Osteoporosis Flashcards
What is osteoporosis?
This is a quantitative defect of bone characterised by reduction in bone mineral density and increased porosity, leading to increased risk of fracture
How is osteoporosis quantified?
Osteoporosis is described as having >2.5 standard deviations below the mean peak bone mass
How is osteopenia quantified?
Osteopenia is described as having 1-2.5 standard deviations below the mean peak bone mass
When does physiological loss of bone density begin to occur?
30 years
Why is peak bone mass found in young adults?
Higher physical activity
Increased muscle strength
Better diet
Hormonal status
What are some causes of primary osteoporosis?
Idiopathic
Post-menopausal
Senile
What are some risk factors for developing osteoporosis?
Smoking
Alcohol abuse
Lack of exercise
Poor diet
What complications can occur in post-menopausal osteoporosis?
Colles fractures
Vertebral insufficiency fractures
What complications can occur in senile osteoporosis?
Femoral neck fractures
Vertebral fractures
What are some endocrine disorders that can cause secondary osteoporosis?
- Cushing’s syndrome
- Hyperparathyroidism
- Hyperthyroidism
What are some gastrointestinal disorders that can cause secondary osteoporosis?
- Hepatic insufficiency
- Malabsorption
- Malnutrition
- Vitamin C or D deficiency
What are some drugs that can cause secondary osteoporosis?
Alcohol
Corticosteroids
How do age related changes occur in osteoporosis?
Age related changes in osteoporosis are caused by the reduction in proliferative and biosynthetic capacity in osteoblasts and an attenuated response to growth factors
How can a reduction in physical activity lead to osteoporosis?
Reduction in physical activity such as immobilisation (or going to space) means that there is a lower load on the bone, so there is a physiological reduction in bone mass
How can genetic factors cause osteoporosis?
Genetic factors such as polymorphisms to genes regulating osteoclastic activity and vitamin D receptors can lead to decreased bone density
How can post-menopause cause osteoporosis?
In post-menopausal osteoporosis, low oestrogen levels causes high bone turnover, however osteoclastic activity exceeds osteoblastic activity, with monocytes also releasing inflammatory mediators
In who are fracture risk assessments used in osteoporosis?
- Anyone over 50 with risk factors
- Anyone under 50 with very strong risk factors (e.g. early menopause, glucocorticoids)
What are some investigations used in osteoporosis?
DEXA scanning (Mineral density)
Bloods
What are some blood tests used in osteoporosis to find underlying causes?
- U+Es
- LFTs
- FBC
- Protein electrophoresis
- Coeliac antibodies
- PTH
What is the aim of treatment in osteoporosis?
No treatments are available to increase bone mineral density
Treatments aim to slow any further deterioration and decrease risk of subsequent fracture
What are soem lifestyle changes used in osteoporosis?
- Increased calcium intake
- High intensity strength training
- Avoidance of excess alcohol
- Smoking cessation
- Fall prevention
What are some pharmacological treatments used in osteoporosis?
- Calcium and/or vitamin D supplements
- Oral bisphosphonates
- Zolendronic acid
- Desunomab
- Teriparatide
- Romosozumab
When should calcium supplements be given in relation to oral bisphosphonates?
Calcium supplements should not be taken within 2 hours of oral bisphosphonates
What do oral bisphosphonates do in osteoporosis?
Reduce osteoclastic resorption
When should oral bisphosphonates be indicated in osteoporosis?
Consider treatment with when T score ≤ -2.5
Or if on steroids (≥7.5mg) for over 3 months, consider if T score ≤ 1.5
What is Zolendronic acid?
This is a once yearly IV bisphosphonate given second line in many patents who cannot tolerate oral bisphosphonates
What is desunomab?
A monoclonal antibody which reduces osteoclast activity
What is teriparatide?
A recombinant parathyroid hormone which stimulates bone growth rather than reducing bone loss
Who is teriparatide treatment recommended in?
Women with severe post-menopausal osteoporosis with high risk of or with vertebral and non-vertebral fractures
What is romosozumab?
A monoclonal antibody that binds to and inhibits sclerostin to increase bone formation and reduce bone resorption
Who is romosozumab recommended in?
Recommended for postmenopausal women with severe osteoporosis who have had a fragility fracture and are at imminent risk of further fracture (24 months)
