Osteoporosis Flashcards
What is the definition of osteoporosis?
Decreased bone density by at least 2.5 standard deviations below young adult mean value.
What does osteopenia refer to?
Less severe decrease in bone density
What does osteomalacia refer to?
Decreased mineralisation
The T-score is the number of ______ _____ the patient is from an average healthy young adult
standard deviations
What measures the T-score of the femoral neck?
DEXA scan
What does a T-score of -1 mean?
The bone mineral density is 1 standard deviation below the average for healthy young adults
What is the T score range for osteopenia?
-1 to -2.5
What is the T score range for osteoporosis?
Less than -2.5
What is the T score for severe osteoporosis?
Less than -2.5 plus a fracture
What does DEXA stand for?
Dual-energy x-ray absorptiometry (type of X-ray, measure how much radiation is absorbed by the bones indicating how dense it is)
What is a Z-score?
The number of standard deviations away the patient it from the average of their age, sex and ethnicity
What are risk factors for osteoporosis?
Older age
Post-menopausal women
Reduced mobility and activity
Low BMI
Low calcium or vitamin D intake
Alcohol
Smoking
History of fractures (personal or family)
Chronic diseases eg CKD, hyperthyroidism, RA)
Long term corticosteroids
Certain medications
What mnemonic can help remember the risk factors for osteoporosis?
SHATTERED
Steroids
Hyperthyroid/ hyperparathyroid
Alcohol and smoking
Thin (decreased BMI)
Testosterone low
Early menopause
Renal / liver failure
Erosive and inflammatory disease
DMT1 or malabsorption
What are symptoms of osteoporosis?
Fractures, often:
Proximal femur
Colles’ (wrist, fall on outstretched hand)
Compression vertebral crush (may cause kyphosis/ “widow stoop”)
What hormone is protective against osteoporosis?
Oestrogen
Drops significantly after menopause
Tamoxifen is a selective oestrogen receptor modulator and used to treat breast cancer. It block oestrogen receptors in b____ t_____ but stimulates oestrogen receptors in the u_____ and b____
breast tissue
uterus and bones
Tamoxifen helps prevent osteoporosis but increases the risk of e______ c____
endometrial cancer (stimulates oestrogen in uterus)
What can be used to assess the 10 year risk of a major osteoporotic fracture and a hip fracture?
QFracture tool
(or FRAX tool)
Patients above __% on the QFracture percentage are considered for a DEXA scan.
10%
Who do NICE recommend assessing (using QFracture tool)?
Anyone on long-term corticosteroids
Anyone with a previous fragility fracture
Anyone 50+ with risk factors
All women 65+
All men 75+
The first step in management is addressing reversible risk factors. How are these managed?
Increase physical activity
Maintain healthy weight
Stop smoking
Reduce alcohol consumption
The second step in management is addressing the insufficient intake of ______ and inadequate v____ _ by giving supplements
calcium (at least 1000mg), vitamin D (400-800 IU)
What is the first line treatment in osteoporosis?
Bisphosphonates
How do bisphosphonates work?
Interfering with how osteoclasts attach to the bone, reducing their activity and decreasing the reabsorption of bone.
What are side effects of bisphosphonates?
Reflux and oesophageal erosions
Atypical fractures
Osteonecrosis of jaw and external auditory canal
When are oral bispohosphonates taken?
On empty stomach with full glass of water.
patient should then sit upright for 30 mins before moving or eating to reduce risk of reflux or oesophageal erosions.
What are some other options when bisphosphonates are not suitable?
HRT
monoclonal antibodies that target osteoclasts/osteoblasts
Synthetic PTH
