Osteoperosis Flashcards
What is osteoporosis?
Decrease in bone mineral density that occurs with age. Increases a patient’s risk of pathological fracture
What are some risk factors for osteoporosis?
Age greater than 50 Low oestrogen- Postmenopausal women, early menopause, nulliparity White/Asian Race Sedentary lifestyle Low BMI Alcohol Smoking Family history
Why does low oestrogen exposure increase an individual’s risk of developing osteoporosis?
Oestrogen can induce apoptosis of osteoclasts- less oestrogen there reduces this inhibitory action of osteoclasts
Why does a sedentary lifestyle increase someone’s risk of developing osteoporosis?
Weight bearing activity strengthens the bones and therefore a lack of it leads to weaker bone
Why does a thinner build increase someone’s risk of osteoporosis?
Weight bearing increases bone mineral density, there is reduced weight bearing with lighter patients
What are some causes of secondary osteoporosis?
Vitamin D Deficiency CKD Steroid use Hyperparathyroidism Hypogonadism (low oestrogen) GI diseases resulting in malabsorption Hyperthyroidism
What test is used to investigate bone mineral density?
DEXA Scan- Dual Energy X-ray Absorption
What T score defines osteoporosis?
T score of -2.5 or less
What T score defines osteopenia?
A T score of -1 to -2.5 defines osteopenia
What is a T score?
This is a measurement of the number of standard deviations relative to the average healthy adult in their 20s
What might you find in the history of a patient with osteoporosis?
History of pathological fractures
Fractures following minor trauma
Vertebral, hip and wrist fractures
May be asymptomatic
What might you see on examination of a patient with osteoporosis?
Thoracic kyphosis Dowager's Hump- Severe kyphosis Decrease in height over time Tenderness over fracture sites Gait instability
Who do NICE recommend should be screened for their fracture risk?
All women aged 65 and over
All men aged 75 and over
Or men/women younger than this with risk factors (e.g. previous fragility fracture, steroid use, history of falls, low BMI, smoking, high alcohol intake)
What tool should be used to determine someone’s risk of fracture?
FRAX- if there is no previous bone mineral density measurements or DEXA
QFracture if DEXA or BMD measured
What does QFracture do? When is it used?
Assess the risk of fracture in patients
It is used if they have already had a DEXA or BMD scan, if not FRAX is used.
What does a FRAX/QFracture risk assessment give?
It provides the probability of a hi, spine, shoulder or forearm fracture
What investigations should be done for a patient with suspected osteoporosis?
DEXA Scan eventually
NOTE- If a fracture is suspected do a X-ray first.
Investigate for causes:
Bloods- FBC, Calcium, PTH, Vitamin D, eGFR, Creatinine, LFTs, TFTs, FSH (If hypogonadism in younger patients)
How is the FRAX/QFracture used to determine managment?
High Risk- DEXA Scan and Drug Treatment if T
What should be done for patients deemed to be high risk with FRAX or QFracture?
DEXA Scan
If T < - 2.5 treat pharmacologically
If T> - 2.5 risk reduction and manage secondary causes- repeat DEXA within 2 years
What should be done for patients with intermediate risk with FRAX or QFracture?
DEXA scan
If T < - 2.5 treat pharmacologically
If T> - 2.5 risk reduction and manage secondary causes- repeat DEXA within 2 years
What should be done for patients with low risk with FRAX or QFracture?
Risk reduction and investigate for secondary causes- follow up within 5 years
What is the pharmacological treatment for osteoporosis?
Bisphosphonates
Vitamin D and calcium supplements should be offered to all women unless confident this may not be a cause.
How do bisphosphonates work?
They reduce osteoclast activity and so reduce bone resorption
Give two examples of bisphosphonates
Alendronate
Risedronate
