Osteoporosis refers to low bone density (BMD) caused by changes in bone microstructure. Patients with osteoporosis have increased risk of fractures and their quality of life are reduced. However, there are still many fallacies and misinformation related to osteoporosis. Can you make a good distinction? Come and test it quickly!
1.From diet to many other conditions, the fallacy related to the cause of osteoporosis has always existed. Which of the following is identified as a risk factor for osteoporosis?
A. Body mass index (BMI) > 30
B. Long-term anticonvulsive treatment
C. Early menstrual menarche
D. Use of IUD
Analysis:
Given that older age and BMD have a direct and strong relationship with the incidence of fractures, it has been determined as a risk factor for osteoporosis. In addition, many other factors are also risk factors for osteoporosis, such as the use of certain drugs associated with the onset of fracture-poverticosis, including systemic steroids, thyroid supplements, heparin, chemotherapy drugs, and insulin.
Long-term anticonvulsive treatment can lead to changes in calcium and bone metabolism, or may lead to reduced bone mass and an increased risk of osteoporotic fractures, especially phenytoin sodium and carbamazepine have direct effects on osteocytes.
In addition to this, other risk factors for osteoporosis include:
•elderly (≥50 years old);
•female;
•white or Asian;
•genetic factors, such as family history of osteoporosis;
•small or short body (e.g., weight <57.6kg);>
•close Menstrual;
• Late menopause;
• Premature menopause;
• Postmenopausal status;
• Inactivity or meditation;
• Alcohol and tobacco use;
• Androgen or estrogen deficiency;
• Calcium or vitamin D deficiency;
• Dowager's hump.
Answer: B
2. Osteoporosis only exists in elderly women is another fallacy. Men and young people will also suffer from osteoporosis. Which of the following will promote osteoporotic fractures in men?
A. Strong physical activity
B. Sudden weight gain
C. Hypogonadism
D. Hypothyroidism
Analysis:
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Men's routine screening for osteoporosis is not as common as that of women. However, up to one-third of hip fractures occur in men, with higher mortality rates in men than in women.
Risk factors for osteoporosis in men include:
• Age 70 years old;
• Hypogonadism;
• Low weight (BMI20-25);
• 10% weight loss (relative to people of the same age group; or relative to weight in recent years);
• Lack of physical activity;
• Corticosteroid use;
• Androgen deprivation therapy;
• Past fragile fractures.
Answer: C
3. Before another obvious fracture occurs, osteoporosis has obvious clinical symptoms, which is another common fallacy related to osteoporosis. Regarding osteoporosis-related vertebral compression fractures, which of the following is the most accurate?
A. When evaluating acute and subacute vertebral compression fractures, palpation is recommended instead of percussion of the corresponding spinous process
B. Acute pain associated with vertebral compression fractures can usually relieve
C within 2 weeks. The presence of paravertebral muscle spasm indicates other fractures except vertebral compression fractures
D. Compressive fractures of vertebral compression fractures are usually painless
Analysis:
Osteoporosis is usually called the "silent killer" and will not appear clinically until after the fracture.
Compressive fractures of the vertebrae are usually painless; however, the patient will have a lower height and kyphosis. Patients with vertebral compression fractures may present with thoracic kyphosis accompanied by excessive lordosis (dowager hump). Subsequently, lumbar lordosis disappeared. After each vertebral compression fracture and progressive kyphosis, the patient's height may drop by 2-3cm.
Patients with acute vertebrae fractures may experience a little tenderness. Palpation of spinous processes usually does not help examiners to locate tenderness, but percussion may help evaluate acute or subacute vertebral compression fractures.
For painful vertebral fractures, typical subjective information may include the following points:
• acute pain may occur after falling or minor trauma;
• Pain is limited to specific, recognizable vertebral levels of the middle thoracic, lower thoracic, or upper lumbar spine.
• Pain is described as sharp or dull; exercise may exacerbate pain; in some cases, pain can radiate to the abdomen.
• Pain is usually accompanied by paravertebral muscle spasm, intensified movement, and the pain is relieved when lying on your back.
•Patients are afraid of the aggravated pain and usually stay motionless in bed.
• Acute pain usually relieves after 4-6 weeks; in the case of multiple fractures and severe kyphosis, the pain may become chronic.
Answer: D
4. Many patients believe that once they develop osteoporosis, they can do nothing, which is also a fallacy. Which of the following osteoporosis treatment drugs is recommended by the American Academy of Internal Medicine (ACP)?
A. For postmenopausal women suffering from osteoporosis, estrogen or estrogen plus progesterone or raloxifene
B should be used. Patients with osteoporosis can use alendronate, risedronate, zoledronic acid or denozumab for treatment
C. BMD
D should be monitored for 5 years before osteoporosis treatment. Patients with osteoporosis should avoid using bisphosphonates. Pharmaceutical
Analysis:
"ACP Clinical Practice Guidelines for the Treatment of Low Bone Density and Osteoporosis to Prevent Fractures in Men and Women" gives two strong recommendations:
① Clinicians should provide drug treatment for women suffering from osteoporosis to reduce the risk of hip and spinal fractures; recommended drugs include alendronate, risedronate, zoledronic acid or denozumab.
② It is not recommended to use estrogen or estrogen plus progesterone therapy, or raloxifene, to treat osteoporosis in women after menopause. The
ACP guide also gives four weaker recommendations:
① For women with osteoporosis, it is recommended that clinicians use drug therapy for 5 years.
② is not recommended for female patients with osteoporosis to monitor bone density within 5 years of drug treatment. Because there is evidence that the risk of fractures may be reduced regardless of the change in bone density.
③ Clinicians should decide whether to treat women with osteopenia and high bone risk based on the patient's preferences, fracture risk and benefits, hazards and drug costs.
④ For clinically identifiable osteoporosis in male patients, ACP recommends that clinicians use bisphosphonates for drug treatment to reduce the risk of vertebrae fractures.
Answer: B
5. There are many fallacies in the drug treatment of osteoporosis. Which of the following descriptions of bisphosphonates (first-line treatment of osteoporosis) is the most accurate?
A. Patients should take
B before going to bed at night. Digestion is better when taken with food or milk. Patients should take
D 30 minutes before the first meal in the morning. Grapefruit is a contraindication for its use
Analysis:
Patients should take bisphosphonate orally with a large cup of water for more than 30 minutes before eating anything (including other drugs).
Foods and beverages (including coffee, milk and dairy products and orange juice) may reduce the absorption of oral bisphosphonates.
grapefruit is not a contraindication for taking bisphosphonates.
After taking the medication, the patient should remain upright ≥30 minutes or until the first time he eats to reduce the risk of esophageal ulcer.
Answer: C
Yimaitong compiled from: Herbert S. Diamond. Fast Five Quiz: Osteoporosis Myths vs Facts. Medscape. August 19, 2022.
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