osteoporosis Flashcards
what
reduction in bone density
= bone less strong and more prone to #
osteopenia
less severe reduction in bone density
risk factors
older age female reduced mobility low BMI alcohol and smoking RA long term corticosteroids SSRIs, PPIs, anti-oestrogens
key group to consider osteoporosis in
post-menopausal women
oestrogen is protective against osteoporosis and unless theyre on HRT they have less oestrogen
FRAX tool
gives risk of fragility fracture over next 10 years
gives results as percentage of 10yrs probabiloty of a
- major osteoporotic fracture
- hip fracture
bone mineral density
measured using DEXA scan
DEXA scan
dual-energy xray absorptiometry
measure how much radiation is absorbed by bones ie how dense they are
bone mineral density: Z score
represents no. of standard deviations the pt BMD falls below mean for their age
bone mineral density: T score
No. of standard deviations below mean for healthy young adult their BMD is
bone mineral density: most important clinical outcome
T score of persons hip
basis for WHO classification of level of osteoporosis
WHO classification T score at hip: > -1
BMD is normal
WHO classification T score at hip: -1 to -2.5
osteopenia
WHO classification T score at hip: < -2.5
osteoporosis
WHO classification T score at hip: < -2.5 plus a fracture
severe osteoporosis
first step in assessing osteoporosis
FRAX assessment
who to do FRAX assessment on
women >65
men >75
younger pt w risk factors: Hx fragility #, Hx falls, low BMI< longterm steroids, endocrine disorders, RA
FRAX outcomes if calculates without BMD
low risk = reassure
intermediate risk = offer DEXA scan and recalcuate SCAN with BMD result
high risk = Rx
FRAX outcomes with BMD
treat
lifestyle advice + reassure
Mx - lifestyle changes
activity maintian healthy weight adequate calcium adequate vitamin D avoid falls stop smoking reduce alcohol
Mx - VitD and Calcium
calcium supplementation with VitD if risk fragilty# and inadequate calcium
e.g. Calcichew-D3
1st line treatment for osteoporosis
bisphosphonates
bisphosphonates S/Es
reflux + oesophageal erosions
atypical fractures
osteonecrosis jaw
osteonecrosis external auditory canal
denosumab
monoloncal antibody against osteoclasts
follow up of patients on bisphosphonates
repeat FRAX and DEXA scan after 3-5yrs
consider treatment holiday if BMD has improved and have not had a fragility #
