Disorders of bone health Flashcards
What is osteoporosis?
Progressive systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue with a consequent increase in bony fragility and susceptibility to fracture
What cell is overactive in osteoporosis?
Osteoclastic activity is higher than osteoblast activity leading to net bone loss
What regulates bone loss?
Sex hormone deficiency Body weight Genetics Diet Immobility Diseases Glucocorticoids and aromatase inhibitors
What are common osteoporotic fracture sites?
NOF
Vertebral bodies
Distal radius
Humeral neck
How is bone density assessed?
DEXA scan
Which areas are assessed in a DEXA scan?
Hip
L1-4
What is the T score?
A T-score shows how much your bone density is higher or lower than the bone density of a healthy 30-year old adult
What is the Z score?
Current bone density with those of your age, gender and weight
What is osteopenia?
BMD more than 1 DS below the young adult mean but less than 2.5 SD below
What is osteoporosis?
BMD more than 1.5 DS below the young adult mean
Who should be referred for a DEXA scan?
Patients over 50 with low trauma fracture
Increased risk of fracture based on risk factors using Qfracture or FRAX
What are modifiable risks for fragility fractures?
BMD Alcohol Weight Smoking Physical activity Pharma risk factors
What should be in the work up of suspected osteoporosis?
U+Es, LFTs, bone biochem, FBC, PB, TSH Coeliac antibodies Testosterone 25OH vit D PTH
What are secondary causes of osteoporosis?
Endocrine: hyperthyroidis, hyperparathyroidism, cushings
GI: coeliac, IBD, chronic liver disease, chronic pancreatitis
Resp: CF, COPD
CKD
What drug treatments are available in the treatment of osteoporosis?
Calcium and vit D supplements Bisphosphonates Denosumab Teriparatide HRT SERMS Testosterone