Endocrine - Osteoporosis Flashcards
What is OSTEOPOROSIS?
Progressive bone disease.
Characteristics are low bone mass
Increasing the risk of fragility fractures (from low level traumas)
Who are more likely to get osteoporosis?
What are risk factors?
Postmenopausal woman
Men over 50 years
Patients taking long term corticosteroids
What are risk factors?
Increasing age
Vit D deficiency
Low calcium intake
lack of physical activity
low BMI
smoking
alcohol in excess
parental history of hip fracture
previous fracture to site
early menopause
What diseases are associated with Osteoporosis
rheumatoid arthritis and diabetes
medication that increases the chance **
Induction of liver enzymes which interfere with vitamin D metabolism
What lifestyle changes aid osteoperosis
Increase physical activity
Stop smoking
Reduce alcohol intake
Maintain normal BMI
Adequate intake of calcium and vitamin D (through diet/supplement if required)
What is the firstline treatment for Postmenopausal Osteoporosis
Oral Bisphosphates e.g.
FIRST LINE:
Alendronic acid (10mg daily [M/F] / 70mg weekly[F])
Risedronate sodium (5mg daily [F] / 35mg weekly [M/F])
if one is unavailable use the other because bc same bioavailability
What other treatments for postmenopausal osteoporosis
Ibandronic acid 150mg ONCE a month
What is used in patients intolerant of oral bisphosphonates
OR
where bisphosphates are unsuitable
Parenteral bisphosphonates
OR
Denosumab
Or
Raloxifene hydrochloride
Or
Strontium ranelate
are alternative options
Younger postmenopausal women with menopausal symptoms who are at high risk of fractures.
Hormone replacement therapy (HRT) or Tibolone
A postmenopausal women with severe osteoporosis with very high risk of fractures
teriparatide or romosozumab
Bone-protection treatment should be started at the onset of glucocorticoid treatment in patients who are at high risk of a fracture. Who would be considered in this group?
Men and Women over 70 years
Previous fragility fracture
Large dose of glucorticoids (>7.5mg daily or equivilant)
Osteoporosis in Men first line treatment
Alendronic acid 10mg daily
or
Risedronate sodium 35mg once weekly
other:
Zoledronic acid or denosumab
teriparatide or strontium ranelate
How long should bisphosphate treatment continue
Some benefit from a drug free period but review after 5 years
(3 years for zoledronic acid)
Drugs that can cause Osteoperosis
PPI
Glucorticosteriod e.g. pre
Valporic acid
Medroxyprogesterone acetate
Aromatase inhibitor e.g. anastrozole
SSRI
Warfarin
Heparins
Pioglitazone and family
