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SPC- MSK > Osteoperosis > Flashcards

Osteoperosis Flashcards

1
Q

What is osteoporosis?

A

Decrease in bone mineral density that occurs with age. Increases a patient’s risk of pathological fracture

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2
Q

What are some risk factors for osteoporosis?

A 
Age greater than 50
Low oestrogen- Postmenopausal women, early menopause, nulliparity
White/Asian Race
Sedentary lifestyle 
Low BMI
Alcohol
Smoking
Family history
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3
Q

Why does low oestrogen exposure increase an individual’s risk of developing osteoporosis?

A

Oestrogen can induce apoptosis of osteoclasts- less oestrogen there reduces this inhibitory action of osteoclasts

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4
Q

Why does a sedentary lifestyle increase someone’s risk of developing osteoporosis?

A

Weight bearing activity strengthens the bones and therefore a lack of it leads to weaker bone

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5
Q

Why does a thinner build increase someone’s risk of osteoporosis?

A

Weight bearing increases bone mineral density, there is reduced weight bearing with lighter patients

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6
Q

What are some causes of secondary osteoporosis?

A 
Vitamin D Deficiency
CKD
Steroid use
Hyperparathyroidism
Hypogonadism (low oestrogen) 
GI diseases resulting in malabsorption
Hyperthyroidism
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7
Q

What test is used to investigate bone mineral density?

A

DEXA Scan- Dual Energy X-ray Absorption

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8
Q

What T score defines osteoporosis?

A

T score of -2.5 or less

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9
Q

What T score defines osteopenia?

A

A T score of -1 to -2.5 defines osteopenia

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10
Q

What is a T score?

A

This is a measurement of the number of standard deviations relative to the average healthy adult in their 20s

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11
Q

What might you find in the history of a patient with osteoporosis?

A

History of pathological fractures
Fractures following minor trauma
Vertebral, hip and wrist fractures
May be asymptomatic

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12
Q

What might you see on examination of a patient with osteoporosis?

A 
Thoracic kyphosis
Dowager's Hump- Severe kyphosis
Decrease in height over time
Tenderness over fracture sites
Gait instability
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13
Q

Who do NICE recommend should be screened for their fracture risk?

A

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)

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14
Q

What tool should be used to determine someone’s risk of fracture?

A

FRAX- if there is no previous bone mineral density measurements or DEXA

QFracture if DEXA or BMD measured

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15
Q

What does QFracture do? When is it used?

A

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.

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16
Q

What does a FRAX/QFracture risk assessment give?

A

It provides the probability of a hi, spine, shoulder or forearm fracture

17
Q

What investigations should be done for a patient with suspected osteoporosis?

A

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)

18
Q

How is the FRAX/QFracture used to determine managment?

A

High Risk- DEXA Scan and Drug Treatment if T

19
Q

What should be done for patients deemed to be high risk with FRAX or QFracture?

A

DEXA Scan

If T < - 2.5 treat pharmacologically
If T> - 2.5 risk reduction and manage secondary causes- repeat DEXA within 2 years

20
Q

What should be done for patients with intermediate risk with FRAX or QFracture?

A

DEXA scan

If T < - 2.5 treat pharmacologically
If T> - 2.5 risk reduction and manage secondary causes- repeat DEXA within 2 years

21
Q

What should be done for patients with low risk with FRAX or QFracture?

A

Risk reduction and investigate for secondary causes- follow up within 5 years

22
Q

What is the pharmacological treatment for osteoporosis?

A

Bisphosphonates

Vitamin D and calcium supplements should be offered to all women unless confident this may not be a cause.

23
Q

How do bisphosphonates work?

A

They reduce osteoclast activity and so reduce bone resorption

24
Q

Give two examples of bisphosphonates

A

Alendronate

Risedronate

25
Q

What is the dose of alendronate?

A

10mg OD or 70mg once weekly

26
Q

What is the dose of risedronate?

A

5mg OD or 35mg once daily

27
Q

How should bisphosphonates be taken?

A

On an empty stomach ideally before breakfast
Swallow tablet whole and don’t suck or chew it
Sit upright for 30 minutes after it has been taken

28
Q

What are some side effects of bisphosphonates?

A 
Nausea
Dyspepsia
Abdominal pain
Bone pain
Joint pin
Muscle pain

Rare
Oesophagitis
Esophageal ulcers
Osteonecrosis of the jaw

29
Q

Why should you advice patients taking bisphosphonates to attend regular dental checkups?

A

Due to the small risk of osteonecrosis of the jaw

30
Q

What is the first line drug management for osteoporosis?

A

Alendronate

SPC- MSK (18 decks)

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