Osteoporosis Flashcards
What is it?
A skeletal condition characterized by low bone mass, deterioration of bone tissue, and disruption of bone architecture that leads to compromised bone strength and an increased risk of fracture
What is osteopenia?
refers to a less severe reduction in bone density than osteoporosis
Modifiable risk factors for Osteoporosis?
- Low body weight- 58 kg or [BMI] <21
- Premature menopause (age<45)
- Calcium/vitamin D deficiency
- Inadequate physical activity
- Cigarette smoking
- Excessive alcohol intake (>3 drinks/day)
- Glucocorticoid excess eg. cushings syndrome
- Medications
How may premature menopause present and what would you add to this pts treatment plan?
- may present with secondary amenorrhoea
- Treat with HRT
What medications increase risk of osteoporosis?
- Long term corticosteroids
- aromatase inhibitors (lower oestrogen levels- treatment of breast cancer in postmenopausal women and in men)
- anti-epileptics
- SSRIs
- PPIs- decreased calcium absorption
Non-modifiable risk factors ?
- Advanced age (>65 years)
- Female gender
- Postmenopausal women- unless on HRT
- Caucasian or south Asians
- Family history of osteoporosis-genetic or maternal hip fracture
- History of low trauma fracture (fall from
standing height or less, at walking speed or
less. - sex hormone deficiency
Secondary causes of Osteporosis
- GI
- Severe liver disease eg. cirrhosis
- Gastrectomy
- Malabsorption diseases eg. Coeliac disease
- Eating disorders
- Inflammatory
- RA
- Hyperparathyroidism
- Hyperthyroidism
- Hypogonadism - treated with testosterone
Differentials ?
Osteomalacia
primary hyperparathyroidism
CKD bone and mineral disorder
Multiple myeloma
Metastatic bone malignancy
Symptoms ?
- Usually presents with a fracture
- May be a vertebral fracture- back pain, vertebral tenderness or doesn’t present with pain
- Loss of height
- Kyphosis
What tool is used to manage risk of fracture? what does it measure the risk of and what does it use?
FRAX Tool- Risk of afragility fracture over the next10 years.
Gives risk of:
- Major osteoporotic fracture
- Hip fracture
Uses age, BMI, co-morbidities, smoking, alcohol and family history
Option to add- bone mineral density (from a DEXA scan) for a more accurate result
Will suggest to either give lifestyle advice, do BMD or treat +/- specialist care
What imaging is 1st line and others?
Dual energy x-ray absorptiometry (DEXA)
Others- if can’t use DEXA
- Ultrasound
- X-ray- may reveal osteopenia and/or fractures- can’t diagnose osteoporosis
- CT
What is the T score ?
represent the number of standard deviations from the mean bone density of a person the same gender at age of peak density (25 years)
- T score of hip and spine is more important than others as used to diagnose
Z score definition? A score of …. prompts evaluation for secondary osteoporosis
represent the number of standard deviations the patients bone density falls below the mean for their age and gender
- A Z-score <−2 should prompt evaluation for
causes of secondary osteoporosis
T score of ,,, at the hip significes what bone mineral densities?
> 1 - normal
-1 to -2.5- osteopenia
<-2.5 - osteoporosis
<-2.5 with fracture - severe osteoporosis
Management of osteopenia?
Focus on risk modification and prevention of worsening
- weight-bearing exercise
- vitamin D3 supplementation (800-2000 IU/day)
- limiting alcohol
- smoking cessation
- Dietary advice (nos.org.uk) regarding calcium intake; supplements if inadequate intake
