Osteoporosis Flashcards
What acronym is used for RF of osteoporosis?
SHATTERED
What are RF for osteoporosis?
- Steroid use of >5mg/d of prednisolone
- Hyperthyroidism, hyperparathyroidism, hypercalciuria
- Alcohol and tobacco use
- Thin BMI <18.5
- Testosterone low
- Early menopause
- Renal or liver failure
- Erosive/inflammatory bone disease
- Dietary: low calcium/malabsorption, DMT1
What is classic epid for osteoperosis?
- Female
- Old
What are symptoms and signs of osteoperosis?
- Asymptomatic until fracture occurs
1. Back pain
2. Kyphosis
3. Impaired vision
4. Impaired gait, imbalance, and lower extremity weakness
What are possible DDx of osteoperosis?
- Multiple myeloma
- Osteomalacia
- CKD bone and mineral disorder
- Primary hyperparathyroidism
- Metastatic bone malignancy
- Vertebral deformities
What is the diagnosis of osteoporosis based on?
history of prior fragility fracture or low bone mineral density T score
What imaging is done for osteoperosis?
- DXA
- X ray
What would DXA show for osteoperosis?
- T-score of ≤-2.5 indicates osteoporosis
2. T-score ≤-2.5 with fragility fracture(s) indicates severe (or established) osteoporosis
What bloods are measured in osteoperosis?
- Ca2+
- PO43-
- ALP
What are the bloods like in osteoperosis?
all normal
What would DEXA score of -1 to -2.5 suggest?
osteopenia, risk of later osteoperositc fracture, offer lifestyle advice
What is the management for a post-menopausal women in osteoperosis?
- 1st line: bisphosphonate e.g. alendronic acid: 10mg orally once daily
Plus: calcium and vit D supplementation - 2nd line: denosumab 60mg sub every 6 months
- 3rd line: parathyroid hormone agonist e.g. teriparatide 20mcg
What is an example of bisphosphonate?
alendronic acid: 10mg orally once daily
What is an example of parathyroid hormone agonist?
teriparatide 20mcg
What other management is available for osteoporosis if these prior are not tolerated?
1st line: Selective oestrogen receptor modulator e.g. raloxifene 60mg orally once daily
Plus: calcium and vit D supplement
2nd line: HRT
What is an example of a selective oestrogen receptor modulator?
raloxifene 60mg orally once daily
What further management is available for osteoporosis?
1st line: intranasal calcitonin
2nd line: conjugated oestrogens
3rd line: romosozumab
What are possible complications of osteoporosis?
- Hip fractures
- Rib fractures
- Wrist fracture
- Chronic pain syndrome
- DVT with raloxifene treatment
What is the deifniton of osteoperosis?
reduced bone density
What are classic osteoperosis fracture types?
- Hip – neck of femur (NOF)
- Wrist – Colles’ fractures
- Lumbar spine - vertebral wedge fractures
- Shoulder - neck of humerus
What does T score calculate?
Patient’s BMD compared to young, healthy adult
What does Z score do?
Patient’s BMD compared to age-matched BMD
What is DEXA used to calculate?
FRAX score:
10 year risk of developing fragility fractures
Which can help decide if Tx is required
What does T score of -2.5 to -1 mean?
osteopenia
