Bone disease Flashcards
Risk factors
- Female
- Maternal history of fragility
- fractures / osteoporosis
- older age
- low BMI
- Weight loss >10
- post menopause
- long term steroid use
- smoker
- Endocrine conditions
- ## conditions assoc with malabsoption
Definition of osteoporosis
low bone density and abnormal bone structure - leads to compromised bone strength
1st line treatment of osteoporosis
bisphosphonate e.g. alendronate
Tools for assessing osteoporotic risk
QFracture or FRAX
WHO defines osteoporosis as…..
BMD of less than 2.5 SD below the young adult mean density
T score of what means treatment is recommended in osteoporosis?
-2.5
how to bisphosphinates work?
decreases demineralisation in bone
SE of bisphosphinates
oesophagitis
oesophageal uclers
diarrhoea / constipation
osteonecrosis of the jaw
may get an acute phase response - fever / myalgia and arthralgia
counselling on bisphosphinates
tablets should be swallowed whole with a glass of water
sit up / stand up for 30 mins
take before breakfast / another oral medication
ONCE A WEEK
regular dental check ups
life style factors on osteoporosis
exercise
stop smoking
pagets disease definition
chronic bone disorder - unbalanced bone turn over
focal bone reabsorption followed by excessive and chaotic bone deposition
which bones does pagets often affect
femoral
pelvis
skull
how does pagets disease most often present
asymptomatic
but can present with long bone pain and facial pain
or pathological fracture
primary imaging modality in pagets disease
plain x-ray - abnormal sclerotic bone
Which blood test is raised in pagets disease
ALP
osteomalacia is -
normal bony tissue but decreased mineral content
osteomalacia in growing children =
rickets
presentation of osteomalacia
bone pain
fractures
muscle tenderness
proximal myopathy
Blood test results in osteomalacia
Raised ALP and low Vit D
how to differentiate osteomalacia from pagets disease
Ostemalacia has low Vit D
Main aim of treatment in pagtes disease
reduce osteoclast activity
two treatment choices in pagets disease
bisphosphinates or calcitonin
When is secondary prevention of osteoporosis treatment started ?
treatment is indicated following osteoporotic fragility fractures in postmenopausal women who are confirmed to have osteoporosis (a T-score of - 2.5 SD or below). In women aged 75 years or older, a DEXA scan may not be required ‘if the responsible clinician considers it to be clinically inappropriate or unfeasible’
vitamin D and calcium supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
alendronate is first-line
Alternatives to alendronate
risederonate and etidronate
When is secondary prevention of osteoporosis treatment started ?
Offer prophylactic bisphosphonates to those with a T-score < -1.5 if they are on steroids / going to be on steroids for 3 or more months (even if <65 years-old)
