Osteoporosis Flashcards
What is osteoporosis?
Disorder affecting the skeletal system characterised by loss of bone mass
What is reduced in someone with osteoporosis?
Bone mineral density
What is the main issue with reduced bone mineral density?
Increased risk of fractures
What type of fractures is there an increased risk of in someone with osteoporosis?
Increased risk of frailty fractures
Which fractures as associated with osteoporosis and an increased risk of morbidity and mortality?
Neck of femur fractures
How is osteoporosis defined by WHO?
Presence of bone mineral density (BMD) of less than 2.5 standard deviations (SD) below the young adult mean density.
Does bone mineral density decrease normally with age?
Yes
Which women are at an increased risk of osteoporosis?
Post-menopausal as oestrogen is protective against osteoporosis.
What are the 2 main risk factors for osteoporosis?
Advancing age
Female
What is a pneumonic for the RF of osteoporosis?
SHATTERED Family
What does SHATTERED Family stand for?
S – Steroid use
H – Hyperthyroidism, hyperparathyroidism
A – Alcohol and smoking
T – Thin (BMI<22)
T – Testosterone deficiency
E – Early menopause
R – Renal/liver failure and Rheumatoid arthritis
E – Erosive/inflammatory bone disease
D – Diabetes
FAMILY HISTORY
What is usually first used when assessing someone’s risk of osteoporosis?
FRAX tool
What is the function of the FRAX tool?
Prediction of the risk of a fragility fracture over the next 10 years
What factors does the FRAX tool take into account?
Age
Sex
Weight
Height
Previous fracture
Parental fracture
Current smoking
Glucocorticoids
Rheumatoid arthritis
Secondary osteoporosis
Alcohol intake
What other tool can be used to assess the 10 year risk of fracture?
QFracture score
Who should have their 10 year fracture risk carried out?
Women aged > 65
Men > 75
Mena and women >50 with risk factors
What risk factors might indicate that a 10 year fracture risk should be carried out?
Family history of hip fracture
Falls history
Previous fragility fracture
Low BMI
Drink >4U per day of alcohol
Are/were on steroids
Disease associated with osteoporosis
If the FRAX assessment was done without a bone mineral density (BMD) measurement and produced a low risk result, how is the patient managed?
Reassure and give lifestyle advice
If the FRAX assessment was done without a bone mineral density (BMD) measurement and produced a moderate risk result, how is the patient managed?
offer BMD test
If the FRAX assessment was done without a bone mineral density (BMD) measurement and produced a high risk result, how is the patient managed?
Offer bone protection treatment
How can osteoporosis be confirmed?
DEXA scan
Which patients taking glucocorticoid therapy require bone protection?
Patients taking steroids for more than 3 months
Which part of the body would you take a DEXA scan of for the classification and treatment of osteoporosis?
The hips
How can bone density be represented from a DEXA scan?
Z score or T score.
What does a z score represent?
The number of standard deviations the patients bone density falls below the mean for their age
What does a T score represent?
The number of standard deviations below the mean for a healthy young adult their bone density is.
What is the more clinically important score?
T score
What does a T score of more than -1 suggest?
Normal
What does a T score of -1 to -2.5 suggest?
Osteopenia
What does a T score of less than -2.5 suggest?
Osteoporosis
What does a T score of less than -2.5 along with a fracture suggest?
Severe Osteoporosis
What is another common site for osteoporotic fractures?
Vertebral fracture
What are the possible signs of a vertebral fracture?
Loss of height
Kyphosis (curvature of the spine)
Localised tenderness on palpation of spinous processes at the fracture site
What is the initial investigation for someone presenting with a vertebral fracture?
X-ray of the spine
What would an x-ray of the spine show with a vertebral fracture?
Wedging of the vertebra due to compression of the bone.
What is the main management of osteoporosis?
Bisphosphonates
What bisphosphonates can be used in the management of osteoporosis?
Alendronate
How does alendronate need to be taken?
Sitting up for at least 30 minutes after dose and drink with glass of water to reduce the risk of developing oesophageal ulcer
Why can some people not tolerate alendronate?
Due to the GI problems
What drugs can be offered as an alternative to alendronate?
Risedronate or etidronate
What are the other possible side effects of bisphosphonates?
Atrial fibrillation
Osteonecrosis of the jaw
Atypical stress fractures
What supplements might be required if there is evidence of deficiency?
Calcium and vitamin D
What are other medications that can be offered if patient can tolerate bisphosphonates?
Denosumab
Raloxifene
Strontium ranelate
