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MSK > Osteoporosis > Flashcards

Osteoporosis Flashcards

1
Q

What is osteoporosis?

A

Disorder affecting the skeletal system characterised by loss of bone mass

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2
Q

What is reduced in someone with osteoporosis?

A

Bone mineral density

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3
Q

What is the main issue with reduced bone mineral density?

A

Increased risk of fractures

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4
Q

What type of fractures is there an increased risk of in someone with osteoporosis?

A

Increased risk of frailty fractures

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5
Q

Which fractures as associated with osteoporosis and an increased risk of morbidity and mortality?

A

Neck of femur fractures

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6
Q

How is osteoporosis defined by WHO?

A

Presence of bone mineral density (BMD) of less than 2.5 standard deviations (SD) below the young adult mean density.

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7
Q

Does bone mineral density decrease normally with age?

A

Yes

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8
Q

Which women are at an increased risk of osteoporosis?

A

Post-menopausal as oestrogen is protective against osteoporosis.

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9
Q

What are the 2 main risk factors for osteoporosis?

A

Advancing age
Female

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10
Q

What is a pneumonic for the RF of osteoporosis?

A

SHATTERED Family

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11
Q

What does SHATTERED Family stand for?

A

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

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12
Q

What is usually first used when assessing someone’s risk of osteoporosis?

A

FRAX tool

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13
Q

What is the function of the FRAX tool?

A

Prediction of the risk of a fragility fracture over the next 10 years

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14
Q

What factors does the FRAX tool take into account?

A

Age
Sex
Weight
Height
Previous fracture
Parental fracture
Current smoking
Glucocorticoids
Rheumatoid arthritis
Secondary osteoporosis
Alcohol intake

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15
Q

What other tool can be used to assess the 10 year risk of fracture?

A

QFracture score

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16
Q

Who should have their 10 year fracture risk carried out?

A

Women aged > 65
Men > 75
Mena and women >50 with risk factors

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17
Q

What risk factors might indicate that a 10 year fracture risk should be carried out?

A

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

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18
Q

If the FRAX assessment was done without a bone mineral density (BMD) measurement and produced a low risk result, how is the patient managed?

A

Reassure and give lifestyle advice

19
Q

If the FRAX assessment was done without a bone mineral density (BMD) measurement and produced a moderate risk result, how is the patient managed?

A

offer BMD test

20
Q

If the FRAX assessment was done without a bone mineral density (BMD) measurement and produced a high risk result, how is the patient managed?

A

Offer bone protection treatment

21
Q

How can osteoporosis be confirmed?

A

DEXA scan

22
Q

Which patients taking glucocorticoid therapy require bone protection?

A

Patients taking steroids for more than 3 months

23
Q

Which part of the body would you take a DEXA scan of for the classification and treatment of osteoporosis?

A

The hips

24
Q

How can bone density be represented from a DEXA scan?

A

Z score or T score.

25
Q

What does a z score represent?

A

The number of standard deviations the patients bone density falls below the mean for their age

26
Q

What does a T score represent?

A

The number of standard deviations below the mean for a healthy young adult their bone density is.

27
Q

What is the more clinically important score?

A

T score

28
Q

What does a T score of more than -1 suggest?

A

Normal

29
Q

What does a T score of -1 to -2.5 suggest?

A

Osteopenia

30
Q

What does a T score of less than -2.5 suggest?

A

Osteoporosis

31
Q

What does a T score of less than -2.5 along with a fracture suggest?

A

Severe Osteoporosis

32
Q

What is another common site for osteoporotic fractures?

A

Vertebral fracture

33
Q

What are the possible signs of a vertebral fracture?

A

Loss of height
Kyphosis (curvature of the spine)
Localised tenderness on palpation of spinous processes at the fracture site

34
Q

What is the initial investigation for someone presenting with a vertebral fracture?

A

X-ray of the spine

35
Q

What would an x-ray of the spine show with a vertebral fracture?

A

Wedging of the vertebra due to compression of the bone.

36
Q

What is the main management of osteoporosis?

A

Bisphosphonates

37
Q

What bisphosphonates can be used in the management of osteoporosis?

A

Alendronate

38
Q

How does alendronate need to be taken?

A

Sitting up for at least 30 minutes after dose and drink with glass of water to reduce the risk of developing oesophageal ulcer

39
Q

Why can some people not tolerate alendronate?

A

Due to the GI problems

40
Q

What drugs can be offered as an alternative to alendronate?

A

Risedronate or etidronate

41
Q

What are the other possible side effects of bisphosphonates?

A

Atrial fibrillation
Osteonecrosis of the jaw
Atypical stress fractures

42
Q

What supplements might be required if there is evidence of deficiency?

A

Calcium and vitamin D

43
Q

What are other medications that can be offered if patient can tolerate bisphosphonates?

A

Denosumab
Raloxifene
Strontium ranelate

MSK (79 decks)

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