Joint disease Flashcards
Epidemiology of osteoporosis?
- In UK, OP results in > 300,000 fractures/year
- Cost to NHS=>3 billion/ year
- Hip fractures main problem- high bed occupancy and mortality
- Of 230,00 fractures / year: 70,000 hip, 120,000 spine (largely go unnoticed so don’t get admitted), 50,000 wrist
- 1 in 2 women>50yrs – may not develop a fracture but will have the disease
- 1 in 5 men>50yrs
- 3 million in UK
Hip fracture epidemiology?
Hip fractures: associated with prolonged hospital admission- 20% die within 6/12 from complications such as hospital acquired infection / VTE
Over half of the people with have serious mobility issues and this may mean they need to adapt there way of life such as move to a care home
Pathogenesis of OP:
- Thick outer shell of bone = cortex
- Meshwork of bone inside cortex = trabecular bone this is what becomes weaker as you develop it which means it is more likely to fracture
- Bone constantly turned over/ remodeled
- Takes around 3 months to remodel
- Osteoblasts build new bone
- Osteoclasts break down old bone (resorption)
OP caused by?
OP caused by: reduced osteoblast activity increased osteoclast activity this means bone is being broken down quicker than it can be remodeled, so we want to try and rebalance this to make sure you have bone less likely to fracture
Peak bone mass?
Peak bone mass – 25-40 years old and after this you lose about 1% of bone mass a year
WHO definition of OP?
Osteoporosis is a generalized skeletal disorder of low bone mass (thinning of the bone) and deterioration in its architecture, causing susceptibility to fracture.
Bone turnover influenced by ________:
Hormones ( oestrogen/ testosterone), cytokines, prostaglandins
Signs and symptoms of OP:
- Fracture- usually first presentation
- Reduced bone density on DXA scan - high intensity scan calculates to determine if the bone is weaker. Very expensive and don’t have them everywhere. Only scan the high risk patients
- Pain
- Reduced mobility
- Kyphosis- in vertebral fractures. Spine starts to curve and this is the first indication they have it. Can cause loss of height and indigestion – this is because there is an increase of pressure = reduction in height
Vertebral fractures factors:
- Can result in height reduction of 10-20cm
- Often underdiagnosed
- Can cause problems with indigestion, neck weakness, back pain, loss of mobility
Notes on trends in bone density?
- Peak bone mass at around 25 years
- After 40 yrs, loss of 0.5-1% bone density / year
- Women have accelerated bone loss around menopause due to loss of protective effect of oestrogens
- Important to have healthy balanced diet / weight bearing exercise early on in life to optimise peak bone mass
What are DXA scans?
- Only for high risk patients / those with established OP
Usually measures bone density at hip / lower spine to get a “T score” - T score of ≤ -2.5 = osteoporosis
- Portable DXA scanners scan ankle- not as reliable as scanning hip / lower spine
Risk factors for OP?
- Hx of fracture
- Hx of fracture in 1st degree relative
- Smoking
- Low body weight – eating disorders increase the risk of - OP as bone density reduces
- Female
- Oestrogen deficiency
- Corticosteroid use- prednisolone ≥ 7.5mg daily for 3/12 or more
- White race
- Increase age
- Low calcium intake
- XS alcohol
- Lack of exercise
- Recurrent falls
- Dementia
- Impaired eyesight
- Poor health/ frailty- especially RA, renal disease, liver disease, IBD
Primary prevention of OP?
Lifestyle changes:
- Adequate Ca and Vit D
- Weight bearing exercise
- Reduced alcohol intake
- Stop smoking
Reduce risk of falls esp in elderly
Secondary prevention of OP?
Pharmacological management:
- Calcium
- Vit D
- Calcitriol
- HRT
- SERMS
- Bisphosphonates
- Calcitonin
- Strontium
- PTH
- Denosumab
Osteoarthritis (OA) epid.?
- Overall affects 2%
- > 65yrs – affects 12%
- Onset most common at 40-60yrs
- More common in women
- Obesity increases risk
