18 - Osteoporosis Flashcards
define osteoporosis?
metabolic bone disease characterised by low bone mass and micro architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk
what is the major risk associated with osteoporosis?
fracture risk
what tool can be used to calculate fracture risk?
FRAX questionnaire
who is the Q fracture applicable to?
those aged 30-85, men and women
name 3 variables in the Q fracture?
cardiovascular risk, falls, tricyclic antidepressants
what scanner can be used?
Prodigy scanner/ DXA scans
what are fracture risk assessment tools used to assess?
whether someone is at risk of osteoporosis/ not
when is the risk considered significant?
> 10% risk of osteoporotic fracture over 10 years
who should always be sent for a DXA scan regardless of their fracture risk %?
those on oral steroids/ suffer a low trauma fracture
how many women > 50 years will have osteoporotic fracture before they die?
1/2
how many men > 50 years will have osteoporotic fracture before they die?
1/5
M:F?
F>M
name 4 endocrine causes of osteoporosis?
Thyrotoxicosis, Hyper/Hypo-parathyroidim,
Cushings, Hyperprolactinaemia
name 4 rheumatic causes of osteoporosis?
Rheumatoid arthritis
Ankylosing Spondylitis
Polymyalgia Rheumatica
name 2 Inflammatory GI causes of osteoporosis?
UC and Crohn’s
name 4 liver causes of osteoporosis?
1y biliary cholangitis, chronic active hepatitis, alcoholic cirrhosis, Hep C
name 4 malabsorption causes of osteoporosis?
Cystic Fibrosis, chronic pancreatitis, coeliac disease, whipples disease
name 4 medications which cause osteoporosis?
steroids, PPI, aromatase inhibitors, warfarin
when is our peak bone mass?
~ 30 years old
when does accelerated loss of bone mass occur in women?
menopause
what is the risk for those who have already had a fracture?
increased - should be offered a DXA bone scan
4 ways in which we can help prevent fractures?
Minimise risk factors, Ensure good calcium and Vitamin D status, Falls prevention strategies, Medications
which medication can be used to decrease the likelihood of fractures?
HRT
3 increased risks associated with HRT?
blood clots, breast cancer, heart disease (stroke)
what type of drug is raloxifene?
selective oestrogen receptor modulator (SERM)
3 disadvantages to SERMs?
hot flushes, increased clot risks, lack of protection at the hip
first line of treatment for osteoporosis?
oral bisphosphonates
3 things which a patient must have to have oral bisphosphonates as 1st line treatment for osteoporosis?
good/adequate -
renal function, calcium and vitamin D status, dental health
name 2 side effects of Bisphosphonates?
oesophagitis, iritis
what type of drug is denosumab?
monoclonal antibody
what is the role of denosumab?
reduces osteoclastic bone resorption
how is denosumab administered and how often?
subcutaneous injection every 6 months
what should patients with renal impairment be given as 1st line?
denosumab
name 2 side effects of denosumab?
allergy/ rash, symptomatic hypocalacaemia
which intermittent human parathyroid hormone can be used to improve patients’ risk?
teriparatide
name 2 side effects of teriparatide?
injection site irritation, allergy
