7.3. Metabolic Bone Disease - Osteoporosis Flashcards
What is the definition of Osteoporosis?
A Metabolic Bone Disease characterised by:
- Low Bone Mass
- Micro-Architectural Deterioration of Bone Tissue
What does the Micro-Architectural Deterioration of Bone Tissue, in Osteoporosis, lead to?
- Enhanced Bone Fragility
2. Increased Fracture Risk
What is the biggest concern with Osteoporosis?
The Fracture Risk
What is the Risk of Fracture related to, with regards to Osteoporosis?
- Age
- Bone Mineral Density (BMD)
- Falls
- Bone Turnover
What is measured to decide the treatment for Osteoporosis?
The Bone Mineral Density
What does the level of Bone Mineral Density (BMD) divide the severity of Osteoporosis into?
- Normal (T score above -1)
- Osteopenia (T score between -1 and -2.5)
- Osteoporosis (T score below -2.5)
What is the treatment for a Bone Mineral Density (BMD) of Normal (T score above -1)?
- Reassurance
2. Life Advice
What is the treatment for a Bone Mineral Density (BMD) of Osteopenia (T score between -1 and -2.5)?
- Lifestyle Advice
2. Treat if previous fracture
What is the treatment for a Bone Mineral Density (BMD) of Osteoporosis (T score below -2.5)?
- Lifestyle Advice
2. Offer treatment
What is the emphasis of Osteoporosis treatment based on?
Fracture Risk Assessment and Reduction
FRAX = WHO Fracture Risk Assessment Tool
What does FRAX (Fracture Risk Assessment Tool) take into account?
- Age - Peaks at 85
- Gender - Higher in women
- Bone Mineral Density (BMD) - higher in low BMD
- Glucocorticoid Use
- Family History
- Country Specific
What are the disadvantages of FRAX (Fracture Risk Assessment Tool)?
- Does not accomodate all known risk factors
- Lacks detail on some risk factors
- Depends on adequacy of Epidemiological data
- Limited country models available
- Model relevant only for untreated patients
- Does not replace Clinical Judgement
What does a FRAX (or QFracture) score of >10% 10 year fracture risk, lead to?
Referral for a Dual X-ray Absorptometry (DXA)
What is the treatment decision of Osteoporosis dependent on?
The Dual X-ray Absorptometry (DXA) scanning and individual report-fracture risk
Note - Threshold of 20% 10 year risk
What are some Endocrine causes of Secondary Osteoporosis?
- Hyperthyroid
- Hyperparathyroid
- Hypoparathyroid
- Growth Hormone Deficiency
- Hyperprolactinaemia
- Cushings
What are some Malabsorption causes of Secondary Osteoporosis?
- Coeliac Disease
2. Cystic Fibrosis
What Malignancy can cause Secondary Osteoporosis?
Myeloma
What are some Rheumatic causes of Secondary Osteoporosis?
- Rheumatoid Arthritis
- Ankylosing Spondylitis
- Polymyalgia Rheumatica
What Drugs can cause Secondary Osteoporosis?
- Steroids (Glucocorticoids)
- Heparin / Warfarin
- Anticonvulsants
- Proton Pump Inhibitors (PPI’s)
- GnRH inhibitors
- Aromatase Inhibitors
What Amenorrhoea issues can cause Secondary Osteoporosis?
- Anorexia Nervosa
- Early Menopause
- Primary Ovarian Failure
What are the methods used to Prevent Osteoporotic Fractures?
- Minimise Risk Factors
- Ensure good Calcium and Vitamin D Status
- Fall-Prevention Strategies
- Medications
What medications can be used to help Prevent Osteoporotic Fractures?
- Bisphosphonates
- Hormone Replacement Therapy (HRT)
- Selective Oestrogen Receptor Modulator (SERM)
What are the Side-Effects of Hormone Replacement Therapy (HRT)?
- Increased risk of Blood Clots
- Increased risk of Breast Cancer (with extended use into the late 50’s / early 60’s)
- Increased risk of Heart Disease and Stroke (if used after large gap from menopause)
What are the Negative effects of Selective Oestrogen Receptor Modulator’s (SERM’s)?
- Hot flushes (if taken close to menopause)
- Increased clotting risk
- Lack of protection at the Hip site
