Osteoporosis (1) Flashcards
What is this?
What is its pre-condition?
What are its risk factors?
What is it characterised by?
➊ Reduction in bone density, making bone weaker and more prone to fractures
➋ Osteopenia
➌ • Elderly
• Female
• Anorexia (BMI < 19)
• Long-term steroids
• Menopause (Oestrogen promotes bone formation)
• Prolonged immobility, Alcohol, Smoking
• RA
➍ Fragility fractures
FRAX Tool:
What is it?
What would make its score more accurate?
If results show a high risk, what should then be done?
➊ Tool to assess risk of fragility fracture over next 10 yrs
➋ Including the BMD (can be done w/o it however)
➌ DEXA scan
Bone Mineral Density/BMD:
What’s used to measure this?
→ Which part of the body is used here?
What are the 2 scores given? What does each mean?
→ Which of these is the more important measurement?
What do the T score levels indicate?
➊ DEXA scan
→ Hip
➋ • Z score - No. of standard deviations of bone density below mean for their age
• T score - No. of standard deviations of bone density below mean for a healthy, young adult
→ T score
➌ • -1 to -2.5 - Osteopenia
• < -2.5 - Osteoporosis
N.B. Bone profile will be normal in these pts.
Management:
What lifestyle advice should be given?
What’s the 1st line medical option?
→ How does it work?
→ What are its key SEs?
What else may be given?
What are the other 2nd line medical options?
➊ • Reduce risk factors - e.g. smoking cessation, reduce alcohol, better diabetic control
• Diet - adequate vit D, calcium, protein
• Exercise
➋ Bisphosphonates e.g. Alendronate, Zoledronic acid
→ Reduces osteoclast activity, therefore preventing bone reabsorption
→ Reflux, Oesophageal ulcers, Jaw osteonecrosis
➌ Calcium and Vit D supplements in those deficient
➍ • HRT in menopausal women
• Denosumab - matures osteoclasts
• Raloxifene - has oestrogenic effects
• Teriparatide (a parathyroid hormone) - stimulates bone growth