Metabolic Bone Disease Flashcards
Risk factors for developing osteoposis?
History of steroid use,
Rheumatoid Arthritis,
Alcohol excess,
Low BMI
Smoking
Premature menopause,
CKD
Medications which may worsen osteoporosis?
SSRIs,
Antiepileptics,
PPIs,
Glitazones,
Long term heparin therapy,
Aromatase inhibitors
Features of DEXA scans?
T score - BMD compared to that of normal young adult. Score >-1.0 is normal. -1.0 to -2.5 is osteopaenia. Score < -2.5 is osteoporosis
Z score - Adjusted for age, sex and ethnic factors
Examples of fragility fractures?
Hip fractures,
Vertebral (compression) fractures,
Distal radial fractures,
Humeral neck fractures.
Who should be risk assessment for fragility fractures?
All women 65+ years old.
All men 75+ years old.
Above is regardless of clinical risk factors.
Go straight to DEXA scan if >50 years of age with fragility fracture. or under 40 who have had major fragility fracture or take >7.5mg pred daily for 3 months.
How can you assess fragility fracture risk and interpret the results
Use Qfracture or FRAX score.
If QFracture > 10% then arrange a DEXA scan.
If FRAX score is orange then do DEXA. if red then do DEXA and start treatment
In what situations should you start osteoporosis treatment?
DEXA scan < -2.5.
Postmenopausal women and men >50 who are treated with steroids (>7.5mg pred for next 3 months) start treatment without dexa.
Postmenopausal women and men > 50 with symptomatic vertebral fracture.
Women > 75 with fragility fracture (start without DEXA)
Follow up for bisphosphonates?
Re-assess fracture risk after 5 years on oral bisphosphonates or 3 years on IV bisphosphonates.
How should patients take oral bisphosphonates?
On an empty stomach with full glass of water and then remain upright for at least 30mins afterwards.
Causes of osteomalacia?
Vitamin D deficiency,
CKD,
Drug induced (anticonvulsants),
Inherited (hypophosphatemic rickets),
Liver disease,
Coeliac disease.
Presentation and investigations and treatment for osteomalacia?
Presentation: Bone pain, bone/muscle tenderness, fractures and proximal myopathy (waddling gait).
Ix - Bloods (low vitamin D, low calcium and phosphate and raised ALP).
Rx - Vitamin D supplementation and calcium if dietary calcium is inadequate.
What is Paget’s disease of the bone? predisposing factors and clinical features?
Disorder of bone remodeling. Most commonly affects skull, spine/pelvis and long bones.
Predisposing factors - increasing age, male sex, northern latitude and family history.
Presentation - Older male with bone pain and isolated rise in ALP. Bone pain and bowing of tibia or bossing of skull.
Investigations and management of paget’s disease of bone?
Ix - Bloods (Raised ALP, normal calcium and phosphate), X-rays (mixed lytic and sclerotic lesions), and bone scintigraphy (increased uptake).
Management - Indicated if bone pain, skull/long bone deformity, fracture and periarticular paget’s. Start bisphosphonates.
Complications of Paget’s disease of the bone?
Deafness,
Bone sarcoma,
Fractures,
Skull thickening,
High output cardiac output.
