Osteoporosis Flashcards
1
Q
Diagnosis
A
- Fragility fracture/fall from standing height
- T score <2.5
2
Q
Assess risk
A
- FRAX calculator
3
Q
RF’s (22!)
A
- FHx of fragility fracutre, vertebral fracture
- Smoking
- ETOH
- Vitamin D <50
- BMI <20
- Recurrent falls
- Low levels of physical activity/immobility
- Hypogonadism
- Cushing’s
- HyperPTH
- Hyperthyroidism
- Premature menopause
- AN >12 months, <45YO or amenorrhoea
- RA
- Malabs - coeliac
- CKD stage 3/Liver disease
- MM/MGUS
- HIV + Rx
- Diabetes
- Steroids - 7.5mg for > 3 months
- AED
- Aromatase inhibitors
4
Q
DEXA
A
DEXA (dual x-ray absorptiometry) scans measure bone density (thickness and strength of bones) by passing a high and low energy x-ray beam (a form of ionizing radiation) through the body, usually in the hip and the spine.
5
Q
Ix
A
- DEXA - 2 sites - antero-posterior spine + hip
- Unlikely to change in 2 years unless on steroids/endocrine disorder
6
Q
Rx
A
- Calcium - 1g/day until 70YO for men, 1g/day until *50YO for women
- Smoking cessation
- Limit ETOH
- Falls prevention strategies
- Weight-bearing and resistance exercise
- Sun-exposure
- Vitamin D
7
Q
Osteoporosis management
A
- Aim for fracture prevention
- Minimise falls risk
- Optimise bone health
8
Q
Fracture on treatment (5)
A
- Doesn’t mean treatment failure
- Nature of #
- Adherence
- Bone turnover markers - CTx/PNP/ALP - for effectiveness of treatment
- Ways to decrease falls risk
9
Q
Fracture on treatment Rx (3)
A
- Continue Rx
- Zoledronic acid/denosumab
- Anabolic agent
10
Q
*Anabolic agent PBS criteria:
A
- 2x fractures, after 1 yr of anti-resorptive therapy & T-score <3.0
