Osteoporosis Flashcards
What are the risk factors for osteoporosis?
History of steroid use,
Rheumatoid arthritis,
History of hip fracture,
Alcohol excess,
Low BMI,
Smoking,
Sedentary lifestyle,
Premature menopause,
Caucasians and Asians,
Endocrine disorders,
Multiple myeloma,
Lymphoma,
GI disorders: IBD, coeliacs, liver disease,
CKD,
Oesteogenesis imprefecta,
What medications may worsen osteoporosis?
Steroids,
SSRIs,
Protein pump inhibitor,
Glitazones,
Long term heparin therapy,
Aromatase inhibitors
What are the investigations required for all patients who are diagnosed with osteoporosis?
full blood count
urea and electrolytes
liver function tests
bone profile
CRP
thyroid function tests
How do you diagnose osteoporosis?
DEXA scan.
T score of <2.5 indicates osteoporosis
What is the treatment for osteoporosis?
Falls prevention,
Vitamin D and calcium supplementation,
HRT for post monopausal women
Oral bisphosphonates
What is the assessment of patients following fragility fractures?
If >75 years old then it is presumed they have osteoporosis so do not need DEXA scan and can start bisphosphonates.
If < 75 then DEXA scan should be arranged. (this is different if on steroids)
What are the adverse side effects of bisphosphonates?
Oesophageal reactions (osteoporosis, oesophageal ulcers),
Osteonecrosis of the Jaw,
Increased risk of stress fractures,
Acute phase response (fever, myalgia, arthralgia may occur following administration)
Hypocalcaemia
What counselling is required for patient taking bisphosphonates?
Tablet to be taken with plenty of water while sitting/standing. Take on empty stomach 30mins before food. Sit upright for at least 30mins after.
Name a monoclonal antibody used in osteoporosis?
Denosumab.
It can be used to prevent pathological fractures in patients with cancer
What are the signs of osteoporotic vertebral fractures?
Loss of height,
Kyphosis,
Localised tenderness on palpation of spinous processes.
Do X-ray or MRI of spine.
