Osteoporosis Flashcards
Why do menopausal women have increased risk of osteoporosis?
Because they lose oestrogen, which normally maintains bone function
What T score on the DXA scan indicates osteoporosis?
< -2.5
What are the risk factors of osteoporosis?
Female
Increasing age
Menopause
Drugs - steroids
Fragile people
Asians/Caucasians
What are the investigations used to diagnose osteoporosis?
DXA (dual energy x-ray) scan to measure bone density
T score
X-ray
What factors should you consider when assessing a person for osteoporosis?
Gender
Menopausal
Current medications
Age
Weight
What is the FRAX tool?
Scoring system to assess the risk of a fracture within the next 10 years.
What factors does the FRAX tool take into account?
Age/sex
BMI
Previous fractures
Smoking/alcohol
Current steroid treatment
Secondary causes
How do bisphosphonates work?
They inhibit osteoclast activity, so less bone is shed
What is the 1st line treatment of osteoporosis?
Oral bisphosphonates, which can include:
Alendronic acid 70mg weekly
Risedronate sodium 35mg weekly
What are the 2 bisphosphonates which are available as injections, and when are they only given?
Ibandronic acid
Zoledronic acid
Only given annually if patients FRAX score is >10%
Why cant Ca2+ be taken with alendronic acid?
Because it will bind to the Ca2+ and have no effect on bones, leading to no efficacy
How should a patient take alendronic acid, and why?
Sitting upright with a full glass of water 30mins before breakfast, to avoid any oesophageal reactions.
What do patients taking IV bisphosphonates/denusomab need?
Good dental/oral hygiene, to avoid osteonecrosis of the jaw.
When should the use of bisphosphonates be reviewed?
Every 5 years.
What can long-term use of bisphosphonates cause?
Osteonecrosis of the auditory ear canal
What is the dosing of denusomab?
60mg every 6 months
How does denusomab work?
It is a monoclonal antibody which inhibits osteoclast formation by binding to RANKL.
When is denusomab used?
In post-menopausal women, if no other treatment has worked.
What 2 substances can bind to osteoblasts, leading to increased bone formation?
Oestrogen and teriparatide
What factors are taken into account when assessing which treatment a patient requires for their osteoporosis?
Age
Alcohol intake
RA
History of fractures
Other risk factors
When is HRT used in osteoporosis?
In premature menopausal women, and stopped at the natural age of menopause
What are the holiday periods for bisphosphonates to avoid atypical fractures?
Remember RAZ123
Risedronate sodium - 1 year
Alendronic acid - 2 years
Zoledronic acid - 3 years
What is the 1st line treatment for osteoporosis in men?
Alendronic acid 70mg weekly, OR
Risedronate sodium 35mg weekly
