, tibia and forearm
at what age range is peak bone mass reached?
30-35 yr
peak bone mass is generally ___% higher in men than women
30%
age related bone loss in men happens ___-___ years later in life than in women
10-15
in a mature adult about ___% of trabecular bone is renewed on an annual basis
25
in a mature adult about ___% of cortical bone is renewed on annual basis
3
about ___% of bone surface is resting at any given time
90
what happens when osteoclasts become active?
they create small cavities in the bone surface
most of the adult skeleton is ___ every 10 years
replaced
what are the 3 calcium-regulating hormones?
Parathyroid hormone (PTH)
Calcitrol (active vitamin D)
Calcitonin
which systemic hormones regulate bone growth?
growth hormone/ insulin-like hormone
growth factor
thyroid hormone
cortisol
which hormone increases intestinal absorption of calcium?
calcitriol
What hormone in small amounts is necessary for normal bone development but in large amounts blocks growth?
cortisol
what is a synthetic form of cortisol?
glucocorticoids
highest stress impacts occur to the ______ due to compression loading
vertebral spine
what are the 2 alternate imaging modalities for 3-D evaluation of trabecular bone
micro-computed tomography (mCT)
MRI
what is microdamage?
fatigue to bone that occurs from daily physiologic loading to the skeleton
how many bones are in the axial skeleton?
80
how many bones are in the adult appendicular skeleton
126
what are the shape classifications of bones?
long
short
flat
irregular
what is Arthrology
study of joints or articulations
what are the common functional classifications of joints?
synarthosis
amphiarthrosis
diarthrosis
synarthrosis-
immovable joint
amphiarthrosis-
limited movement joint
diarthrosis-
freely movable joint
what is the definition of a structural classification
based on the type of tissue that separates the ends of the bone
what are the 3 structural joint categories
fibrous
cartilaginous
synovial
Fibrous joint-
lacks a joint cavity and adjoining bones are held together by fibrous connective tissue
Cartilaginous joints-
lack a joint cavity and are only slightly movable.
Synovial joints-
freely movable with a fibrous capsule containing synovial fluid
The development of critical thinking skills allows imaging professionals to:
D) all of the above
Today, in the US ___ million people already have osteoporosis.
D) 10
and almost 34 million more have low bone mass
Nearly 1 in 5 hip fracture patients end up in a nursing home.
a) True
b) false
a) true
Experts predict that by 2025, the direct care expenditure costs in the US will rise to approximately ___ billion
B) 25
All of the following are calcium regulating hormones except:
C) insulin
Insulin-Like growth factor (IGF-1) is produced in large amounts int the:
A) liver
IGF-1 is produced in large amounts in the liver and locally produced in other tissues, particularly in bone
In the mature adult, approximately ___% of trabecular bone and about ___% of cortical bone is renewed on an annual basis.
B. 25, 3
Even when there is no fracture many people with ___ & ___ may suffer from bone pain.
Osteomalacia
Rickets
How long does the rapid phase last?
4-8 years
Women have ___ phase of age related bone loss
2
Gonadatropin-releasing hormone agonists are used in men and women to treat what?
Prostate cancer
endometriosis
___% of patients with Paget's disease are men
60
Which IO has frequent fracture and short stature?
type III
What is the adult equivalent of Rickets?
Osteomalacia
What are the 7 clinical risk factors for FRAX?
prior low trauma fracture
rheumatoid
high alcohol intake
systemic steroid use
parental history of hip fracture
secondary osteoporosis
current smoker
What is also known as Type II Osteoporosis
Secondary
What medications can cause bone loss?
corticosteroid
thyroid drugs
heparin
antiseizure
What is a result of cumulative impact of bone loss and deterioration of bone structure that occurs as people age?
A) Primary Osteoporosis
What is also referred to as age related Osteoporosis?
C) Primary Osteoporosis
Women are ___-___ times more likely to develop osteoporosis than men
2-3
What phase of bone loss begins at menopause?
Rapid Phase
__-__% of cortical bone is lost during rapid phase
5-10
__-__% of trabecular bone is lost during rapid phase.
A) 20-30
the slow phase of bone loss results ___% of cortical and trabecular loss.
B) 20-25
What is thought to be the main cause of both rapid and slow phase loss?
B) Estrogen Deficiency
___% of elderly men are deficient in biologically active sex steroids.
30-50
What is also referred to as senile osteoporosis?
a.) Secondary
b.) Primary
a.) Secondary
Which type of bone loss occurs particularly in the 7th decade of life?
C) Secondary Osteoporosis
Secondary Osteoporosis is caused from decreased absorption of calcium from the ___.
intestine
Which eating disorder is associated with Secondary Osteoporosis?
Anorexia
Most of the loss occurs ___ in the course of glucocorticoid use.
C) Early
What skeletal deformity is caused by Rickets?
B) Bowed Legs
Rickets-
childhood disease that results from a delya in depositing calcium phosphate mineral in growing bones
Why is there no bone deformity in Osteomalacia?
longitudinal growth has stopped
Can Rickets/Osteomalacia be genetic?
A.) Yes
B.) No
A.) Yes
Define Paget's Disease
bone grows abnormally large in some areas but not in others due to over active osteoclast
What is the 2nd most common bone disease?
A) Paget's Disease
Most Prostate metastasis are ___
A) Osteoblasic
Most breast metastasis are ___.
C) Osteolytic
what T Score indicates osteoporosis?
-2.5
What qualifies as "established" osteoporosis?
-2.5 T-score and 1 or more fractures
What T-score is considered osteopenia?
-1 to -2.5
What is the most common benign bone tumor?
Osteochondroma
is the most common malignant bone tumor
Ewing's Sarcoma
How many Clinical risk factors are used in FRAX?
D) 7
What is considered high alcohol intake for FRAX?
3 or more drinks per day
All of the following are true regarding causes of bone loss and fractures in osteoporosis except:
A) increased sex hormone production
Primary Osteoporosis is mainly a disease of :
A. the elderly
Approximately ___% of patients with inflammatory bowel disease are diagnosed with osteopenia as children.
C) 25
The rapid phase of bone loss in postmenopausal women and the slow phase of bone loss in aging women and men appeared to be largely a result of ___ deficiency.
D) estrogen
All of the following are contributing factors and causes of secondary osteoporosis except:
B. ) active lifestyle
Most individual with osteogenesis imperfecta suffer from:
D. ) all of the above
All of the following are factors associated with lower risk of women developing osteoporosis except:
B. ) white or Asian ethnicity
FRAX algorithms give a ___ year probability of hip fracture and a ___ year probability of a major osteoporotic fracture.
a.)2, 5
b.)5,10
c.) 10,10
d.) 10,15
c.) 10, 10
According to the NOF, a T-score between ___&___ at the femoral neck or lumbar spine is ostopenia
C. -1.0 and -2.5
The cells within bones responsible for bone remodeling are:
B. osteoblasts
Which of the following contains predominantly trabecular bone?
A. spine
Peak bone mass is achieved between ___-___ years of age
A) 30-35
A geometric property that describes the distribution of mass around the neutral bending axis of and object is called:
D. area moment of inertia
a term used to describe a rounded projection on bone is known as:
C. condyle
the spinal column consists of:
D. all the above
What is the upper flat curved part of the main portion of the ilium?
ala or wing
what is a rounded prominence on the outer/ lateral border of a bone?
B) trochanter
refers to a rounded outward or elevated surface.
a. convex
b. concave
a. convex
which parts of the spine are lordotic?
A. cervical
c. lumbar
What is the first primary compensatory curve?
cervical lordosis (concave)
what is the secondary compensatory curve?
lumbar lordosis (concave)
___ is used to describe the normal anterior concavity of the cervical and lumbar spine, but can also refer to an abnormally increased curvature.
A. lordosis
What 4 things can cause kyphosis?
metabolic and neuromuscular conditions
osteogenesis imperfecta
spina bifida
scheuermann's disease
What is the most common spinal curvature disorder?
A. scoliosis
the body of C2 fuses with the odontoid process between __ and __ years of age
3-6
Persistent lateral curvature of the vertebral spine of more than 10 degrees in the upright standing position is known as:
B) scoliosis
Schuermann's disease is characterized by the presence of at least ___% anterior wedging in at least ___ adjacent thoracic vertebrae.
C. 5, 3
there are ___ pairs of spinal nerves.
D. 32
the type of vertebral deformity caused by vascular insufficiency during fetal development and may affect more than one vertebrae is:
a. asomia
b. coronal cleft
c. block vertebra
d. hypoplasia
d. hypoplasia
the final carpal bone to ossify by 9 yr old is:
A. pisiform
is a large sesamoid bone and is the last to ossify
When imaging the proximal femur, in an effort to bring the femoral neck parallel to the plane of the scan table, the technologist should internally rotate the femur __ degrees
B. 15-20
if the BMD measurement by central DXA of the lumbar spine or the femoral neck cannot be obtained, the NOF recommends BMD measurement by DXA at the on third (33%):
D. radius site
the NOF recommends BMD testing of:
A. postmenopausal women age 65 and older and me age 70 and older
Recommended frequency of BMD testing states that at least ___ months must have passed since the month of the last measurement except in specific situations
A. 23
Based on the ACR Appropriateness Criteria for DXA scanning, variant ___ is for suspected fracture of a vertebral body in a patient with suspected osteoporosis and a negative initial radiograph.
D. 8
suspected fracture of a vertebral body based on clinical history, height loss, or steroid therapy, DXA and VFA is given a 9 rating and radiography of the T&L spine is given and 8 rating.
Osteoporosis is diagnosed when BMD is:
B. 2.5 SD or more below that of a young-normal adult
The first established unit of x-ray dose which quantifies amount of radiation exposure in air is called:
C. Roentgen
An acute dose of radiation of ___rads to the ovaries or testicles can result in permanent sterilization.
C. 600 rad
The usual effective radiation dose received during CT of the pelvis is ___mrem
A. 1000
The distance the technologist should stand or sit from the x-ray tube when preforming DXA scans is ___ft
3 ft
The risk for vertebral and non vertebral fractures has been proven to be reduced by ___ after one year of treatment.
C. Bisphosphaonate
recent findings have linked ___ therapy to increased incidence of heart attack and stroke and physicians frequently reconsider its use in the treatment of osteoporosis
C. estrogen
gastrointestinal disturbances with some severe reactions have been reported in patients taking ___ for the treatment of osteoporosis.
A. bisphosphonates
controllable lifestyle factors that are responsible for 10-15% of bone mass structure include:
D. diet and exercise
The most critical period for bone health is during ___
D. adolescence
The recommend calcium dose for individuals age 19-50 is ___mg/day
B. 1000
diets with an increase of ___-rich foods may reduce the need for calcium to be withdrawn from the skeleton
B. potassium
The US Surgeon General recommends a minimum of ___ min of moderate intensity physical activity most, if not all, days of the week.
C. 30
Weight loss of ___% or more in older women increases risk for hip fracture.
C. 10
extended lactation and multiple pregnancies are strongly associated with subsequent osteoporosis related to hormones that affect calcium absorption.
a. true
b. false
b. false
doses of 7.5 mg/day of ___ can completely shut off formation of new bone, while the loss of older bone continues at a faster rate than normal.
A. prednisone
the most common causes of secondary osteoporosis in men is related to all of the following except:
C. hypocalciuria
a disorder causing too much calcium to be lost through the urine, making calcium unavailable for bone building is known as:
A. hypercalciuria
hormone deprivation thearapy in men which has been found to have a strong link with osteoporosis is typically a treatment of:
A. prostate cancer
men who sustain a hip fracture are more likely than women to die from complications.
true/false
true
in men the diagnosis of osteoporosis is often not made until a fracture occurs
true/false
true
reasons to consider bone density testing in men include___
D. all the above
men age 50 and over require ___mg of calcium daily
A. 1200
the drug used for treatment of men with primary or hypogonadal osteoporosis who are at high risk for fracture is:
A. teripartide (forteo)
osteoporosis in a child is characterized as ___ when there is no identifiable cause
B. idiopathic
at birth an infant has as many as ___ separate skeletal bones in the body.
A. 270
the intra-membranous ossification process occurs during the formation of all of the following except:
A. ulna and radius
it is believed by bone health experts that 75% of an individual's final bone mass is influenced by ___
A. genetics
the AAP recommendation for upper level calcium intake in children ages 4-8 yr is ___mg
C. 2500
The recommended level of vitamin D intake for infants, children and adolescents including breastfed infants is ___IU per day
B. 400
persons with anorexia nervosa have increased bone formation and decreased bone resorption
True/False
false
improvement of BMD is often seen in sufferers of anorexia nervosa when ___ occurs
D. all of the above
"fish vertebra deformity" is a manifestation of ___ disease
D. sickle cell
The diagnosis of osteoporosis in children should be based on___.
presence of low BMD and significant fracture history.
The most common site of fracture in children in the ___
C. forearm at 45%
vs fingers 13%, clavicle 5%, humerus 3%
define epiphyseal plates
cartilaginous plates found between the diaphysis and each epiphysis until skeletal growth is complete
What do the dark areas show?
B. central sites
What is this an image of?
D. radiographic photodensitometry
What does the arrow indicate?
C. L1 fracture
What does the arrow indicate?
A. end plate sclerosis
What does the arrow indicate?
A. osteophytes
What does the arrow indicate?
D. aortic calcification
ch 2. indicates the faint outline of the calcified aorta
What is this an image of?
B. Lateral L-spine DXA
this is an image of :
D. PA proximal femur
this is an image of:
C. left femur
Which DXA is properly positioned?
C. A
What is wrong with this DXA positioning?
D. nothing
What is wrong with this DXA positioning?
C. not enough internal rotation
define %CV
percent coefficient variation.
is given by manufacturers to express the precision of the equipment
name the weight bearing sites of the skeleton:
total spine
lower extremitys
portions of the pelvis
what is the most sensitive weight bearing bone?
calcaneus
name the appendicular sites:
extremitys
girdles (includes scapula and pelvis)
name the central sites for DXA:
T-spine
L-spine
proximal femur
do central densotometers measure peripheral sites along with central sites?
a. true
b. false
a. true
ch 1 densotometers that measure central sites are called Central Densotometers, though some have the ability to measure peripheral sites too.
name the peripheral sites for DXA:
calcaneus
tibia
metacarpals
phalanges
forearm
Which DXA ROI have predominantly trabecular bone?
L-spine
Ward's Area
Calcaneus
portions of the forearm
define trabecular bone:
spongy, has a higher metabolic rate
What ROIs are predominantly cortical bone?
femoral neck
phalanges
portions of the forearm
how is BMC quantified for DXA?
how is BMC quantified for QCT?
how is BMD reported for the L-spine?
C. total BMC for each vertebra divided by total area for each vertebra
What is QUS?
quatitative ultra sound
how does QUS measure bone?
speed of sound (SOS)
Broadband Ultrasound Attenuation (BUA)
Stiffness index
explain Speed of Sound (SOS).
speed that sound wave passes through the bone. expressed as meters/sec
explain Boadband Ultrasound Attenuation (BUA).
amount of energy lost from sound wave as it passes through bone. expressed as decibels/mgz
What is the T-score compairing?
the patient's BMC with the peak value for an average healthy young adult of the same sex
How is a Z-score compared?
the patient's BMC compared to the average values for a healthy person of the same sex, age, and race.
explain Standard Deviation (SD).
the plus/minus scale from the average
Why is the Z-score used?
to suggest if bone-loss may/may not be caused by something other than normal age related bone loss if the patient's BMC is lower than the average of their age, sex, and race.
What is an Age-regression Graph?
the top line is a young adult peak.
the bottem line is the expected change of BMD as the patient ages if nothing changes
How much bone demineralization has to occur before it can be seen on diagnostic x-rays?
at least 40%
What is Qualitative Spinalmorphemetry (QSM)?
uses a lateral spine x-ray to look at the cortical shell thickness and trabecular patterns.
What is the Singh Index?
uses an AP hip x-ray to look at the cortical shell thickness and trabecular patterns
Describe radiogrammetry.
radiograph of the hand is measured with fine calipers across the metacarpals.
Can be used with digital radiographs and use a computer analysis.
Correlates well with BMD.
what is the Radiologic Osteoporosis Score?
uses radiogrammetry of the femur and the bio-concavity of the L-spine to determine BMD
what is Radiographic Photodensitometry?
was the starter technology for SPA, DPA, and current DXA
is a radiograph of the bone alongside a step wedge which is then measured with a photodensity scanner and compared to known BMD correlations with the step wedge densitys
describe Radiographic Absorptiometry (RA).
2 x-rays of the left hand are taken on non screen film at 2 different KVp techniques
it is then sent to a lab and digitized for computer analysis of the ring and middle finger
is good for long term reproducible results
what is Single Photon Absorptiometry (SPA)?
uses a single radioactive material that produces 1 level of radiation as a radiation source
scanned forearms and heels because it needs a water bath to insure uniformity.
why was SPA and DPA considered un precise?
because of the radioactive decay over time followed by sudden increase in radioactivity when old source was repalced
what is Dual Photon Absorptiometry (DPA)?
works the same as SPA, but uses a radioactive material that produces 2 different KV intensity's.
doesn't need a water bath, so it could scan central sites.
How is DXA different from DPA?
DXA uses x-ray generators rather than a radioactive isotope.
faster scan times
what is a K-Edge filter for?
for DXA equipment that filters the beam into two different KVp ranges.
What is a pulse power KV source for?
the same as a K-edge filter
what is a highly collimatied beam that follows the detector pattern (zig-zags)?
pencil beam
Which beam is wide and scans a whole detector row at at time
fan beam
what does a Morphometric x-ray absorptiometry look for?
looks for spinal fx in the lateral spine
What is the difference between SXA and DXA?
SXA is the counter part to single photon absorptiometry, but is now obsolete since DXA is more avalible
What is Quantiative CT (QCT)?
BMC given via CT scan of the L-spine
How does QCT work?
patient is scanned in the CT scanner with a phantom.
8-10mm slices through 2 or more vertebral body (T12-L3).
only looks at trabecular portion of the vertebral body.
t.
marrow fat decreases with age
true/false
false
what is Dual Energy QCT used for?
to eliminate error from marrow fat
What does a pereferal QCT look at?
the forearm. best for patients who's bones are still growing
what are the 6 parts of an individual vertebra?
Body
pedicles
lamina
spinus process
transvers process
articulating surface
what shape is L1-L3 vertebra in?
B. U or Y
what is unique about L3's shape?
it has the largest transverse processes.
What shape is L4 vertebra in?
D. H or X
what shape is L5's vertebra?
D. Dog Bone
Why is L5 not to be included in a PA DXA scan?
it has too much interference with the pelvis
Why do you count the lumbar spine from L5-L1 instead of L1-L5 for a DXA scan?
so that you don't accidentally factor in a T-spine vertebra as it will lower total BMC and possibly create a false positive result
Should a vertebra with a previous fracture (new or old) be included in a PA L-spine DXA?
no. because it can inacuratly increase the BMD for that vertebra
What spinal artifacts can inaccurately increase BMD of the spine?
osteophytes
facet sclerosis (grade 2 or 3 only)
aortic calcification
vertebral fx
is there a way to overcome most spinal artifacts?
yes. Lateral Spine DXA
which lumbar vertebra in the lateral position is least affected by ribs or pelvis?
A. L3
why should a Lat L-spine DXA be paired with another scan site measurment?
for better accuracy since L3 may be the only vertebra measured and it is mainly a trabecular measurment
what forms the Ward's area?
anatomic region in the neck of the femur that is formed by the intersection of 3 trabecular bundles
what are the DXA ROIs of the proximal femur?
femoral neck
Ward's Area
trochanteric region
shaft
how far should you rotate the leg and which direction to bring the femoral neck parallel to the table?
internally 15-20 degrees
what does the lesser trochanter look like on a DXA image if it is not rotated enough?
pointy
How do you reposition if you can not see the lesser trochanter?
C. externally rotate
does leg domination have any effect on the BMC of the femurs?
no
in cases of scoliosis lower BMD is shown on which hip?
the side of convexity
does previous femur fracture (with out surgery) have any affect on a proximal femur DXA?
yes, it will be in accurate and should not be scanned
What are the forearm measurment sites?
33% or 1/3 site
50%
10%
5-8mm
ultradistal
name the proximal forearm sites
33% or 1/3
50%
name the distal forearm sites:
5-8mm
10%
ultra distal
Which arm should be scanned?
D. non dominate arm
What is the importance of least significant change (LSC)?
it determines the minimum interval between follow up measurements before a change in BMC can be seen
how long does a short term precision study last?
2-4 weeks
how long does a long term precision study last?
usually 1yr
What is the recommended follow up time between DXAs for a normal patient?
L-spine is recommended once per year
Proximal Femur is recommended every 2 years
What is the recommened follow up time between DXAs for a patient taking steroids?
every 6 months
what is an anthropormorphic phantom?
replicates skeletal region to detect a shift in BMD values over time
what is an anthroporomrphic phantom made of?
hyoroxaptite or aluminum
what is a European Spine Phantom?
was developed independently from DXA equipment manufactures and is generally used in research
What is the WHOs deffinition of osteoporosis?
a BMD that is 2.5 SD or more below average peak BMD of the young adult
What is the WHOs deffinition of established osteoporsis?
A BMD of 2.5SD or more below the average of a young adult and a history of fracture
Define a clinical spine fracture
a spinal fracture that causes symptoms
what is a morphometric spinal fracture?
a fracture that can be seen on a radiograph but has little to no symptoms
What can cause a failure to attain peak BMD?
genetics
dietary calcium deficiency
lack of exercise
What are the non prescription interventions?
life style modifications and OTC meds
Most DXA images are approved by the FDA for use in making structural diagnoses
True/False
False
how many contiuous vertebrae is preffered for PA spine DXA
C. 3-4
the anticipated rate of change in the total hip ROI is ___ than the femoral neck ROI
faster or slower
slower
what special imaging should be done for some one with hyperparathyroidism?
C. 33% forearm
because hyperparathyroidism tends to have more effect on cortical bone and the 33% forearm is mostly cortical bone
why is the forearm typically not used to monitory osteoporosis thearpy?
the rate of change is slower than the L-spine or hips
what type of bone is measured in a total body scan?
cortical
the risk of fracture ___ for each SD decline in BMD.
a. double
b. tripples
d. sees very little increase
c. decreases
a. double
Name the bisphosphonate anti resorptive medications:
alendronate (fosamax)
risedronate (actonel)
ibandronate (boniva)
zoledronic acid (reclast
name the non bisphosphonate anti resorptive meds
etrogen thearapys
raloxifene (evista
denosumabb (prolial)
name the anabolic osteoporosis meds
teripartide (forteo)
for pediatric DXA a cancer survivor is recommended to have imaging done at what point?
either 2yr after chemo or by the age of 18 which ever comes first
when is DXA recommened for children?
recurrent fractures
bone pain
bone deformitys
osteopenia seen on x-ray
cancer survivors
females with eating disorders/excessive exercis
females after 6+ months without menstrul cycle
what are the prefered sites for children 3yr old and up?
PA L-spine and total body
When should a T-score be used for comparison on children?
never before age 20
according to the WHO criteria, when making a diagnosid of osteoporosis using T-Scores, which of the following requirements must always be met?
A. must have a T-score less than -2.5 at the hip spine, or 1/3 radius by DXA and be male 50+ years old or post menopausal female
The technology for DXA BMD in the U.S uses which of the following.
D. x-ray
the WHO guidlines for BMD classification may be applied to:
B. men 50+ years old and post menopausal women
serial measurments of BMD involve:
C. comparison of BMD of the 2 studies
compares the patients actual g/squared cm rather than the standard deviation from normal young adult (T-score)
the most appropriate value for reporting BMD assessment in children is:
A. Z-score for any patient 20 years old and under
Which of the following is the best definition of osteoporosis?
B. BMD of -2.5 or less is osteoporosis
The diagnosis of osteoporosis:
C. can be made by BMD testing
Who should a VFA (vertebral fracture assessment)?
Postmenopausal women with Low BMD and atleast 1 clinical factor
Men with low BMD plus atleast one clinical factor
Patients on chronic steroids (3+ months)
Any patient with osteoporosis that a diagnosis of vertebral fracture would alter clinical managment
What are the reference database for T-score criteria?
use a uniform Caucasian female normative for all women of all ethnic groups
use a uniform Caucasian male normative for men of all ethnic groups
the NHANES III database should be used for T-score derivation at the hip ROI
Osteoporosis cannot be diagnosed in me ___ years or younger based on BMD alone.
50 years or younger
Which hip ROI should be used for diagnosis of osteoporosis?
Either the femoral neck or the total proximal femur, which ever is lowest
When should a vertebrae be omitted?
when there is a clear abnormality and non-assailable within the resolution of the system
if there is greater than 1-SD between adjacent vertebrae
Can a Lateral L-spine DXA be used to diagnose osteoporosis?
no, but it can be used to monitor treatment
should BMD be based off of 1 vertabre even if the others have structural artifacts?
never
in patients under 50 years old a Z-score of what is considered below expected range for age?
-2.0
People with low bone mass are high risk for fracture
True/ False
False
low bone mass does not necessarily mean a high fracture risk
When can women under 50 years old be diagnosed with osteoporosis?
if they are in menopausal transition
is the FRAX score and a diagnosis of osteoporosis the same?
no. FRAX determines the likely hood of a future fracture based on risk factors AND BMD
What is the WHO international reference standard for an osteoporosis diagnosis?
T-score of -2.5 or less at the femoral neck for men and women over the age of 50 years old
when should the forearm be measured with DXA?
Hip/Spine cannot be measured or interpreted
Hyperparathyroidism
Patient exceeds the table weight limit
What 3 major categories are defined as high-risk groups that should consider treatment with FDA-approved medicines to lower their risk:
History of fracture of the hip or spine
Bone mineral density in the osteoporosis range (T-score of -2.5 or lower)
Bone mineral density in the low bone mass or osteopenia range with a higher risk of fracture defined by FRAX score for
Major osteoporotic fracture 10-year probability of 20% or higher OR
Hip fracture 10-year probability 3% or higher
What does the N-telopeptide (blood or urine) test for?
N-telopeptide (NTx). It is a bone turnover marker that can measured from a urine or blood sample. N-telopeptide is a breakdown product of collagen
What is the generic name for Actonel?
risedronate
it is a bisphosphonate
tablet taken by mouth. It’s most commonly prescribed once a week or in a higher dosage once a month.
Actonel is poorly absorbed if you eat or drink something at the same time
What is the non fasting option of Actonel?
Atelvia
Is Actonel is approved for use in both men and women?
yes
What are the bisphosphonate-class medicines 5 potential serious side effects:
1. Esophagus problems
2. Low calcium levels in your blood (hypocalcaemia)
3. Severe jaw bone problems (osteonecrosis of the jaw)
4. Bone, joint, or muscle pain
5. Unusual thigh bone fractures (atypical femur fractures)
What is the most common medication prescribed for osteoporosis treatment in the US?
Alendronate
What is the brand name for Alendronate
Fosamax
Alendronate is a tablet taken by mouth usually once a week.
Because alendronate is poorly absorbed if you eat or drink something at the same time
What type of medication is Binosto?
Binosto is another formulation of alendronate: an effervescent tablet that is dissolved in water.
Binosto is taken first thing in the morning on an empty stomach once weekly
One additional warning is the sodium content in the effervescent tablet, which contains 650 milligram sodium.
What is the Generic form of Boniva?
ibandronate
Boniva is given as a once monthly tablet most commonly.
also available for administration by vein every three months.
In contrast to other bisphosphonates, the indication for use of Boniva is limited to treatment of postmenopausal women with osteoporosis
What is Calcitonin (natural in the body)?
Calcitonin is a natural hormone produced by the thyroid gland that contributes to calcium regulation in the bone, kidney, and intestine.
What are the Brand names for Calcitonin (as a medication)?
Calcitonin is available by the brand names Miacalcin® and Fortical®.
Miacalcin, which is made from salmon, is available by injection or nasal spray.
Fortical is a recombinant version available in nasal spray dosing one spray once a day.
Who is approved to use Calcitonin as a medication?
Calcitonin is a medicine approved for treatment of osteoporosis in postmenopausal women who are 5 years or more after menopause
HOWEVER
most authorities no longer consider calcitonin to be appropriate treatment for osteoporosis.
What are the brand names for Denosumab?
Prolia® and Xgeva®
What is Prolia?
Prolia is 60 mg of denosumab administered under the skin twice a year – every 6 months
indicated for postmenopausal women or men at high risk for fracture.
Also it is approved for use in women with breast cancer or men with prostate who have not had spread of their cancer and are taking medicines that accelerate bone loss
What is Xgeva used for?
Xgeva is 120 mg of denosumab administered under the skin every 4 weeks. It is indicated for individuals with solids tumors like breast and prostate cancer that has spread to the bone (metastases) to prevent further complications in the bone
What type of medication is Evista?
Evista (raloxifene) is an osteoporosis medicine that is called a selective estrogen receptor modulator or SERM. You may also see it referred to as an estrogen agonist antagonist (EAA).
Evista is beneficial to the bone without causing stimulation of breast tissue or lining of the uterus (endometrium).
What is the generic name for Evista?
raloxifene
How is Forteo different than most other osteo medications?
it stimulates bone rather than inhibit bone loss.
What is the generic name for Reclast®
ibandronate.
what is reclast?
Reclast is administered by vein once a year
What are the WHO T-Score criteria catagories?
normal (T-score -1.0 and above)
low bone mass, referred to as osteopenia (T-score between -1.0 and -2.5)
osteoporosis (T-score -2.5 and below)
severe osteoporosis (T-score -2.5 and below with history of a fracture)
What is Zoledronic Acid?
Zoledronic acid is the generic name for an osteoporosis medicine with the brand name Reclast
Author
adavis
ID
332302
Card Set
Bone Density
Description
skelatal anatomy for bone densetometry registry review
