Metabolic Bone Diseases - Osteoporosis Flashcards
What is it?
The reduced mass of structurally normal bone
Does it increase/decrease the risk of OA?
Reduces risk of OA
What is the milder form of this?
Osteopenia
What type of bone is lost?
Trabecular bone + cortical thinning
What sex is it more common in?
Women
Fragility Fractures:
What does this mean?
Where do they commonly occur? - 3
What is this fracture called?
Fractures resulting from a low energy mechanism of injury that should not have caused fractures in healthy bone
Vertebrae
Hips - proximal femur
Wrist - distal radius
Pathological fractures
Vertebral fractures:
What is this also called?
What symptom do they get?
What spinal curvature does it cause?
What neurological complications can arise? - 2
Vertebral collapse
Compression fracture
Back pain
Thoracic kyphosis
Cauda equina syndrome
Radiculopathy
Risk factors:
Primary OP:
- What group of people is it common in?
Secondary OP:
- What drug causes OP?
- What thyroid disease causes it?
- Why does Rx for prostate cancer cause OP?
Steroids - increases resorption and reduces the body’s ability to absorb calcium
Hyperthyroidism - same as above
It is an anti-androgen Rx therefore testosterone is low
Post-menopausal women
Risk factors:
SHATTERED mneumonic is used!
What does it stand for?
Steroid use >5mg/day prednisolone
Hyperthyroidism; hyperparathyroidism, hypercalciuria
Alcohol and tobacco use
Thin (BMI <22)
Testosterone low (e.g. anti androgen in cancer of the prostate)
Early menopause
Renal or liver failure
Erosive/inflammatory bone disease (e.g. RA or myeloma)
Dietary Ca low/malabsorption
Investigations:
What scan is the gold standard for diagnosis?
XR - What does it show?
DEXA scan - T score used
Low density and cortical thinning
Investigations:
Bloods:
- What is done for inflammatory disease? - 2
- What 4 things are measured as part of a bone profile?
Risk stratification:
- What score is used to show the 10 yr fracture risk of patients?
FBC
ESR/CRP
ALP
Calcium
Phosphate
Albumin
FRAX score
Management:
Lifestyle - what should they do? - 3
What supplements should they begin?
Medical - What is the main Rx? - 2
There are a range of other Rx!
Stop smoking
Reduce alc
Weight-bearing and balance exercises (e.g. tai chi)
Calcium and vit D supplements
Bisphosphonates
Steroid patients:
All patients aged > 70 who are on regular steroids should receive bisphosphonates.
If younger, yearly DEXA scan
Steroid patients:
All patients aged > 70 who are on regular steroids should receive bisphosphonates.
If younger, yearly DEXA scan
Biphosphonates:
Give an example?
How do they work?
Alendronate - they all end with nate!
Increase osteoclast apoptosis, thus reducing bone breakdown
