16 - Orthogeriatrics Flashcards
When do Ps have Sx of osteoporosis?
At first fracture
How is osteoporosis defined in terms of SDs?
Is defined as less than 2.5 SD away from the mean
DEXA scans produce T and Z scores - what do these mean?
T score = mean bone density compared to general population
Z score = mean bone density compared to their age
What are the commonest fragility fractures?
NOF
Vertebral
Pubic rami
Colleys
NOH (humerus)
Ribs
What is a fragility fracture defined as?
What is the most common reason for emergency surgery in elderly Ps?
Is also the commonest cause of death following a fall.
Hip fracture
What percentage of Ps will die within 12 months of a hip fracture?
26%
When is peak bone mass reached?
30s
In which bone is remodelling most active?
Trabecular bone
Overproduction of which cell membrane protein is linked to osteoporosis?
RANKL
How does oestrogen deficiency affect bones?
Deficiency = inc bone resorption and therefore bone loss.
How can Vit D deficiency affect bones?
Can cause secondary hyperparathyroidism => inc bone turnover and reduced Ca absorption
How do steroids affect bones?
Inc PTH secretion
Reduced oestrogen
Impairs Vit D absorption
-> acute suppression of osteoblasts & stimulation of osteoclasts
What are the RF for osteoporosis?
Which diseases inc the risk of osteoporosis?
Diseases that affect absorption
Diseases that inc steroids (either endogenously or exogenously)
Which drugs increase the risk of osteoporosis?
Steroids
PPI
Anti-epileptics
Depot Provera
Hormone Deprivation Therapy
SSRIs
Heparin
Anti-retrovirals
Which tool is used to assess for fragility fracture risk?
FRAX Tool
What diseases other than osteoporosis can cause fragility fractures?
Metastatic bone disease
Multiple myeloma
Osteomalacia
Paget’s disease
What is the daily calcium intake of calcium?
700-1200mg, preferably through diet
In postmenopausal women, how much Vitamin D should they take if supplementation is needed?
1000 IU - 2000 IU
What lifestyle measures should Ps at risk of osteoporosis take?
Smoking cessation
Reduce alcohol
Do regular weight bearing and muscle strengthening exercises
What exercises should Ps at risk of osteoporosis not undertake?
Forward flexion
Side bending
Heavy lifting
Want to avoid compressing the spine = can lead to fractures
Which Rx is first line for treatment of osteoporosis?
Alendronic acid (70mg OW)
When is Alendronic acid not recommended?
If eGFR is less than 35ml/min
What are the SEs of Alendoronic acid?
Upper GI Sx
Bowel disturbance
Headaches
MSK pain
How should alendrotnic acid be taken?
After overnight fast - 30 mins before any food/water. Take sitting up, dont lie down for 30 mins after taking. Swallow whole with glass of water.
How is Zolendronic acid given?
IV once a year - 5mg
What are the side effects of Zolendronic acid?
Poss acute phase reaction
Can poss inc AF
Dont use if creatinine clearance <35ml/min
What drug is a RANK-L inhibitor that is used for osteoporosis?
Denosumab
Can Denosumab be used with renal failure?
Yes
What are the SEs of Denosumab?
Abdominal discomfort
Cataracts
Constipation
Hypocalcaemia
Inc risk of infection
Pain
Sciatica
Skin reactions
Which drug is a PTH analogue that is used for osteoporosis?
Teriparatide
When is Teriparatide used?
When Ps cannot tolerate or have failed with bisphosphonates + have severe osteoporosis
