Endocrine osteoporosis Flashcards
what is OP
Progressive bone disease- reduction of bone mass & density, causing increased risk of fractures
RISK FACTORS FOR OSTEOPOROSIS?
POSTMENOPAUSAL WOMEN
MEN>50
LONG-TERM ORAL CORTICOSTEROIDS (glucocorticoids)
Age increase
Vitamin D+Calcium deficiency
Lack of exercise
Low BMI
Smoking+drinking
History of fractures
Early menopause
LIFESTYLE CHANGES?
Increase exercise
Smoking cessation - nicotine slows production of bone forming cells
Maintain an ideal BMI
Reduce alcohol intake
Increase intake of vitamin D+calcium (supplements if needed)
OSTEOPOROSIS- TREATMENT
Review need for medication after how many years?
After 5 years for most meds, 3 years for Zoledronic
OSTEOPOROSIS- TREATMENT
1st LINE?
ORAL BISPHOSPHONATES (alendronic acid/risedronate sodium)
alendronic acid dose and does it need to be taken on same day each week?
10mg OD men
70mg once a week on same day women
risedronate dose and does it need to be taken on same day each week?
men also once weekly
doesnt matter for women
OSTEOPOROSIS- TREATMENT
POSTMENOPAUSAL? IDRS and class of each?
ibandronic acid - bisphosphonate
denosumab- mab, inject every 6mo over 18s, can cause hypokalaemia
raloxifene - bone resorption inhibitor
strontium - bone resorption inhibitor
OSTEOPOROSIS- TREATMENT
YOUNGER MENOPAUSAL WOMEN?
USE HRT/TIBOLONE
hrt help maintain bone density thru menopause
severe OSTEOPOROSIS- TREATMENT postmenopausal women
TERIPARATIDE
OSTEOPOROSIS TREATMENT
MEN?
ZOLENDRONIC ACID
DENOSUMAB
TERIPARATIDE
STRONITUM
OSTEOPOROSIS TREATMENT
GLUCOCORTICOID-INDUCED?
FIRST LINE
ALENDRONIC ACID/RISEDRONATE
ZOLEDRONIC ACID
DENOSUMAB
TERIPARATIDE
GLUCOCORTICOID-INDUCED OSTEOPOROSIS
Bone-protection treatment, considered in everyone on large dose corticosteroids for how many months?
> 3 months
GLUCOCORTICOID-INDUCED OSTEOPOROSIS
WOMEN- RISK FACTORS?
aged ≥70 years,
previous fragility fracture,
taking large doses of glucocorticoids (prednisolone ≥7.5 mg daily or equivalent)
GLUCOCORTICOID-INDUCED OSTEOPOROSIS
MEN- RISK FACTORS?
aged ≥70 years AND either:
Previous fragility fracture
OR
Large doses of glucocorticoids
BISPHOSPHONATES- 3 MHRA WARNINGS?
cautions
ATYPICAL FEMORAL FRACTURES- thigh/hip/groin pain
OSTEONECROSIS OF THE JAW- dental pain/swelling/non-healing sores/discharge
OSTEONECROSIS OF THE EXTERNAL AUDTIORY CANAL- report ear pain/discharge/ear infection
BISPHOSPHONATES- SIDE-EFFECTS
OESOPHAGEAL REACTIONS,
REPORT & STOP when?
REPORT & STOP for: oesophageal irritation, dysphagia & heartburn
How do you avoid oesophageal reactions w bisphosphonates? counselling
Take w/
FULL GLASS OF WATER
SITTING/STANDING
EMPTY STOMACH AT LEAST 30MINS BEFORE BREAKFAST/ OTHER ORAL MEDS
SIT UP RIGHT/STAND 30MINS AFTER
ALENDRONIC ACID
RISEDRONATE COUNSELLING?
TAKE 30MINS BEFORE BREAKFAST
OR
LEAVE 2 HOURS BEFORE & AFTER FOOD/DRINK AT OTHER TIME OF DAY
t/f/ late menopause is a risk factor for OP
false
early menopause not late
t/f vit D deficiency is a risk factor for OP
true
vit d helps w Ca absorption
low vit D, low Ca
