[Geriatrics] Osteoporosis Flashcards
what is osteoporosis characterised by?
low bone mass and structural deterioration of bone tissue
what does osteoporosis result in?
increased bone fragility and susceptibility to fractures
osteoporotic fractures are usually low impact and what do they affect?
- hip (neck of femur)
- vertebrae (compression fracture)
- wrist (Colles’ fracture)
what is the WHO definition for osteoporosis?
bone mineral density of 2.5 standard deviations below the mean peak mass
what is the 1st line ix for osteoporosis?
DEXA scan
how is a DEXA scan reported?
as a score:
T-score = BMD compared to young adult
Z-score = BMD compared to age matched individual
what DEXA scan score should prompt further ix?
-2
risk factors for osteoporosis: age
all women >65 years
men >75 years
risk factors for osteoporosis: >50 years + risk factors
- past fragility fracture
- use of steroids
- smoker / high alcohol intake
- low BMI
- endocrine conditions / chronic illness (i.e. CKD / COPD / chronic liver disease)
risk factors for osteoporosis: <50 years
- past fragility fracture
- use of steroids
for pts with risk factors for osteoporosis, what should be done next?
calculate “Q-Fracture” or “FRAX” score
when do you arrange a DEXA scan?
if:
- high fracture risk (≥10% using QFracture risk or FRAX red zone)
- intermediate risk (8-10% QFracture or FRAX orange zone) + risk factors
what does a DEXA score of 0 to -2.5 mean?
osteopenia
how do you manage a pt with osteopenia?
- lifestyle advice
- regular exercise
- reduce alcohol
- balanced diet
- treat underlying causes
when should you repeat DEXA for a pt with osteopenia?
at 2 years
what does a DEXA score of
osteoporosis
how do you manage a pt with osteoporosis?
1st line: bisphosphonates (oral) e.g. alendronic acid 10mg OD or 70mg once weekly
replace vitamin D (if inadequate sunlight exposure) and calcium (if inadequate intake)
when should you repeat DEXA for a pt with osteopenia?
review Rx every 3-5 years
what can be trialled if pt cannot tolerate 1st line Rx for osteoporosis?
IV bisphosphonates, denosumab, raloxifene and teriparatide
what should be discussed in women with premature menopause?
hormone replacement therapy (HRT)
osteoporosis vs osteopenia: bone mass
osteoporosis - reduced
osteopenia - normal
osteoporosis vs osteopenia: bone mineral density
osteoporosis - reduced
osteopenia - may be reduced
osteoporosis vs osteopenia: symptoms
both: asx, fractures, bone pain
osteoporosis vs osteopenia: pt demographic
osteoporosis - post-menopausal women, chronic steroid use, older age
osteopenia - people with little sunlight exposure, disorders causing hypophosphatemia
what blood results can you see in osteoporosis?
normal calcium, phosphate and ALP
what blood results can you see in osteopenia?
reduced calcium, phosphate and vitamin D
elevated ALP
bisphosphonate use, jaw pain and swelling. dx?
osteonecrosis of the jaw
fall onto outstretched hand and “dinner fork deformity”. dx?
Colles’ fracture
normal serum calcium and phosphate, with elevated ALP. dx?
Paget’s disease of the bone
