Osteoporosis Flashcards
What are the two unique characteristics of osteoporosis
Low bone density and micro-architectural defects in bone tissue
What is th result of low bone density and micro-architectural defects in bone tissue
[characteristics of osteoporosis]
Increased bone fragility and susceptibility to fragility fractures
Define osteopenia
Less severe reduction in bone density than osteoporosis (-1 to -2.5 T score)
Define fragility fracture
A fracture following a fall from standing height or less
What are the two main risk factors for osteoporosis
Age and female sex
Age is a risk factor for osteoporosis, but it is different between genders.
What age is a risk factor for males and females
> 50 for women
> 65 for men
Age and female gender is the two main risk factors for osteoporosis.
Name furthur risk factors
“SHATTERED FAMILY”
S – Steroid use
H – Hyperthyroidism, hyperparathyroidism
A – Alcohol and smoking
T – Thin (low BMI)
T – Testosterone deficiency
E – Early menopause
R – Renal/liver failure
E – Erosive/inflammatory bone disease
D – Diabetes
Family history
What are the clinical features of osteoporosis
With the exception of fracture, osteoporosis is an asymptomatic condition.
What are the 3 most common places to get a fragility fracture
Wrist
Spine
Hip
What is FRAX or QFracture
Screening tool for osteoporosis
Assesses the 10-year risk of a patient developing a fragility fracture
What is the name of the screening tool used in osteoporosis to assess the 10-year risk of a patient developing a fragility fracture
FRAX or QFracture
FRAX or QFracture is the screening tool used in osteoporosis to assess the 10-year risk of a patient developing a fragility fracture. It categories patients into three groups based on their risk.
Name these groups
high, intermediate and low risk
The scan is not mandatory and clinicians may proceed straight to DXA scan
What is the gold standard investigation used in osteoporosis
DXA scan (dual energy x-ray absorptiometry)
What is a DXA scan
X-ray scan used to measure bone mineral density
Gold standard investigation for osteoporosis/osteopenia
DXA Scan is used at the gold standard investigation for osteoporosis. Where in the body is it usually done on?
Hip
DXA Scan is used at the gold standard investigation for osteoporosis. The result is represented as a T score.
What is the T score
The number of standard deviations below the mean for a healthy young adult their bone density is
DXA scan is used as the gold standard investigation for osteoporosis.
What is the T score for osteoporosis
< - 2.5
DXA scan is used as the gold standard investigation for osteoporosis.
What is the T score for osteopenia
Between -1 and -2.5
What is the goal of osteoporosis management
Preventation of fragility fractures
Osteoporosis managed with a combination of lifestyle changes and pharmacological treatment.
Name some lifestyle changes
Adequate calcium and vitamin D intake (can be given supplementation)
Weight-bearing exercise to maintain bone strength
Osteoporosis managed with a combination of lifestyle changes and pharmacological treatment.
What is the 1st line pharmacological used in osteoporosis management
Oral Bisphosphonates
Oral bisphosphonates is the 1st line pharmacological used in osteoporosis management.
Describe bisphosphonates mechanism of action
Interfere with osteoclasts reducing their activity and thus inhibits bone resorption
Oral bisphosphonates is the 1st line pharmacological used in osteoporosis management.
Name some side effects of bisphosphonates
GI disturbance
Oesophagitis
Atypical femoral fractures
Osteoporosis managed with a combination of lifestyle changes and pharmacological treatment.
What is the 2nd line pharmacological used in osteoporosis management
Denosumab
Denosumab is the 2nd line pharmacological used in osteoporosis management.
Describe denosumab mechanism of action
Monoclonal antibody that blocks the activity of osteoclasts
Denosumab is the 2nd line pharmacological used in osteoporosis management.
Name a side effect of denosumab
Cellulitis
Oral bisphosphonates and denosumab are the 1st and 2nd line therapy in the pharmacological management of osteoporosis.
What other drugs can be used
Raloxifene
Hormone replacement therapy (in women with premature menopause)
Raloxifene can be used as an additional therapy in managing osteoporosis.
What is its mechanism of action
Binds to oestrogen receptors and exerts same protective action that oestrogen performs on bones by inhibiting osteoclastic action
Raloxifene is an additional therapy in the pharmacological management of osteoporosis.
In what patient group is it most useful in
Post-menopausal women
